High-tech hospitals

Thursday, September 20, 2001

At Cooper Hospital in Camden, N.J., patients don't have to worry about a misread doctor's chicken scratch giving them the wrong drug or dose. Prescriptions are typed into a computer.

At the nation's veterans hospitals, bar code scanners identify the patient's medicine and also ensure that it won't cause any harm.

And at Jersey Shore Medical Center in Neptune, N.J., a pharmacy robot reads electronic medical charts, pulls bar-coded medicine from stock shelves, makes labels and sorts them into labeled bins, eliminating human error.

Under the microscope after a damning 1999 report about errors killing thousands of patients each year, hospitals across America are testing a wide range of solutions. They are trying everything from better training and new medication-handling procedures to installing sophisticated, multimillion-dollar technology meant to catch mistakes that harried doctors and nurses sometimes miss.

"I think all hospitals are trying to do something to make the use of medication safer," although many still have not laid out the money for pricey, high-tech solutions, said Dr. David Classen, a consultant and hospital internist.

The most complex systems can cost up to $5 million, plus millions more for customizing, staff training and maintenance, said Classen, who works for First Consulting Group of Long Beach, Calif., which helps hospitals choose computerized systems.

Most hospitals making big investments today are focusing on computerized physician order entry (CPOE) systems, which can eliminate common causes of confusion: illegible handwriting, drugs with similar names, misinterpreted abbreviations and decimal points that aren't noticed, resulting in patients getting an excessive dose.

He estimates that up to 10 percent of U.S. hospitals now have such systems.

Eliminating errors

Cooper Hospital-University Medical Center in Camden went to a computerized order entry system three years ago, and within two weeks made every doctor, intern and resident stop writing paper orders.

That has eliminated all errors due to illegibility, said Dr. Simon Simaha, a practicing physician who is vice president for information technology.

Bar-coding systems use handheld scanners -- waved over bar codes on the nurse's ID badge, patient's wristband and medication packet -- to link information from each with a computer database. That can catch everything from worrisome side effects and look-alike drug names to lab tests indicating the dosage should be changed.

Veterans Affairs medical centers across the country have implemented them. The VA hospitals in East Orange and Lyons, N.J., upgraded theirs with automated, continuous backup of all information onto personal computers, so if the computer system crashes, the medical staff has current information.

Local efforts

Cape Girardeau hospitals also are concerned about the problem.

Dr. Barbara Werner, a clinical pharmacist with Saint Francis Medical Center said that Saint Francis has made medication errors in the past.

"Everybody everywhere, has them," she said. "The processes break down at any institution and anybody that tells you they don't make any errors is not telling the truth."

She said that Saint Francis has been "quite proactive" in attempting to prevent medication errors.

"For a little hospital, we would surprise you," she said. "We have been working on this for quite some time."

Saint Francis is continually gathering data about medication errors, evaluating data and looking at trends, she said.

"When we see things repeating, we try to intervene," she said. "We have found that it's not just one individual case that causes an error, it's the process that causes the error. So we try to identify different processes that may have ahigh potential for error, then make changes."

Something that Saint Francis has recently done to combat medication errors is install nurse alert buttons to let nurses know that a doctor is with a patient.

"What has happened before is that the physician comes in to write the prescription order and no one knows he's here and the order is missed because no one knows the order is on the chart," Werner said.

The button alerts the nurse that the medication process has started an to check the chart for details, she said.

Saint Francis has nine other "checks" to prevent the medication errors, starting with a pharmacy technician who reviews it, then puts it in a computer which also checks the prescription for accuracy. A different pharmacist then confirms the prescription and a floor nurse checks the prescription.

Susan Janzow, the director of quality management for Southeast Missouri Hospital, said Southeast stresses the importance of having a well-trained, educated and experienced workforce.

"Southeast Missouri Hospital provides ongoing education programs in all different areas no matter the type of job," she said. "We are double checking, even triple checking to make certain that information is accurate. These checks and balances help ensure patient safety."

Southeast also reviews processes and if that process breaks down, then those involved come together and reviews the process step by step, Janzow said. Reviews may result in a change to eliminate the chance of error or at least reduce it.

"Risk management and performance improvement programs are in the business because we all want to be safe and be sure we have well trained people performing their jobs accurately," Janzow said. "Health care is no exception to that rule."

Staff writer Scott Moyers contributed to this report.

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