Pharmacists More Effective Than CPOE for Error Prevention

A study published in Oxford University Press’s International Journal for Quality in Health Care found that clinical pharmacists offer the second-best and most cost-effective protection against microbial contamination and other errors related to the administration of injectable drugs.

The findings suggests employing pharmacy staff may be a more effective, affordable approach than computerized physician order entry (CPOE), widely presented as a panacea for the dangerous, costly issue of medication error.

Researchers examined the drug delivery process in a university hospital’s pediatric and neonatal intensive care units. Injectable medications were evaluated using a failure mode, effects, and criticality analysis (FMECA)--a tool medication safety experts use to assess a drug’s potential to cause error. Each prospective error was assigned a "criticality index" based on its likelihood of occurrence, probability of detection, and severity of impact.

31 errors were identified, the mean of their entire criticality index totaling 4540. Ten safety measures were then ranked based on their cost to implement and their impact on the mean criticality index. Measures with the best rankings included ready-to-use syringes, employment of clinical pharmacists, double-check by nurses, and computerized physician order entry (CPOE).

Of the 4 highest-ranking measures, ready-to-use syringes had the most impact on the criticality index, followed by clinical pharmacists, then double-check by nurses. Clinical pharmacy staff showed the best cost-efficacy ratio, followed by double-check by nurses, then ready-to-use syringes.

In both impact and cost-effectiveness, CPOE ranked the lowest of the 4--a fact the authors attribute to the high investment cost of implementing CPOE systems. Previous research suggests CPOE can even be counterproductive, complicating the medication process by introducing new technology that can multiply errors.

“Based on our risk and pharmacoeconomic analyses, clinical pharmacy and ready-to-use syringes appear as the most promising safety tools,” the authors concluded.

For other articles in this issue, see:

• Drug Makers Push for Pay Delay in Part D Discounts
• Many Stroke Patients Aren't Prescribed Statins
• Depressed Americans Favor Medication