Can Technology Reduce Clinician Medication Errors?

BUFFALO, N.Y -- Medication errors are one of the most serious problems occurring in doctor's offices and out-patient clinics, and older persons with chronic conditions are the most vulnerable.

An experimental information technology (IT) intervention designed to help reduce such errors, developed by Gurdev Singh, Ph.D., director of the Patient Safety Research Center at the University at Buffalo, will begin this spring in eight ambulatory medical offices throughout Western New York.

The study is funded by a $1.2 million, 3-year grant from the federal Agency for Healthcare Research and Quality. The patient safety center is part of the Family Medicine Research Institute in the Department of Family Medicine in the UB School of Medicine and Biomedical Sciences.

Physicians and office staff in the eight sites will be assigned randomly to conduct "business-as-usual" or to implement an IT-based Team Resource Management (TRM) tool embedded in the ACORN office quality management system developed by Dendress Corp. of Buffalo, in collaboration with the center.

Singh, the study's principal investigator, developed the study in consultation with his research team and Upstate New York Practice Based Research Network (UNYNET) clinicians who already are using electronic medical records and were interested in identifying useful and affordable error-reducing approaches for their offices.

Outcome assessment will be based on medication safety among geriatric patients and on office staff use of the IT-based tool.

The study will focus on patients 65 or older who are being treated for cardiovascular disease. The first aim will be to determine the impact of the intervention on reducing injuries such as falls or internal bleeding resulting from the use of a drug. Data will be gathered by reviewing patients' records obtained at baseline and at 12 months post-baseline.

Secondly, the study team will assess physicians' compliance with recommended laboratory testing of patients taking specific cardiac medications: ACE inhibitors or angiotensin receptor blockers (ARBs) for controlling blood pressure, treating heart failure and preventing kidney damage in people with hypertension or diabetes; diuretics; digoxin, a drug used to treat congestive heart failure and certain heartbeat irregularities, and statins for lowering cholesterol.

The chart review for this outcome measure will include recording whether the medication was prescribed (for at least 6 months during the preceding 12 months), whether the recommended lab test was ordered (at least once during the measurement year) and whether the lab results were recorded in the patient's chart.

The final aim of the study will be to determine if the IT tool is practical in a primary-care office setting and if it is embraced by office staff.

This demonstration project will provide pilot data for a larger study on the usefulness of the specific IT software.

The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. The School of Medicine and Biomedical Sciences, School of Dental Medicine, School of Nursing, School of Pharmacy and Pharmaceutical Sciences and School of Public Health and Health Professions are the five schools that constitute UB's Academic Health Center. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.