Technology-Associated Medical Errors Medical Technology and Patient

Technology-Associated Medical Errors Medical Technology and Patient Safety Advances in medical technology can be a double-edged sword, according to the numerous research findings discussed by Powell-Cope and colleagues (2008). On the one hand improved technology can prevent adverse events from happening, thereby reducing the prevalence of medical errors, but the introduction of new technology into a clinical setting can create unintended consequences as well, including patient harm. The main factors controlling the efficacy of medical technology discussed by the authors were organizational, social, and environmental.

Organizational factors that influence the success of technology implementation include organizational policies, culture, and resources (Powell-Cope, Nelson, & Patterson, 2008). One of the examples discussed was an increase in pediatric mortality following hospital-wide implementation of a computerized physician order entry (CPOE) system. Shock was the strongest predictor of mortality in the Pittsburgh pediatric intensive care unit (PICU) study, but the second strongest predictor was use of the CPOE system (OR: 3.71; 95% CI: 1.88-6.25) (Yong et al., 2005).

The authors of this study attributed the observed medication errors to disruptions in workflow caused by the CPOE system, which is an organizational factor. The main problem cited by clinicians was the inability to prepare medications in anticipation of the patient's arrival. Other organizational factors that could have contributed to the increased mortality rates were relocating critical medications to a central and less accessible location and an inflexible design preventing physicians from making change orders.

The study by Yong and collegues (2005) also uncovered social factors that might have increased the risk of medical errors. These included clinicians spending less time with patients and colleagues because of the need to sit at the computer terminal. The assumed consequences included being less aware of important changes in the patient's status and missing opportunities through collaboration for improving the quality of care.

When Longhurst and colleagues (2010) took the lessons learned from the Pittsburgh PICU study and applied them to a CPOE implementation in a Seattle PICU, the results were much better. Mortality rates were not significantly changed and a may have even improved by 20%. Acknowledging the organizational factors that may have contributed to the problems in Pittsburgh the Seattle PICU CPOE system was implemented gradually over time in phases, rather than all at once as it was done in Pittsburgh. Medication order sets were created and thoroughly vetted before implementation.

Critical medications were not centralized, but left in place for easy access during emergencies. The CPOE system was also modified to permit ordering medications in anticipation of the patient's arrival. Social factors were addressed by requiring all clinicians to train in the use of the CPOE system before implementation, which would tend to minimize the time spent at the computer terminal and free up more time for attending to patients (Longhurst et al., 2010). A code of conduct was also established, which was designed to foster increased communication between clinicians.

The invasiveness of CPOE and electronic health record systems into clinical workflow appears to be universal, at least in my experience as an ED nurse. The patient no long captures the lion's share of my attention, because at least half of my time is spent documenting patient history, patient status, procedures performed, and medications prescribed. Medication and health record mistakes still happen, so I'm not convinced that it improves patient safety; however, there is room for improvement at.