New Survey Suggests Interdisciplinary Action Needed to Address Medication Administration and Specimen Collection Errors
Contact: Walter Kalmans
Franklin Lakes, NJ (March 09, 1999) -- The incidence of medication administration and specimen collection errors is not being widely shared across hospital disciplines. Responses to a recent poll suggest that the way errors are tracked, which varies widely from institution to institution, makes them difficult to quantify. These are among the findings of a recent poll sponsored by B-D.id, a division of Becton Dickinson, and CAP Today, the official publication of the College of American Pathologists.
The survey points up a perceptual disconnection between various disciplines, specifically regarding the number of errors that occur. When queried about their awareness of medication administration errors occurring at their institution, an overwhelming 91 percent of all respondents, including CEOs, Heads of Nursing and Pharmacy Managers responded that they were well informed. But when asked to estimate the number of medication errors occurring at their institutions within the past month, 43 percent of CEOs and 25 percent of heads of nursing did not know. By contrast, 34 percent of pharmacy managers, the group closest to the problem, estimated that as many as 21 medication errors occur at their institution in a 4-week period.
Similarly, when asked how well informed they were about specimen collection errors occurring at their hospitals, 85 percent of heads of nursing and 67 percent of CEOs responded that they were well informed. But when asked to estimate the number of specimen collection errors occurring at their institution in the past 4 weeks, 58 percent of CEOs and 38 percent of heads of nursing did not know. By contrast, 33 percent of laboratory managers estimated that as many as seven or more errors occur in a 4-week period.
The survey results were reviewed and discussed by a four-member panel of health care professionals at the HIMSS (Healthcare Information and Management Systems Society) convention in Atlanta, led by Jim Conway, Chief Operations Officer of Dana-Farber Cancer Institute. “We need a much larger focus,” Conway commented recently, in addressing the issues surrounding error prevention. “We need to look at the role of leadership, system design, interdisciplinary practice, and how we collaborate with patients and families.”
Absence of Fully Automated Systems
In discussing “medication misadventures, including how to prevent as well as detect them,” panel member Stan Pestotnik, MS, RPh, Director of Drug Surveillance at LDS Hospital, observed that “the sheer complexity of the issues requires an information system-based solution.” Yet, in the survey, an extremely slim percentage of health care institutions reported fully automated systems to minimize medication administration error (12 percent) and specimen collection errors (10 percent), and relatively few reported efforts to design new system solutions (4.5 percent for specimen collection; 10 percent for medication administration).
“One has to understand the history of information systems in hospitals,” Pestotnik explained. “As a refocusing on quality improvement initiatives has generated demands for new types of systems, vendors have attempted to migrate their financial-based systems, which has proved to be difficult at best. A financial information system is the antithesis of a clinical information system,” Pestotnik continued. “Health care providers have come to the realization that clinically based systems have to be built from the ground up.”
“By using information system solutions,” he added, “LDS Hospital has been able to significantly increase detection of adverse drug events. If you put in solutions to help detect adverse drug events, you can take it to the next step where you can prevent them, and that’s what we’ve been able to demonstrate. What it really boils down to for us is that drug misuse most often results from inadequate information rather than from bad behavior, and so we believe that successful programs will strive to improve medical decisions, and that has to come from the IT world.”
Specimen Collection Error Not on Radar Screen
Widely accepted industry figures estimate the cost of medication errors for a 450-bed hospital at $2500 to $3500 per bed, or $1.1 million to $1.6 million annually. Such figures help explain why the vast majority of survey participants (93 percent) expressed concern about medication errors. By contrast, the average cost of specimen collection errors for a similar-sized institution is estimated by Becton Dickinson at $200,000 annually. Does the disparity in expense and consequence explain the absence of concern that top management reported in the survey? 38 percent of heads of nursing and 30 percent of CEOs were not very concerned about specimen collection errors. The lack of concern about specimen collection error disturbs panelist Steve Steindel, PhD, Supervisory Health Scientist at the Center for Disease Control and Prevention, but does not surprise him. He confirms that “there are quite a large number of simple to solve process errors that can be addressed, such as introducing better computerization, better identification of the specimens, more foolproof patient identification. And they also can be corrected by improving systems in the institution where the laboratories talk better with nursing services and administration.”
Relating cost and quality issues to specimen collection errors, panelist Dr. Philip Foulis, pathologist at James Haley Veterans Hospital, cited a Digoxin dosing Q-Probe cost analysis study in 1991 in which 67,241 samples were acquired at questionable timing. Based on an $18.75 reference laboratory charge per test, the average estimated 4- to 6- week cost for each institution was $1,852.67 or $1,233,877 for all institutions participating in the study. And that’s only one test. Summarizing where computerized information services can intervene in the laboratory, Dr. Foulis cited improved patient identification, ensuring that orders are collected at the right time, assisting the clinicians in providing correct interpretation, and suggesting interventions by providing for timely follow-up with automatic messaging and reminders.
“Computers play an unbelievably critical role,” notes Jim Conway, “and in a document mailed to every hospital in the Commonwealth, the Massachusetts Hospital Association is saying leadership has to be taken by the vendors in this industry if we are going to move the field forward.”
The Survey: Bruskin Goldring Research was commissioned by B-D.id to conduct a study among hospital executives to determine their awareness of medication administration and specimen collection errors and the procedures in place to eliminate this problem. A total of 301 interviews were completed among CEOs (60), Heads of Nursing (81), Lab Managers (80) and Pharmacy Managers (80). CAP Today, the official publication of the College of American Pathologists, cosponsored the laboratory portion of the survey with B-D.id.
The Panel: The survey results were reviewed on Wednesday, February 24, 1999, at the HIMSS Convention by a panel of health care professionals: Jim Conway, Chief Operations Officer of Dana-Farber Cancer Institute; Stanley Pestotnik, MS, RPh, Director, Drug Surveillance Program, LDS Hospital; Steve Steindel, PhD, Supervisory Health Scientist, CDC; Philip Foulis, MD, MPH, James Haley Veterans Hospital, University of S. Florida.
B-D.id: This new division of Becton Dickinson is developing a range of customized solutions designed to reduce medication and specimen collection errors. The B-D.id Dx System integrates current laboratory information system and sample collection methods, helping to ensure that the sample is collected at the right time, correctly identified and linked back to the patient. The B-D.id Rx System is designed to enhance the medication administration process, offering nursing access to critical medication information when and where it is most useful.
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