Medication Errors in Nursing Homes - Part 2

• Estimated one adverse drug event occurs per patient per day


• Treating avoidable events conservatively cost $billions annually


• Information technology plays a key role in improving resident medication safety

Nursing home residents take an average of eight medications per month. One-third of them take nine or more. Despite the excellent care provided to these residents, one avoidable adverse drug related event is estimated to occur per resident per day at an annual healthcare cost of billions. Many events are caused by inefficient information systems offering incomplete or inaccurate information to the clinician. Increasing access to accurate resident specific information empowers physicians in perhaps their most important role in long-term care facilities; that of monitoring for inevitable drug interactions between diseases, symptoms and other drugs in the medication use process. Three emerging technologies (EMRs, CPOE and CDSS) actively enlist clinician participation in this ongoing process.

Information Technology (IT) Opportunities

Electronic medical records (EMRs) store resident specific information electronically thus centralizing information and enhancing operational efficiencies for clinicians and the interdisciplinary team. Other benefits include:

• Increased accessibility to and sharing of information


• Ongoing clinician maintenance and review of the resident specific medication list


• Legible clinician documentation consistently compliant with regulatory language


• Enhanced systematic surveillance of disease/symptom/drug monitoring


• Updated drug information resources

Computerized Physician Order Entry (CPOE)

CPOE enables electronic entry of clinician orders. Prescribing medications electronically with an EMR is safer and more reliable than paper based prescribing and reduces medication error rates.

Clinical Decision Support Systems (CDSS)

Clinical decision support systems provide care guidelines to clinicians and promotes resident safety, education and communication. Diagnosis specific treatment guidelines (e.g., myocardial infarction plus aspirin or atrial fibrillation plus warfarin) support optimal health through proactive disease management. Automated resident-specific reminders for drug allergies, interactions, dosing adjustments and evidence-based interventions prevent errors of omission. The reminders become a reliably consistent surrogate for resources inefficiently spent in retrospective, individual chart reviews. When combined with clinical decision support systems CPOE reduce medication errors by 80 percent. Benefits of CPOE and CDSS include:

• Better documentation for drug usage indications, allergies and interactions


• Warning messages triggered by incomplete, incorrect or excessive dosing orders


• Improvements in therapeutic drug dosing adjustments


• Avoidance of preventable pharmacotherapeutic organ toxicity


• Improved clinician adherence to guideline-based care


• Positive influence on provider prescribing behavior


• Increased adherence to corollary orders

Cultural Changes

Residents and families, institutional partners and third party payers now expect system approaches to ensure policies and procedures follow evolving standards of care. Cost related quicker and sicker hospital discharges into nursing facilities and lawsuits involving adverse drug events are a few of the change drivers for using these integrated information systems to improve communication efficiency and quality of care. Despite demonstrated improvements using an EMR, CPOE and CDSS, the long term care industry has been slow to voluntarily adopt these technologies. The government is considering mandating e-prescribing as requisite for physician Medicare participation with all prescriptions being written electronically by 2010.

Raise the Bar

Specialty EMR, CPOE and CDSS give institutions and clinicians the ability to revolutionize healthcare quality with accurate, comprehensive information systems. The time has come for us to use electronic medical records and embrace a higher standard of resident safety and advocacy in long term care by integrating these systems into the disease and medication monitoring process. This ensures clinicians and facilities deliver the best care they are capable of and that residents receive the excellent care they deserve.