Information technology and medication safety

Medication can harm patients. Measures to prevent medication errors, are often based on information technology (IT)to improve standardization, transparency, documentation and process structure. Despite this potential, medication errors were also reported when using IT-based interventions. The studies in this thesis aim to increase our understanding of the use of IT-based interventions in healthcare to prevent medication errors. We analyzed a significant number of medication errors reported by healthcare professionals from Dutch hospitals and community pharmacies. One in six reported medication errors was found to be IT related. Man- machine interactions played a crucial role in these errors. In almost 80% of the errors people miscommunicated with IT systems, e.g., not knowing how to react to system output or computer failures. Bad software design caused computer input problems. System designers and software programmers should learn from this. Our study in four hospitals in the Netherlands using Bar-Code-assisted Medication Administration (BCMA) systems identified workarounds in more than two-thirds of medication administrations. These were significantly associated with medication administration errors. Workarounds consisted of failures to scan patient wrist bands and medication barcodes, technological difficulties and nurses not following protocols. Our studies highlight the importance of good software design, training healthcare professionals in using IT-based interventions and increasing their awareness of potential IT system imperfections that can harm patients. Optimizing staffing levels can reduce the workload of nurses, potentially preventing workarounds. Finally, performing a prospective risk analysis before the implementation of IT-based interventions can be an excellent opportunity to engage end users