A progress report on how California hospitals are complying with a state law requiring them to implement programs to reduce med errors
Outside pressure works. That's the conclusion in California, where hospitals have surpassed medication safety requirements set by the state legislature in 2000. Hospitals in the state also garnered praise from the Leapfrog Group for joining the national group's voluntary patient safety survey in record numbers.
The California Healthcare Foundation (CHCF) found that California hospitals' plans for technology and process improvements go far beyond minimum requirements. The state requires hospitals to implement one medication error-reduction technology by January 2005, but the typical institution plans to implement three different technology solutions as well as procedural changes.
"This new focus on patient safety and medication safety by the state, Leapfrog, and the Joint Commission on Accreditation of Healthcare Organizations has pushed hospitals to be very aggressive," said Jennifer Eames, program officer for the nonprofit CHCF. "Pharmacists seem to be playing a central role in most hospital safety programs. They are taking a significant leadership role."
Computerized physician order entry (CPOE) is the most common fix, planned by 46% of hospitals in the state. New pharmacy information systems are the second most popular technology, planned by 44% of hospitals, followed by automated dispensing systems, planned by 38% of institutions.
Other popular technologies include electronic medication administration records, point-of-care bar-coding, electronic laboratory information access, personal digital assistants, pharmacy robotics, and programmable IV pumps with automated dosing calculations and medication-specific dosing limits.
"This is something we should be proud of," said Robert Mowers, immediate past president of the California Society of Health-System Pharmacists and senior pharmacist at the University of California Davis Medical Center. "Pharmacists have always had a voice in hospitals, but it was not always listened to. We have always had answers for reducing medication errors and increasing patient safety. Now we have people's attention."
It is not just pharmacists and the state legislature that have grabbed hospitals' attention. So has the Leapfrog Group, representing more than 145 large private and public sector health-benefit buyers covering more than 34 million lives. Leapfrog reported that nearly two-thirds of California's 323 urban hospitals are part of a voluntary survey measuring CPOE and two other hospital practices that have been shown to reduce preventable medical mistakes.
"CPOE is one of the three big leaps that hospitals can take to dramatically reduce medical errors," said David Hopkins, director of quality measurement and improvement for Pacific Business Group on Health. PBGH is Leapfrog's California sponsor.
Leapfrog is also pushing hospitals to implement intensive care unit management by trained ICU specialist physicians and evidence-based referrals for five high-risk surgeries and neonatal ICUs. Among participating hospitals, 27% meet at least one of Leapfrog's three safety standards.
"Today, very few hospitals actually have CPOE," Hopkins continued. "They are finally finding ways to include CPOE in their capital spending plans. We will get to widespread adoption in California hospitals within the next three years. Leapfrog would say it is the payers who are bringing these changes to the hospital world."
In 2000, California lawmakers required general acute care hospitals, specialty hospitals, and surgical clinics to adopt written plans to reduce or eliminate medication errors as a condition of licensure. Under the Medication Safety Bill, plans had to include at least one technology such as CPOE that has been proven to reduce medication errors. Rural hospitals could opt out of the technology provision, and hospitals faced with significant seismic upgrade expenditures could delay implementation. Plans had to be submitted to the state department of health by Jan. 1, 2002, and implemented by Jan. 1, 2005.
A CHCF study found that only one of California's 411 hospitals requested a delay because of seismic upgrades. Just one rural hospital decided not to implement technological solutions.
"Our internal customers are realizing what pharmacists can do to reduce medication errors and are asking us to do even more," Mowers said. "That change in attitude will translate into more resources for pharmacy and more demand for pharmacists. We are going to see even more pharmacists providing more patient care and more attention to high-risk medications."
Fred Gebhart. California hospitals beat medication error deadline. Drug Topics Dec. 8, 2003;147:HSE20.