Education And Debate

Using information technology to reduce rates of medication errors in hospitals

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7237.788 (Published 18 March 2000) Cite this as: BMJ 2000;320:788
  1. David W Bates (dbates@partners.org), chief
  1. Division of General Medicine and Primary Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA

    Data continue to show that medication errors are frequent and that adverse drug events, or injuries due to drugs, occur more often than necessary.14 In fact, the frequency and consequences of iatrogenic injuries seems to dwarf the frequency of other types of injuries that have received more public attention, such as aeroplane and automobile crashes.2 A recent meta-analysis reported an overall incidence of 6.7% for serious adverse drug reactions (a term that excludes events associated with errors) in hospitals.4 Between 28% and 56% of adverse drug events are preventable. 3 57

    Though the reasons this issue has received so little attention are complex, the reasons that medical injuries occur with some frequency are perhaps less so; medicine is more or less a cottage industry, with little standardisation and relatively few safeguards in comparison to, say, manufacturing. In fact, most of the systems in place in medicine were never formally designed, and this holds for the entire process of giving drugs.

    Summary points

    Although information technologies are widely used in hospitals, relatively few data are available regarding their impact on the safety of the process of giving drugs

    Exceptions are computerised physician order entry and computerised physician decision support, which have been found to improve drug safety

    Other innovations, including using robots to fill prescriptions, bar coding, automateddispensing devices, and computerisation of the medication administration record, though less studied, should all eventually reduce error rates

    The medication system of the future will include these and other technologies, all electronically linked

    Take, for example, the allergy detection process used in our hospital several years ago, which was similar to that used in most hospitals at the time. Physicians, medical students, and nurses all asked patients what their allergies were. This information was recorded at several sites in …

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