Sources of medical errors have come under increasing scrutiny since the Institute of Medicine estimated that 100,000 or more patients die each year from errors. Subsequent studies have even boosted that figure.
But identifying sources of error can be tricky. Even when hospital work practices encourage errors, clinicians may not complain for fear that errors will be blamed on individuals rather than systems.
Several institutions have considered voluntary error reporting, asking nurses, physicians and other hospital staff to report medication errors and log them into a computer database.
In July of 2005, President George Bush signed a bill allowing the creation of databases maintained by patient safety organizations that would allow clinicians to report errors without fears of lawsuits.
However, according to the Hopkins researchers, few studies have examined the accuracy and impact of voluntary reporting. The Hopkins study focused on medication errors, a subclass of medical errors. Clinicians were asked to describe the errors in free text and also to answer a series of multiple-choice questions about the errors. Though the multiple-choice format makes seeing patterns easier, the free text answers can capture more nuances.
In their study, the researchers reviewed all 1,010 medication errors entered into Childrens Center voluntary error-reporting system between July 2001 and January 2003 and compared the free-text reports with the structured ones.
Marlene Miller, study author and director of quality and safety initiatives for the Childrens Center, said the structured format worked. "There were some incorrect reports, but the overall trends were accurate, which allows us to say that this reporting system is a reliable index of problematic areas," she said. Generally, the structured format led to over-reporting of errors because some errors were classed in more than one category.
None of the errors were fatal or caused serious harm. Two percent required additional treatment or a longer hospital stay. However, the researchers were surprised at the distribution of errors, which occurred at every step in the medication process, from prescribing the drug, to ordering it from a pharmacist, to administering it to the patient.
"One of the more interesting findings was that drug-administering errors, such as giving the patient the wrong drug or the wrong dose or at the wrong time, were quite common," said co-author Christoph Lehmann, director of clinical information technology at the Childrens Center. "We had focused in the past on ordering errors. This finding made us look for possible interventions on the administration side."
Simply creating a system for logging errors is not enough, Miller said. Voluntary reporting systems will only reduce errors if they are examined for patterns, and then used to change practices that can lead to errors, she said.
Hopkins has already introduced computerized tools to help doctors order chemotherapy for children with cancer. Other tools are online calculators that help determine how much of an IV drug to give over what time period, and a total parenteral nutrition calculator, originally designed to prevent nutrition errors for premature babies in the neonatal intensive care unit, and now used for all pediatric patients.