How to implement individual approaches, such as CPOE, bar coding, and smart pumps. Implementation problems with electronic prescribing systems and unintended consequences arising from the implementation of such systems have been well documented (Ash et al., 2004; Han et al., 2005; Berger and Kichak, 2004; Koppel et al., 2005; Fernando et al., 2004). Guidance manuals are needed to help all stakeholders implement these systems successfully. In particular, more research is needed to understand the specific challenges that exist for institutions of different sizes and different staffing models (Kuperman and Gibson, 2003).
How to link the various individual applications (CPOE, bar coding, and smart pumps) together and with electronic health records and the patient’s personal health record. A better understanding is needed of how to ensure that data can pass seamlessly from one application to another, and that the data are interpreted in a consistent way across all applications.
New approaches to improve the safety of transitions between providers and patient care units, and especially as the patient leaves the hospital. Most current prevention strategies are applied in one particular care setting. Transitions from one provider to another are error prone (Forster et al., 2003). Applications need to be developed that can keep all a patient’s providers (inpatient and outpatient prescribers, pharmacists) up to date when any one of the prescribers or the patient changes the patient’s medication or the pharmacist learns that the patient has failed to fill a particular prescription.
Although CPOE with clinical decision support has been implemented successfully in many acute care hospitals, there are few descriptions of its use in the long-term care setting (Rochon et al., 2005). Use of the technology in nursing homes poses many challenges, and its effectiveness in preventing medication errors and ADEs in this setting needs to be assessed. The impact of staffing levels on medication errors and preventable ADEs in the nursing home setting also has not been adequately studied, nor have deficiencies in communication between nursing home staff and the clinicians accountable for prescribing medications.
Many approaches to medication safety derive from the inpatient setting, and it is not clear to what extent these approaches are transferable to the ambulatory setting. For example, instruments used to assess the safety climate for the ambulatory setting lag far behind those for the inpatient setting (Nieva and Sorra, 2003). Tools for such assessment for a full range