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Computers and errors, report card on U.S. health care, more

February 2005

Published in the February 2005 issue of Today’s Hospitalist

Computer systems involved in 20% of drug errors

While up to 20 percent of drug errors may involve a computerized physician order entry system, the technology appears to keep those errors from reaching patients.

According to data collected in 2003 by the United States Pharmacopeia (USP), nearly 20 percent of all errors reported to its Medmarx voluntary reporting system involved a computerized physician order entry system. Nearly 600 hospitals and health care facilities reported just over 235,000 errors.

While mistakes involving an automated ordering system were the fourth most common type of error reported to the USP, they were on average about half as harmful as other errors. According to USP data, more than 99 percent of errors associated with computer order entry systems never reached or harmed patients, suggesting that the systems help reduce the impact of errors.

Computer entry errors occur when incorrect or incomplete information ” patient names, drug doses or lab results “is entered into the computer. USP data found that most of these errors occurred in either the transcribing/documenting phase or the dispensing phase of the overall process. Dosing errors also occurred in nearly half of all computer errors.

Computer errors have been steadily increasing and represent 11.5 percent of all errors reported to the USP between 1999 and 2003. USP data indicate that three-quarters of those errors occur after an order is written but before the medication is given to a patient.

USP data also indicate that computer errors are most frequently caused by performance deficit. That term describes incidents in which the health care practitioner had the necessary skills to perform the task correctly, but made an error nonetheless.

Hospital infection control shows room for improvement

A look at infection control departments in some U.S. hospitals shows that there are some significant opportunities for improvement.

Researchers from VHA Inc., a health care cooperative that serves not-for-profit hospitals and health systems across the country, examined the infection control practices of 31 organizations. Among other things, they found the following:

“¢ One in three hospitals had less than the recommended ratio of one infection control staff for every 100 patient beds.

“¢ Surveillance was conducted monthly to monitor catheter-related bloodstream infections, catheter-related urinary tract infections and ventilator-associated pneumonia, and less frequently for antimicrobial use and resistance.

“¢ The two biggest obstacles to doing a better job were insufficient resources and lack of physician support.

Researchers also examined the hospitals’ use of site preparation products when placing central venous catheters. They noted that while the chlorhexidine-impregnated sponge is generally thought to be the best choice based on evidence, it was chosen as the preferred agent for CVC site dressing by a minority of the respondents.

More information about the study is on the VHA Web site.

Report gives U.S. health care a C+

A leader of the hospitalist movement gave the United States health care system an overall grade of C+ in a recent report.

In the report, Robert M. Wachter, MD, from the University of California, San Francisco, looks at five areas: error-reporting systems, information technology, the malpractice system, regulations, and issues related to work force and training. He concludes while there has been “striking” progress in many of these areas, particularly since the landmark Institute of Medicine report on patient safety was released five years ago, there are still clear opportunities for improvement.

The report, which was published on the Web site of Health Affairs (www.healthaffairs.org) late last year, gave U.S. health care a B- for information technology. While information technology systems are becoming more popular in health care, the report points to a “dark side” of technology that involves system crashes and errors.

The report, which acknowledges that it used no scientific criteria to assign grades, also gave error-reporting systems a C, a D+ to the malpractice system, an A- to regulation, and a B to workforce and training issues.

New threat to safety: brightly colored wristbands

Hospital officials are concerned that the growing popularity of brightly colored plastic wristbands may be confused with their own bracelets that indicate end-of-life preferences.

The yellow wristband worn to show support for the Lance Armstrong Foundation, for example, resembles the yellow bracelets used by some hospitals to indicate that the patient has signed a do-not-resuscitate order. Since it began selling the bracelets last May, the foundation has sold nearly 30 million of the $1 items.

A news report in the St. Petersburg Times says that officials at several area hospitals have asked patients to remove their wristbands or cover them with white tape.

There are also concerns about the purple bracelets that show support for the American Cancer Society’s “Celebrate Hope” campaign. Some Florida hospitals, for example, use purple bracelets to indicate that a patient is at risk of falling.

Wristbands from these foundations and retailers have become popular in the last six months.

Interns’ hours tied to car accidents

Interns who work shifts longer than 24 hours are more than twice as likely to get into an accident after leaving the hospital and five times as likely to have a near miss as their colleagues working shorter shifts.

A study published in the Oct. 28, 2004, New England Journal of Medicine, examined nearly 3,000 interns from around the country between April 2002 and May 2003. Most of the interns studied routinely worked more than 30 consecutive hours.

Researchers identified more than 320 accidents during the 12-month study period. Of those, 133 required a trip to the ER, caused property damage of more than $1,000, or led to the filing of a police report. Nearly 70 percent of the interns studied drove to work.

For every extended shift that interns worked in a given month, the rate of accidents on the commute from work increased by 16 percent. The rate of any car accident increased by 9 percent for every additional extended shift interns worked.

Researchers also found that interns were twice as likely to fall asleep while driving, and more than three times as likely to fall asleep while stopped in traffic during the months they worked five or more extended shifts.

The study was conducted by the divisions of sleep medicine at the Brigham and Women’s Hospital and Harvard Medical School in Boston. It was the third study published on work hours and fatigue in recent months.

Many hospitalists seek career guidance; all seek job satisfaction. Watch for the forthcoming feature: 2008 Hospitalist Salary Survey appearing in October 2008.