A few years ago I toured hospitals with a Canadian health economist. Our tour guide demonstrated a pharmacy cart robot, sometimes called an automated dispensing cabinet. It was a large boxy unit sort of like a big tool chest on wheels. It could navigate the hallways on its own, wait for the elevator and even wait longer if the elevator was full or had more than one or two people in it. The unit would arrive at the hospital floor with all the medications required for that floor for that day. It was preloaded with drugs in the hospital pharmacy before being locked up for its drive to the destination. Information was available electronically on the cabinet advising nurses which patients got which drugs in which doses. They would enter information electronically that they administered the drugs. It saved a lot of time.
Hospital pharmacies are highly automated. When a hospital-based physician orders a drug, it is entered into the pharmacy system and the medication loaded into the cart. At least that’s how it’s supposed to work. It’s does always work right, according to a new study.
Every time you are prescribed medicine in hospital, a computer will prompt your doctor about the appropriateness of the medicine and its dose.Every time health professionals update patient records on the computer, they need to fill in the appropriate information in the correct spot, or choose an option from a drop-downBut as a growing body of research shows, these electronic systems are not perfect.
Technology-related errors can threaten patient safety. Up to one-third of medication errors (which are the most common medical errors that cause patient injury) are related to technology. How does this occur?
Errors can happen for a number of reasons. For instance, prescribers can be confronted with a long list of possible dose options for a medication and accidentally choose the wrong one. This can lead to a dose less than, or more than, the one intended.In our study, we found high-risk medications were frequently associated with technology-related errors. These included oxycodone, fentanyl and insulin, all of which can have serious adverse effects if prescribed incorrectly.
A technology error can occur anytime a computer is involved in the care process, but sometimes humans make errors in using the systems.
One case in the United States involved a nurse accessing and administering the wrong medicine. She obtained the medicine from a computer-controlled dispensing cabinet (known as an automated dispensing cabinet), which is used to store, dispense and track medicines.
Other circumstances that can lead to medication errors are overworked staff, staff who are working nights when lights are low and staff who are tired from working more than one shift. The study authors identified human factors design flaws that should be corrected but caution there are likely more. Technology should be tested and retested to verify it works under all conditions. For instance, one pharmacy cart calculator would round up when preparing doses. For a large adult this may make no difference but for small children it results in a higher degree of variation. Also, some drugs have a much narrower therapeutic index than others. The authors caution they are not advocating for a return to paper records (which are prone to cause their own set of errors) but advise testing electronic prescribing and dispensing systems more thoroughly. There also needs to be a more efficient feedback loop process so when clinicians discover weaknesses or outright errors they can feed the information back to system developers to correct.