Fewer than 20 percent of US hospitals use computer systems to prevent medication errors. But for New York City public hospitals, this high tech approach to medication safety is really "old hat."
"We started to employ computerized systems for medication safety in 1995," says Frances Pandolfi, HHC Chief Information Officer. "At that time, less than 2 percent of the hospitals nationwide had them."
Over a decade later, after investing more than $100 million in automated medical systems, HHC continues to lead the nation in computerized technology that adds layers of safety checks before a medication reaches any of the 1.3 million patients served every year.
HHC’s entire chain of medication delivery is enhanced by computerized solutions that include physician order entry systems (CPOE) to prevent mistakes due to illegible handwriting, sound-alike drugs and improper abbreviations. Pharmacy robots at many HHC facilities stock 500 different drugs and fill more than 200 prescriptions every hour with precision, while pharmacists double-check each order by comparing it to a computer image of the size, color and shape of the medication. And, at patient’s bedside, HHC nurses get help from patient ID bracelets scanned against computerized records for an extra layer of accuracy to follow the five “rights” of medication safety and ensure the right patient gets the right medication, in the right dosage, by the right route, at the right time.
HHC has developed specialized computer programs that go even farther for specific types of medication that require extra care. For example, an electronic program has been piloted at Bellevue Hospital and will be in all 11 HHC hospitals by the end of 2008 to help manage anti-coagulation medications, which are considered high risk yet are commonly prescribed for many patients to prevent dangerous blood clotting.
"There is a very narrow therapeutic range for anti-coagulants," said Jean Fleischman, MD, Chief of Pulmonary Services and Critical Care Medicine at Queens Hospital. "Too little and the patient may get blood clots, which can go to the lungs; too much and the patient may bleed uncontrollably. Either problem could be fatal."
The anti-coagulation drug computerized system gives physicians dosing recommendations based on the profile of the patient and automatically schedules lab testing at the frequency needed to determine when each patient has reached the appropriate therapeutic range.
"The system displays each patient's dosage, their most recent lab results -- all the information the doctor needs to prescribe anti-coagulation medication most safely," says Dr. Fleischman. "It's really beautiful."
(See the related story "Tips to Prevent Medication Errors.")