Irish Medical Journal

February 2010 Volume 103 Number 2

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Internally-Developed Electronic Reporting System for Medication Errors

E Relihan, B Silke, F O’Grady
St James’s Hospital, James’s St, Dublin 8

Abstract
To date, no work has been published regarding internal electronic patient safety reporting systems in the Irish hospital setting and limited international data is available regarding the impact of such programmes. In this report we describe the successful design and implementation of an online medication error reporting system in a 1017-bed Irish teaching hospital. In-house development has resulted in a system tailored to the needs of the hospital, with the flexibility to adapt to the future demands of the medication safety programme. Its introduction has led to a positive impact on reporting rates and on data management and has facilitated the development of safety initiatives.

Introduction
Until the early 1990s, patient safety initiatives were restricted to the niche areas of anesthesiology, blood transfusion, and emergency medicine. Factors which contributed to the growing interest in medical errors and injuries at this time included the rapidly rising rate of litigation during the 1980s and the increasing focus of the media on medical accidents which attracted the attention of both healthcare professionals and the general public.¹
In 1999, the Institute of Medicine (IOM) in the US published a report entitled ‘To Err is Human’ which estimated that the number of patients which incurred an adverse outcome from medical treatment exceeded the combined number of deaths and injuries from motor and air crashes, suicides, falls, poisoning and drowning annually in the US.²The impact of the report was that for the first time patient safety was prioritised by both the healthcare professions and the healthcare industry.¹ The IOM report emphasised the importance of reporting systems as a strategy for learning from errors and potentially preventing their recurrence.² Irish hospitals are increasingly introducing internal reporting programmes to capture patient safety data within their own organisations. Although proprietary programmes for on-site medical error tracking are available, these may require significant capital investment to access, and have limited capacity for customization.³Our hospital opted to design an online reporting system specifically for medication errors, which could be tailored to our local needs and was inexpensive to develop and maintain.

The online reporting system aimed to overcome the weaknesses of the existing paper-based system, which included; (1) an unavoidable lag time of several days from the time of completion of a form to its review, resulting in delayed follow-up to an event, (2) data confidentiality and security concerns, (3) time-consuming storage and retrieval of the forms, (4) illegible and incomplete data, (5) labour-intensive manual transfer of data from forms into a database for analysis.

Methods
Characteristics considered to be important for a successful voluntary reporting system include a non-punitive environment, simplicity in reporting and timely and valuable feedback.⁴ We therefore aimed to design a process that would simplify the transmission, storage and retrieval of large volumes of sensitive data, whilst being easily accessible, transparent and user-friendly. Key features of the internal reporting system developed are: (1) an e-form, accessible via the hospital intranet created using HTML, ASP and JavaScript; the form is designed for ease/speed of completion and generates a standardised data set via pre-coded drop-down menus, tick boxes and mandatory fields, (2) an intranet-based process accessible to all hospital personnel, (3) e-mail notification facility i.e. managers are alerted to the occurrence of an event in their clinical area by an email message and can view the form as soon as it is submitted, (4) automated population of a Microsoft SQL Server® database with criteria from the e-form, eliminating the need for manual data entry, (5) secure storage, retrieval and tracking of data - the database is housed on the hospital server, backed up daily and individual forms are tracked and retrieved by means of unique identity numbers, (6) paperless system; follow-up investigation data are added to the e-form by the reviewer via a password protected log-in and relevant documentation e.g. prescription sheets, may be scanned and attached to the form as a PDF file.

Discussion
Similar to previous studies⁵, a dramatic increase in the volume of reported events was observed following the introduction of the electronic reporting system (from 380 reports in 2004 to 905 reports in 2008). It is impossible to determine to what extent this positive effect can be attributed to the online system, as its introduction coincided with the appointment of a medication safety officer and multiple education and training initiatives. Nevertheless, it is certain that the efficiency of the electronic system has resulted in multiple benefits for patient safety in our hospital. Real-time reporting has enabled a far speedier initiation of the investigation process into an error. The e-mail notification system has introduced greater individual accountability as senior staff are prompted to follow up events in their area of responsibility. In addition, the quality and consistency of the data has enabled detailed trend analysis and timely feedback at institution, directorate, and ward level.

Correspondence: E. Relihan
CEO Offices, St James’s Hospital, James’s St, Dublin 8
Email: erelihan@STJAMES.IE

References
1. Brent J. Five years later-are we any safer? Advances in patient safety; from research to implementation. Agency for Healthcare Research and Quality and the Department of Defense Health Affairs Compendium 2004.
2. Institute of Medicine. To err is human: building a safer health system. Washington DC. National Academy Press, 1999.
3. Smith KM, Trapskin PJ, Empey PE et al. Internally-developed online adverse drug reaction and medication error reporting systems. Hospital Pharmacy 2006;41;5:428-436.
4. Tuttle D, Holloway R, Baird T et al. Electronic reporting to improve patient safety. Qual Saf Health Care 2004;13:281-286.
5. Pierson S, Hansen R, Greene S et al. Preventing medication errors in long-term care: results and evaluation of a large scale web-based based error reporting system. Qual Saf Health Care 2007;16:297-302.



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