believes the focus of such research should be on developing efficient, robust tools for computerized monitoring that would allow all organizations to monitor routinely for ADEs. Ultimately, it may be practical to mandate such monitoring. To this end, research is needed on improving, across all settings, the utility and reliability of computerized detection (e.g., eliminating alert fatigue; see Chapter 6); also needed are testing and validation specific to the site of care (Field et al., 2004).

In the ambulatory setting, medication monitoring, particularly for ADEs, is virtually nonexistent. Research is needed on what data sources are necessary for a robust background monitoring system in the ambulatory environment, such as the systems used for inpatients at Brigham and Women’s Hospital in Boston, Massachusetts, and LDS Hospital in Salt Lake City, Utah. Development and testing of such systems would be a major step forward in medication safety in the ambulatory setting, particularly if facilitated by the incorporation of electronic health records and electronic prescribing.


International comparison studies provide valuable benchmarking data concerning safe medication practices. These studies help challenge paradigms and encourage thinking beyond the traditional views concerning just what constitutes safe medication practice. An example of such a study is one undertaken in a hospital in the United States and a hospital in the United Kingdom (Dean et al., 1995). The medication error rate in the U.S. hospital was 6.9 percent, higher than the 3.0 percent rate observed in the U.K. hospital. The committee believes this study was very useful, but acknowledges that such studies are challenging to conduct.

The committee suggests that more international sharing of ideas on medication safety would be highly beneficial and recommends that more international studies be carried out to evaluate different medication systems and their effects on the rates of medication errors and ADEs. An important prerequisite is that researchers carrying out such international studies need to adopt common taxonomies for describing errors. In this context, the World Health Organization is taking a lead role (WHO, 2005). In addition, international studies should use multiple error detection methods.


Many industries face safety challenges. Industries such as aviation, nuclear power, and chemical manufacturing have implemented successful safety strategies and continue to achieve advances in this regard. These industries have addressed safety issues of relevance to health care, generally

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