Quality Versus(?) Safety

02.27.2012 02:17 PM by David Yak

Not every problem that we see with an electronic prescription is a black and white safety issue.  The vast majority of the issues we see are inconsistencies or inaccuracies that do not meet the Guidelines, but are not absolutely going to cause a patient safety issue.  The point is that the inconsistencies increase the possibility that an error will result, because it requires interpretation, analysis, study, or re-keying of data.

There are two outcomes from this observation.  First, getting attention on problems that are not themselves safety issues is challenging.  Everyone wants to fix patient safety problems.  I have a harder time getting attention on problems that are absolutely quality problems but not outright safety issues.  Second, this can account for the different opinions on how many errors there are.  Depending on how you define "error", two different people can look at the same prescription and one will call it an error while the other will not.

Is it really quality versus safety, or is it safety in the context of quality?

Do you have an opinion on this subject?  If so, please add your comments to this discussion.

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Comments

Jerry...
I believe my personal experience is appropriate to this discussion. My wife and I both experienced the following problem with e-prescriptions that we had not experienced before using e-prescriptions. Our Doctor sent new prescriptions to our mail order pharmacy.  When we received the Rx it had our name wrong on the bottles.  Upon inquiry, the Doctor had input both names correctly as verified on the printed copy.  The mail order pharmacy had received the order with the name errors.  The pharmacy would/could not change the name on the prescription. The Doctor did not have anything to correct.  Neither party would/could fix the name error for future refills.  Resubmittal of the prescripton by the Doctor got the same error result.  This problem must be caused by replicating data input by a network employee between the issuing Doctor and the filling Pharmacist who is not accepting the data input directly by the Doctor and is re-entering the data.   The network should achieve no replication of input data, whether it be patient names, account numbers, drug names, or technical data.    The patient does not have direct access to anyone in the network between the issuing Doctor and filling Pharmacist to pursue a correction of identified errors.  Errors of this type might not be considered a safety issue, but it could, where names are similar, result in the wrong person getting a medication.  Also, a name error indicates other type technical/safety errors could result as well from replications of input data.  
3/16/2012 6:41:26 PM #
I appreciate hearing about this kind of a problem.  In a case like this, if we heard about this and were able to collect more specific details, we would be able to do an investigation and find out exactly where the problem happened.  I can imagine three or four places that I would like to check to see exactly what happened.

I am not advocating for doing that investigation in this case - although I will if you send back a comment and ask me to do that.  I would have to contact you offline so that I can protect your privacy.

One thing that e-prescribing does provide is a detailed audit trail of everything that happened so that an investigation is possible.  Often with handwritten or verbal systems, there is not enough evidence to be able to find out what really happened.

Thanks for reading and thanks for posting.  Hearing about real world problems (without personally identifiable details) keeps us grounded in the fact that problems do occur and we need to remain vigilent.
3/26/2012 10:38:11 AM #

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