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    Sunday, January 30, 2005

    Medical Electronic Errors: A reader on the article about data entry errors:

    Aside from the content, I found these two amusing things in the article:

    1. One of the patient safety experts who was quoted said she was surprised, shocked, and disturbed "that a new type of error is replacing handwriting". Really? As surprised, shocked, and disturbed, let us suppose, as were experts in the early 20th century to discover that injuries from automobiles were overtaking injuries from horses?

    2. There is actualy a glaring error in the report - in the second table that accompanies the report titled "Most errors don't cause harm". The 6th entry down should be 0.24% - NOT 24.0%. Ah, well, entry errors are truly feisty things, good that this one caused no harm!

    The article is an important one and warrants a closer look as the push towards electronic medical records continues:

    'Computer entry' was the fourth-leading cause of errors, accounting for 13% (27,711) of the medication errors reported in 2003. In contrast, illegible or unclear handwriting was the 15th-leading cause, and accounted for 2.9% (6,134) of reported errors.

    It would be very useful to know what percentage of medical errors were due to illegible hand-writing before computerized systems were adopted. For that matter, it would be interesting to know if medical errors have actually increased with the adoption of computerized systems. When a pharmacist or a nurse sees illegible hand-writing, they know they can't read it, and the responsible thing to do is to take the time to ask the doctor what it says. When they see a typed number they have know way of knowing it's wrong until it's too late. And it's much easier to type in a wrong number than it is to write a wrong number.

    Although this study was in an inpatient setting, where the computer entries are usually done away from the bedside, I've found in just the two days I've been using electronic medical records in my office, that patient's are less respectful of the time it takes to enter the information. For example, when I'm writing a prescription by hand or a lab order, my patient's will often start to tell me something else they've thought of, but stop themselves and say "I'll wait 'til you're finished writing." They don't do that when I'm entering their prescription into the computer, and it actually takes a little more concentration for me to do the electronic one, because I'm trying to make sure there aren't any typographical errors in it -that the quantity and the dosage are correct. But they keep right on talking. I have to admit, I don't hear what they're saying, and I appear distracted when I look up from my task and ask them to repeat it. The irony is, I can write prescriptions by hand and listen at the same time, but I can't proofread and listen at the same time.

    And this, I have trouble believing:

    Cousins said the good news was that errors related to electronic prescribing are less likely to lead to patient harm.

    Defined as an error caused by incomplete or incorrect entry of a medication by a licensed prescriber, USP added "computerized prescriber order entry" to its list of "cause of error variables" in May of 2003. It received more than 7,000 reports of this type, but only 0.1% of these led to patient harm. In comparison, the percentage of patient harm associated with all errors reported in 2003 was 1.51%.

    Typing the wrong dosage or giving the wrong medication to the patient in the wrong room due to a typing error would have a great deal of potential for harm.

    posted by Sydney on 1/30/2005 08:45:00 AM 0 comments


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