Chapter 13

At the end of the chapter, the reader will be able to:

1. Explain how pharmacists can use technology in the quality improvement process.

2. Describe three different technologies that can be used to improve quality in pharmacy.

3. List two challenges to the adoption of technology in the quality improvement process.

Medication errors and adverse drug events (ADEs) are the indicators of choice for the quality of medication distribution in inpatient and outpatient settings. Medication errors are typically defined as any deviation from a prescriber's order, while ADEs are defined as an injury resulting from medical intervention related to a drug.1,2 Inpatients experience one medication error every day in the hospital,1 and rates of ADEs have been measured between 2.4 and 52 per 100 inpatients.2–6 Medication dispensing errors in community pharmacies occur on 2–22 prescriptions out of every 100.7,8 A systematic review of the literature on ADEs in ambulatory patients found 14.9 ADEs per month out of every 1000 patients.9 All of these quality results are based on observation or manual chart review, which can be time-consuming. What are the prospects for expanding the collection of such quality indicators using technology and accelerating progress toward error-free systems?

Technology is being used to distribute medications in a variety of settings because it replaces the need for human involvement when the tasks are repetitive, tiring, or require memory-intensive record-keeping. The health care provider's ultimate goal is to close the loop and make it possible to technologically oversee the accuracy of the entire medication distribution process. This oversight would start with prescriber ordering and continue to the patient receiving the intended medication, ending with feedback on the effectiveness of the therapy provided via laboratory tests and physical monitoring. Until this ideal is reached, pharmacists need to monitor the performance of medication distribution technology in terms of quality control measures for each step of the process involving humans or automation.

Chaudhry described one of the important benefits of health information technology (HIT) on the quality of medical care as enhanced surveillance and monitoring of ADEs, which could ultimately lead to fewer ADEs and medication errors. Examples of HIT include:

• electronic health records;
• Computer physician order entry (CPOE);
• decision support (systems);
• electronic results reporting;
• electronic prescribing;
• consumer health informatics/patient decision support (DS);
• mobile computing;
• telemedicine;
• electronic health communication;
• data exchange networks;
• knowledge retrieval systems.10

Some of the above-mentioned technologies have the potential to contribute quality monitoring data and should be designed and used to take advantage of this potential. Computerized surveillance of ADEs has been described since 1991.11–18 This chapter will describe state-of-the-art electronic quality monitoring systems for medication distribution technologies.

Clinical event monitoring systems can continuously assess patient data for triggers that may indicate a medication-related problem. Clinical event monitors are automatic and typically programmed into the hospital's information system. They ...

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