preventing medication errors related to electronic ......preventinggy medication errors with...

Preventing Medication Errors Related Preventing Medication Errors Related ggto Electronic Medication Systemsto Electronic Medication Systems

Laura Finn CGP, FASCP, Laura Finn CGP, FASCP, RPhRPhConsultant PharmacistConsultant PharmacistConsultant PharmacistConsultant Pharmacist

Adjunct Associate Professor of Pharmacy PracticeAdjunct Associate Professor of Pharmacy PracticePhilaPhila. College of Pharmacy. College of Pharmacy

August 10, 2012August 10, 2012

Objectives

Discuss ways prescribers can be alert toDiscuss ways prescribers can be alert to Discuss ways prescribers can be alert to Discuss ways prescribers can be alert to potential sources of error in using electronic potential sources of error in using electronic medication systemsmedication systemsmedication systems medication systems

D ib i di i ili iD ib i di i ili i Describe areas in medication reconciliation Describe areas in medication reconciliation where electronic health records are prone to where electronic health records are prone to

di i i kdi i i kmedication error risks medication error risks

Objectives

Identify the role of the prescriber in theIdentify the role of the prescriber in the Identify the role of the prescriber in the Identify the role of the prescriber in the prevention of medication errors, improving prevention of medication errors, improving therapy adherence and achievement of positivetherapy adherence and achievement of positivetherapy adherence and achievement of positive therapy adherence and achievement of positive outcomesoutcomes

Develop an awareness for potential sources of Develop an awareness for potential sources of di i i ibi i ddi i i ibi i dmedication errors in prescribing, processing and medication errors in prescribing, processing and

administering medication orders with electronic administering medication orders with electronic systemssystems

Preventing Medication Errors with Electronic Medication SystemsPreventing Medication Errors with Electronic Medication Systemsg yg y

El t i M di ti S tEl t i M di ti S t B fitB fitElectronic Medication Systems Electronic Medication Systems –– BenefitsBenefits

Standardization of electronic health recordStandardization of electronic health record EE--prescribing (elimination of pharmacists’ need prescribing (elimination of pharmacists’ need p g ( pp g ( p

to read illegible handwriting) to read illegible handwriting) Prescribing alerts and warningsPrescribing alerts and warnings –– DecisionDecision Prescribing alerts and warnings Prescribing alerts and warnings –– Decision Decision

support softwaresupport software R p rti f d r tR p rti f d r t Reporting of adverse events Reporting of adverse events


El t i M di ti S tEl t i M di ti S t B fitB fitElectronic Medication Systems Electronic Medication Systems –– BenefitsBenefits

Transfer of health information between care Transfer of health information between care sitessites

BarBar--coding technology in our dispensing coding technology in our dispensing systemssystems

Ease of medication administration and Ease of medication administration and documentation in our institutional practicedocumentation in our institutional practice

Better address medication adherence outcomesBetter address medication adherence outcomes Better address medication adherence outcomesBetter address medication adherence outcomes


What are the medication safety Risks withWhat are the medication safety Risks with What are the medication safety Risks with What are the medication safety Risks with electronic medication systems?electronic medication systems?

As prescribers and pharmacists we are educatedAs prescribers and pharmacists we are educatedAs prescribers and pharmacists we are educated As prescribers and pharmacists we are educated to always be aware of both risks and benefits.to always be aware of both risks and benefits.


Expectation is that electronic prescribingExpectation is that electronic prescribing Expectation is that electronic prescribing, Expectation is that electronic prescribing, medication order processing, administration, and medication order processing, administration, and monitoring will reduce medication errorsmonitoring will reduce medication errorsmonitoring will reduce medication errors.monitoring will reduce medication errors.

B fi dil b iB fi dil b i Benefits are readily apparent but unsuspecting Benefits are readily apparent but unsuspecting health care professionals may be less aware of health care professionals may be less aware of h i kh i kthe risks.the risks.


Could electronic systems contribute to medication Could electronic systems contribute to medication d i ?d i ?errors and negative outcomes?errors and negative outcomes?

Role of electronic order entry in contributing to Role of electronic order entry in contributing to medication choice errorsmedication choice errors

Warning fatigue , excessive warningsWarning fatigue , excessive warningsg g , gg g , g Medication reconciliation concernsMedication reconciliation concerns Lack of accuracy in med lists for consultingLack of accuracy in med lists for consulting Lack of accuracy in med lists for consulting Lack of accuracy in med lists for consulting

disciplinesdisciplines


Could electronic systems contribute to medication Could electronic systems contribute to medication d i ?d i ?errors and negative outcomes?errors and negative outcomes?

Role of electronic records in unnecessary Role of electronic records in unnecessary medication usemedication use

Decisions based on inaccurate, incomplete, Decisions based on inaccurate, incomplete, , p ,, p ,outdated electronic health informationoutdated electronic health information

New technology “learning curve” andNew technology “learning curve” and New technology learning curve and New technology learning curve and alterations to workflowalterations to workflow


Patient Scenario #1Patient Scenario #1

WarfarinWarfarin –– high risk medicationhigh risk medication

Telephone order by attending MD on Thursday: “to Telephone order by attending MD on Thursday: “to hold hold warfarinwarfarin dose today and then decrease dose today and then decrease warfarinwarfarin by by 0.5mg daily and recheck INR in 1 week” 0.5mg daily and recheck INR in 1 week”

Original order was Original order was warfarinwarfarin 3.5mg PO daily.3.5mg PO daily.What happened next?What happened next?


Discussion: Discussion: How could this error by prevented?How could this error by prevented?

-- PrescriberPrescriber -- Charge Nurse Charge Nurse -- Releasing Pharmacist Releasing Pharmacist -- Dispensing Pharmacist Dispensing Pharmacist gg p gp g-- Med Nurse Med Nurse -- Electronic Med SystemElectronic Med System


Why should prescribers get involved inWhy should prescribers get involved inWhy should prescribers get involved in Why should prescribers get involved in identifying these risks?identifying these risks?

P iti t f di ti ill l ifP iti t f di ti ill l ifPositive outcomes from medication use will only occur if Positive outcomes from medication use will only occur if the best choice of therapeutic option is followed by the best choice of therapeutic option is followed by proper dispensing safe administration and appropriateproper dispensing safe administration and appropriateproper dispensing, safe administration and appropriate proper dispensing, safe administration and appropriate monitoring regardless of whether selfmonitoring regardless of whether self--administered at administered at home or administered in an institution.home or administered in an institution.


Need to acknowledge that a potential exists forNeed to acknowledge that a potential exists for Need to acknowledge that a potential exists for Need to acknowledge that a potential exists for medication errors throughout that process.medication errors throughout that process.

By recognizing the potential for medicationBy recognizing the potential for medication By recognizing the potential for medication By recognizing the potential for medication errors, prescribers can identify their own role in errors, prescribers can identify their own role in preventing them as well as educate otherpreventing them as well as educate otherpreventing them as well as educate other preventing them as well as educate other disciplines on their role in preventing disciplines on their role in preventing medication errorsmedication errorsmedication errors.medication errors.

Why be concerned with electronic technology?Why be concerned with electronic technology?

Professional Core Objectives for Medicare and Professional Core Objectives for Medicare and M di id I iM di id I iMedicaid Incentives:Medicaid Incentives:

11.. Include Use of CPOE11. . Include Use of CPOE

2. Implement Drug-Drug and Drug-Allergy interaction checks3. Maintain an up-to-date problem list of current and active p p

diagnoses4. Generate and transmit permissible prescriptions electronically

5 M i i i di i li5. Maintain an active medications list6. Maintain an active medications allergy list7 Record demographics7. Record demographics8. Record vital signs and chart changes

Professional Core Objectives Required for Medicare Professional Core Objectives Required for Medicare d M di id I id M di id I iand Medicaid Incentives:and Medicaid Incentives:

9. Record smoking statusg10. Report ambulatory clinical quality measures11. Implement clinical decision support rules12. Provide patients with an electronic copy of their health

information

13 Provide clinical summaries for patients for each office visit13. Provide clinical summaries for patients for each office visit14. Capability to exchange key clinical information electronically

including medication list among care providers g g p15. Protect electronic health information by use of certified

technology


Study published in JAMA identifiedStudy published in JAMA identified wherewhere Study, published in JAMA, identified Study, published in JAMA, identified where where adverse drug events traditionally occuradverse drug events traditionally occur::

Prescribing Prescribing --39%39%

Administration Administration -- 38%38%Dispensing Dispensing -- 12%12%

Transcribing Transcribing -- 11%11% gg %% Leape,etLeape,et al. System analysis of adverse drug events. JAMA. 1995;274:35al. System analysis of adverse drug events. JAMA. 1995;274:35--4343


Determine ways to identify potentialDetermine ways to identify potentialDetermine ways to identify potential Determine ways to identify potential problems:problems:

Analysis of Medication Errors and Near MissesAnalysis of Medication Errors and Near Misses Root Cause AnalysisRoot Cause Analysis Failure Mode and Effects AnalysisFailure Mode and Effects Analysisyy


Medication Errors are oftenMedication Errors are oftenMedication Errors are oftenMedication Errors are often

MultifactorialMultifactorial !!

Multiple opportunities to prevent!Multiple opportunities to prevent!


Questions to ask ourselves:Questions to ask ourselves:

What types of problems can occur with eWhat types of problems can occur with e--prescribing / computerized medication order prescribing / computerized medication order p g pp g pentry?entry?

How do we identify potential problems andHow do we identify potential problems andHow do we identify potential problems and How do we identify potential problems and create systems to prevent them?create systems to prevent them?

How do we safely utilize electronic medicationHow do we safely utilize electronic medication How do we safely utilize electronic medication How do we safely utilize electronic medication administration systems in our institutional administration systems in our institutional practice settings?practice settings?practice settings?practice settings?


Questions to ask ourselves:Questions to ask ourselves:

Do electronic systems label medications in aDo electronic systems label medications in a Do electronic systems label medications in a Do electronic systems label medications in a manner most easily understood by our manner most easily understood by our outpatients?outpatients?outpatients?outpatients?

Do electronic medication administration systems Do electronic medication administration systems track medication use in a meaningful way?track medication use in a meaningful way?track medication use in a meaningful way?track medication use in a meaningful way?


IOM report IOM report -- Hazards of technology Hazards of technology -- 20112011Urged greater oversight by gov and private sector over

HIT Difficulty technology – leading to mistakesIncessant warnings on drug interactions can lead to “alert

fatigue” in prescribers Med admin scanners – nurses may not be using their eyes

to identify meds and patients


Potential risks of HIT:Software vendors “nondisclosure clauses” may decrease sharing of error-prone software issues Hold harmless clauses force risk on the customer not software vendor

Source: Nov. 2011 Institute of Medicine (IOM) report -Health IT and Patient Safety: Building Safer Systems for Better Care”


Prescribing issues Prescribing issues –– Decision Support Decision Support Although prescriber decision support software may assist

in appropriate medication choice, the software needs input of accurate information.

Is patient specific information current? - Accurate med, list diagnoses, conditions, allergies, intolerances, height, weight, lab values, use of PRN meds, updated drug references


Prescribing and order entry issuesPrescribing and order entry issues

What does CPOE stand for?What does CPOE stand for? ComputerizedComputerized PhysicianPhysician Order Entry …….Order Entry ……. Computerized Computerized PhysicianPhysician Order Entry ……. Order Entry …….

BecameBecame ComputerizedComputerized PrescriberPrescriber Order EntryOrder Entry Computerized Computerized PrescriberPrescriber Order Entry ……. Order Entry …….

which has becomewhich has becomeC i dC i d P idP id O d EO d E Computerized Computerized ProviderProvider Order EntryOrder Entry



In institutional setting, prescriber may order In institutional setting, prescriber may order verbally, by telephone or written orders

Who interprets order and enters into computer? Who interprets order and enters into computer? - often a nurse in Long Term Care setting



Risk: Order interpretation takes place at the nursing station and then nurse’s entry of Rx g yorder is viewed by the releasing and/or dispensing pharmacist.p g p

Original paper order or transcription of the verbal order may not be viewed by theverbal order may not be viewed by the pharmacist at all.



Order entry may not be completed by prescriber Order entry may not be completed by prescriber or pharmacist whoor pharmacist whopp-- interpret the prescriber’s orderinterpret the prescriber’s order

choose product from drop down menuchoose product from drop down menu-- choose product from drop down menuchoose product from drop down menu-- calculate dosecalculate dose-- complete directions for labeling & MAR and complete directions for labeling & MAR and -- review/interpret computerized warnings.review/interpret computerized warnings.p p gp p g



Risk: If order entry or electronic prescription is not entered by prescriber and the pharmacist is y p pnot involved in the medication choice, is the health care professional sufficiently trained to p ychoose correctly?



Product choice may result in wrong drug or Product choice may result in wrong drug or duplicate therapy.duplicate therapy.p pyp py

Lack of awareness of dosage forms, Lack of awareness of dosage forms, concentrations, salts that are available may resultconcentrations, salts that are available may resultconcentrations, salts that are available may result concentrations, salts that are available may result in inappropriate choice.in inappropriate choice.

Lack of review of written/telephone orders andLack of review of written/telephone orders and Lack of review of written/telephone orders and Lack of review of written/telephone orders and hospital discharge list by a pharmacist. hospital discharge list by a pharmacist.


Order entry issuesOrder entry issuesExample: Improper selection of medication product or dosing Wrong medication chosen from drop down menu:

amoxicillin is chosen instead of amoxicillin clavulanate Prednisolone instead of prednisone (21st choice of drop

down menu after pred was entered)


Order entry issuesOrder entry issues

Example:

Lack of cross-reference between brands, generic, drug classes in menu choice leads to poor drug choice:

Bactrim® single strength is hand written order but nurse chooses SMX TMP DS administer 0.5 tab



Example: Choice of concentration: prescriber states order p

in mg but menu choice includes multiple concentrationsconcentrationsorder entry professional must choose concentration and then calculate mL for dosingconcentration and then calculate mL for dosing amount

l i l l ex. lorazepam topical gel



Example: Difficulty in choosing among salts of y g g

medication, diluent, unfamiliarity with available doses

Example: valproic acid formulations, doxycycline hyclate or doxycycline monohydratedoxycycline hyclate or doxycycline monohydrate


Even simple nonEven simple non--prescription medications can prescription medications can f i i d d h if i i d d h iappear confusing in a drop down menu choice:appear confusing in a drop down menu choice:

Mylanta Supreme® - calcium carbonate 400mg with Mg hydroxide 135mg / 5 mL

Mintox® (substituted for Mylanta®) Aluminum ( y )hydroxide 200mg, Magnesium hydroxide 200mg, simethicone 20mg / 5mL g

Note 30mL Mylanta Supreme® = 2400mg Calcium carbonateCalcium carbonate


KClKCl 10meq daily 10meq daily

Potassium CL CR Capsule Extended Release 10 MEQPotassium CL CR Capsule Extended Release 10 MEQPotassium CL CR Tablet Extended Release 10 MEQPotassium CL CR Tablet Extended Release 10 MEQPotassium CL CR Tablet Extended Release 10 MEQPotassium CL CR Tablet Extended Release 10 MEQPotassium Chloride Potassium Chloride CrysCrys CR Oral Tablet ExtendedCR Oral Tablet ExtendedRelease 10 MEQRelease 10 MEQRelease 10 MEQRelease 10 MEQ


Recommendations: Recommendations:

Read before signing written or electronic orders Work with pharmacy to remove problem-p y p

creating menu choices Acknowledge the need for order entry staff to Acknowledge the need for order entry staff to

be educated on medication selection and verification proceduresverification procedures

System needs more checks/balances


Errors at transition of care Errors at transition of care

Electronic Health Records may contribute to med reconciliation errors.

Estimated greater than 50%+ medication errors occur at time of care transition –

Source: National Transitions of Care Coalition, Transitions of Care Measures, paper by the NTOCC Measures Work Group, 2008.Measures, paper by the NTOCC Measures Work Group, 2008.



Two common unintended changes to regimen:1. Omissions of preadmission medsp2. Previously discontinued meds reinitiated

Tam et al. 2005 “Frequency, Type and Clinical Importance of Medication History Errors at Admission to Hospital: A Systematic Review”


Errors at transition of care Errors at transition of care Patients with several conditions (multiple medications

prescribed by different physicians) –there is a vital need to reconcile the prescribed regimen with what a patient is actually taking and to understand why there is a difference between the two.



Optimizing and reconciling medications requires substantial investments of time along with l delectronic data sharing among practitioners —

neither of which is widely available in today’s modelFi i l i i R d id f -Financial incentives - Reward providers for

coordinating care “M i f l " f HIT th t d t r l ti -“Meaningful use" of HIT that needs to cross locations

of care - accurate data shared across settings


Errors at transition of care Errors at transition of care Patient Scenario #2: antidepressantsResident transferred from independently living to hospital

for 5 days then discharged to skilled nursing facility.

I d d li i dIndependent living orders:- bupropion XL 100mg daily, escitalopram 10mg daily

In hospital orders:– duloxetine 60mg daily and sertraline 25mg daily


Errors at transition of care Errors at transition of care Discharged to skilled care with discharge orders for:

duloxetine 60mg daily and sertraline 25mg daily

On admission to skilled care unit, CRNP changed d b i XL 100 i l 10orders to bupropoin XL 100mg escitalopram 10mg

What happened?


Errors at transition of care Errors at transition of care ElElectronic Medication Records reviewed upon hospital

admission began with most recently recorded di ti li t (M h 2010)medication list (March 2010)

Paper orders sent upon transfer to hospital were not utilized to update hospital admission ordersutilized to update hospital admission orders.

P ti t S i #3 li i il Patient Scenario #3 lisinopril


Misinterpretation of Dose at Transition of careMisinterpretation of Dose at Transition of care

Patient Scenario #4Patient Scenario #4

phenytoinphenytoin 100mg bid at 9am and 6pm100mg bid at 9am and 6pm phenytoinphenytoin 100mg 1pm as special instruction time 100mg 1pm as special instruction time

April labs therapeutic level = 13.8 April labs therapeutic level = 13.8 Upon hospital admission, order input as Upon hospital admission, order input as phenytoinphenytoin

100mg bid. 5 days in hospital and 4 days at skilled care 100mg bid. 5 days in hospital and 4 days at skilled care facility before pharmacist review detected change in facility before pharmacist review detected change in dose. Level checked on morning of 10dose. Level checked on morning of 10thth day = 4.6day = 4.6H did l i ib dH did l i ib d How did electronic systems contribute to dose How did electronic systems contribute to dose misinterpretation?misinterpretation?


Problem:Problem: Order entry provider may have Order entry provider may have i ffi i k l d f h d ii ffi i k l d f h d iinsufficient knowledge of the computer ordering insufficient knowledge of the computer ordering processprocess

Risk:Risk:

Incorrect start and stop times (medication order Incorrect start and stop times (medication order p (p (span) may lead to medication errorsspan) may lead to medication errors

PreventingPreventing Medication Errors with Electronic Medication SystemsMedication Errors with Electronic Medication Systemsgg yy

Patient Scenario #5:Patient Scenario #5: warfarin 5mg dailywarfarin 5mg daily INR called to physician’s office with return call at 5:50.Nurse is instructed to hold today’s 5mg dose and enters order at 6:01pm for a one time dose of warfarin 10mg today and return to 5mg tomorrow.

However the next day, both 10mg and 5mg dose appear th l t i d d i i t ti ft lti ion the electronic med administration software resulting in

dose of 15mg. What went wrong?


Recommendations:Recommendations:

Create system with redundancy in medication Create system with redundancy in medication safetysafety

Require double checks and sufficient training of Require double checks and sufficient training of order entry professionalsorder entry professionalsy py p

Emphasize pharmacists role in reviewing Emphasize pharmacists role in reviewing medication orders completely.medication orders completely.medication orders completely. medication orders completely.


Patient Scenario #6 LevofloxacinPatient Scenario #6 Levofloxacin IV levofloxacin 750mg upon admission day 1 750mg PO 0800 on day 2 but ordered changed to 1000 (due to

potential flouroquinolone time policy) Second dose given 1000potential flouroquinolone time policy) Second dose given 1000 on day 2 (same nurse)

Labs showed moderate Renal dysfunction – order changed to 750mg PO q 48 hours.

Dose on day 3 and discharged to skilled with illegible written order above electronic order for 750mg PO q 48 hours x ds?order above electronic order for 750mg PO q 48 hours x ds?

Entered into computer to start next day since no date or time of last dose.


Potential for misinterpretation of warnings Potential for misinterpretation of warnings ddupon order entry: upon order entry:

Warnings and alerts are being interpreted at Warnings and alerts are being interpreted at point of care which can be helpful if interpreted point of care which can be helpful if interpreted and acted on properly.and acted on properly.

Excessive warnings difficulty in interpreting Excessive warnings difficulty in interpreting warnings, improper response can result in warnings, improper response can result in g , p p pg , p p pmedication errors.medication errors.

Role of warning fatigueRole of warning fatigue Role of warning fatigueRole of warning fatigue


Underuse of Dispensing Pharmacist Dose Underuse of Dispensing Pharmacist Dose llalertsalerts

Does your pharmacy system warn of:Does your pharmacy system warn of: wrong route of administrationwrong route of administration wrong route of administrationwrong route of administration contraindications based on patient’s diseasecontraindications based on patient’s disease

d b d i ’ i h ?d b d i ’ i h ? overover--dosage based on patient’s weight?dosage based on patient’s weight?


Underuse of Dispensing Pharmacist Dose Underuse of Dispensing Pharmacist Dose llalertsalerts

ISMP computer survey of 182 pharmacy ISMP computer survey of 182 pharmacy systems in both 1998 and 2005 systems in both 1998 and 2005

Compared to the similar study in 1998 Compared to the similar study in 1998 ––p yp yfewer systems in 2005 provided drug dosing fewer systems in 2005 provided drug dosing alerts due to patient’s age weight or bodyalerts due to patient’s age weight or bodyalerts due to patient s age, weight or body alerts due to patient s age, weight or body surface areasurface area

Medication Safety Alert! August 25, 2005; 10(17)Medication Safety Alert! August 25, 2005; 10(17)y g ( )y g ( )


Drug allergy potential for errorDrug allergy potential for error

Risks: Does your hospital system maintain allergies from a past admission? For a readmission, is allergy verification required?

Problem: New allergic reaction may have occurred since last admission and the allergiesoccurred since last admission and the allergies may need a prompt to be updated


Drug allergy potential for adverse eventDrug allergy potential for adverse event

Do pharmacy systems allow for documentation of type of allergic reaction and drug intolerances?

Example: nitrofurantoin causing nausea or amoxicillin causing diarrhea documented as drugamoxicillin causing diarrhea documented as drug allergy


Potential for errors in medication Potential for errors in medication d i i i b i h id i i i b i h iadministration by patient or home caregiver:administration by patient or home caregiver:

ProblemProblem: Labels may be difficult to understand : Labels may be difficult to understand due to small print, mail order bottles /labels all due to small print, mail order bottles /labels all p ,p ,looking alike, directions not easily interpretedlooking alike, directions not easily interpreted


Potential for errors in medication Potential for errors in medication d i i i b i h id i i i b i h iadministration by patient or home caregiver:administration by patient or home caregiver:

Risks: Patient may be confused about how much di i kmedication to take.

Example: “Take 0.5 tablet….” Data entered for medication order may be user

friendly to prescriber and pharmacy but is it user friendly for the outpatient to understand?friendly for the outpatient to understand?


Potential for errors in administration by nurse Potential for errors in administration by nurse i i i l ii i i l ior institutional caregiver:or institutional caregiver:

ProblemProblem: Nurse administers medications which are : Nurse administers medications which are di l d b i d i hdi l d b i d i hdisplayed on computer screen to be given during the displayed on computer screen to be given during the time slot chosen for medication administration. time slot chosen for medication administration. Thi d i l d h i MAR dThi d i l d h i MAR d This does not include the entire MAR and may This does not include the entire MAR and may decrease nurse’s awareness of entire medication decrease nurse’s awareness of entire medication regimenregimenregimen.regimen.


Potential for errors in administration by nurse i i i l ior institutional caregiver:

Nurse may not be aware of PRN medications, di i i h hif di i imedications given on other shifts, medication time

changes, new orders.E lExamples:

PRN dose changed to routine kl d i d D d d Weekly med missed – Dose documented as not

available


Lack of Awareness of Recent Medication Changes:

P i S i #Patient Scenario #7:Patient with nausea, loss of appetite – Evening nurse

ll d di h i i d k i h llcalled attending physician and spoke with on call provider

Ne order for promethazine s ppositoriesNew order for promethazine suppositoriesRecent order for : ?


Monitoring Systems: Does your electronic system track total daily dosing or medications with maximum dosing?

Example: acetaminophen, dextromethorphan


Takes a team and your input to reduce the risks for medication errors and increase the possibility of p ypositive medication outcomes. Questions and Discussion:Questions and Discussion:

g{tÇ~ çÉâ!


References:L LL B DW C ll DJ l S l i f1. Leape LL, Bates DW, Cullen DJ, et al. System analysis of adverse drug events. In Cohen, M. ed. Medication Errors Second Edition. Washington, DC: American Pharmacists Association; 2007: 414-415

2. Tam et al. 2005 “Frequency, Type and Clinical Importance of Medication History Errors at Admission to Hospital: AMedication History Errors at Admission to Hospital: A Systematic Review,” CMAJ 173(5): 510-515

3. Institute for Safe Medication Practices. Safety still ycompromised by computer weaknesses; comparing 1999 and 2005 pharmacy computer field test results. ISMP Medication Safety Alert! August 25 2005; 10(17)Safety Alert! August 25, 2005; 10(17)

4. USP US PharmacopiealConvention. MEDMARX 2006 data report. www.usp.org/products/medMarx.


Medication Errors Second edition. Cohen, M. ed. Medication Errors Second edition. Cohen, M. ed. Washington DC:Washington DC: APhAAPhA 20072007Washington, DC: Washington, DC: APhAAPhA, 2007, 2007

Website of resources: www.ismp.org Institute for SafeWebsite of resources: www.ismp.org Institute for SafeMedication Practices

“The great aim of education is not knowledge but “The great aim of education is not knowledge but action.” action.” H. Spencer H. Spencer

Thank You ! l f @ [email protected]

preventing medication errors related to electronic ......preventinggy medication errors with...

Documents