group of high-impact interventions in each care setting that can be implemented first.
For the most part, interventions that appear to have the strongest evidence are consistently incorporated into recommended best practices for reducing medication error rates, such as the National Quality Forum’s (NQF) Safe Practices for Better Healthcare (NQF, 2003). Computerized provider order entry (CPOE) is almost universally recommended, as is incorporating clinical pharmacists into the inpatient medical team during daily rounds and creating specialized protocols for high-alert medications. Other strategies for which the evidence is not as strong but that are commonly recommended include standardizing prescription writing, limiting oral orders, improving medication error identification systems, adopting system-based approaches to reducing medication errors, promoting a culture of safety, implementing bar coding, and using unit dosing.
Bar coding and smart pumps are widely recommended interventions for which more rigorous testing appears warranted. In addition, there is a need to investigate nontechnical strategies that address human factors, such as techniques for combating fatigue (e.g., adequate staffing of professionals involved in medication use); elimination of redundancies (e.g., identifying when double-checks add value in decreasing errors); echoing and readback; the use of reminders, constraints, and color differentiation; and systematic approaches that couple continuous surveillance of error reports/alerts and review of good-practice guidance from internal and external sources with proactive prevention strategies.
Beyond the validation of individual approaches to error reduction, the next steps in research on prevention strategies for hospital care should focus on evaluation of the following:
How to make a business case for investment in error prevention strategies. CPOE, bar coding, and smart pumps are expensive applications and have to compete with other investments for a health care organization’s limited resources. Financial models for the benefits of CPOE are beginning to emerge (Kaushal et al., 2006).
How to select an individual application, such as CPOE, bar coding, and smart pumps. Tools are needed to evaluate applications in the way they present information to users, their effectiveness at intercepting medication errors, and the quality of the information provided through decision-support tools. Leapfrog has begun to develop a tool to evaluate hospital CPOE systems with decision support (Kilbridge et al., 2006).