Use computerized systems to cut adverse drug events: report
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* Barbara Sibbald

Computerized monitoring systems can reduce the number of medication errors and prevent many adverse drug events (ADEs), a new report indicates. In addition, the systems can save hospitals as much as US$500 000 annually in direct costs, not including liability costs or the cost of injuries to patients.

*Reducing and Preventing Adverse Drug Events to Decrease Hospital Costs*, from the Agency for Healthcare Research and Quality, “pulls together in one place a very, very strong body of evidence that these computer systems can mitigate ADEs and medical errors,” says Dr. Gregg Meyer, director of the department's Center for Quality Improvement and Patient Safety.

Patients who experience an ADE are hospitalized, on average, 8 to 12 additional days at an extra per-patient cost of US$16 000 to US$24 000. The total cost of ADEs is as high as US$5.6 million annually per hospital.

“I've been using this [computerized system] for 8 years now and it has prevented me from making mistakes,” says Meyer, a physician at the Walter Reed Army Medical Center in Washington. “It has added value to my ability to practise.”

All US military and veterans' hospitals and 5% of civilian hospitals now use computerized monitoring systems. The challenge “is to get the other 95% on board,” says Meyer, but cost is a major deterrent: a 200-bed hospital could spend up to US$2-million on a start-up system. Their scope varies from systems that allow direct entry of prescriptions into a computer to an all-encompassing system that uses bar codes on patient wrist bands and warns of drug interactions and other potential problems.

ADE incidence ranges from 2% to 7% of admissions, and 1 study estimated that 9.7% of ADEs cause permanent disability (*Medical Care* 2000;38:261-71). The most commonly documented errors that cause ADEs involve dosage problems (58%), failure to recognize known allergies (13%) and giving the wrong drug or treating the wrong patient (5%).

The report says that entering prescriptions into a computer instead of writing them out can prevent up to 84% of dosage errors. Dr. Patrick Croskerry, Halifax's regional head of emergency medicine, is unaware of any computerized monitoring systems in use in Canada, but agrees that “There's no question that these systems would reduce error.” He is organizing an international symposium on recent developments in correcting medical error, to be held at Dalhousie University Aug. 11–12 ([xkerry@accesscable.net](http://xkerry@accesscable.net)).

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/164/13/1878.2/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/164/13/1878.2/F1)

Figure. **Each year, more than 770 000 Americans are injured or die because of ADEs in hospitals.** Photo by: Art explosion