Abstract
Both hospitals and hospital patients are bearing a massive cost as a result of the occurrence of medication prescribing errors in the public health system (Bates, D., et al. J. Am. Med. Inform. Assoc. 8(4):299–308, 2001; Lombardi, T. Medscape Pharm. Online J. 02(1), 2001; Roberts, M., and Stokes, J. eMed. J. Aust. 168:317–318, 1998). Consequently, it is important to examine and address the possible causes of this problem. In this paper we suggest that poor information systems may be a contributing factor in the occurrence of these errors. We research this issue in an HIV ward of a large public hospital through interviews and a survey instrument. We find that in a significant number of instances prescribing errors are linked to situations where information is unavailable or inaccessible. This link, between problems in information delivery and prescribing errors, is a link whose extent has not been measured previously. It is, however, a link which exposes all stakeholders in the hospital system, the patient, the clinicians, the hospital, and governments funding prescription medications, to possible loss and damage and indicates a need for the implementation of more effective systems in this area. We use Reason’s model for predicting systems error (Vincent, C. BMJ 316:1154–1157, 1998) as a tool to suggest that prescribing errors have an increased likelihood of occurring if one or more of the types of failure identified in the model are present in the existing prescribing information delivery process in the hospital. While Reason’s model has been applied in a medical context, it has not been previously applied to errors which result from information systems failure. We feel that applying it in this way may shed some light on the causes of prescribing error.
Similar content being viewed by others
REFERENCES
Bates, D. W., Cohen, M., Leape, L., Overhage, J. M., Shabot, M. M., Sheridan, T., Reducing the frequency of errors in medicine using information technology, J. Am. Med. Inform. Assoc. 8(4): 299–308, 2001.
Hepler, C., and Strand, L., Opportunities and responsibilities in pharmaceutical care. Am. J. Hosp. Pharm. March, 1990, 47:533–543.
Wilson, R., Runciman, W., Gibbert, R., The quality in Australian health care study. Med. J. Aust., 1995, 163:458–471.
Vincent, C., Framework for analysing risk and safety in clinical medicine. BMJ 316:1154–1157, 1998.
Roberts, M., and Stokes, J., Prescriptions, practioners and pharmacists. eMed. J. Aust. 168:317–318, 1998.
Sintchenko, V., Clinical decision support for antibiotic prescribing. Proc. 9th Natl. Health Inform. Conf. Health Informatics Society of Australia, Canberra, Australia, pp. 91–92, 2001.
England, I., Stewart, D., and Walker, S., Information technology adoption in health care: When organisations and technology collide. Aust. Health Rev. 23(3):176–183, 2000.
Smith, R., What clinical information do doctors need? BMJ 313:1062–1068, 1996.
Lombardi, T., Promotion of a safe medication environment. Medscape Pharm. Online J. 02(1), 2001.
Yin, R., Case study research, Applied Social research Methods Series, Sage, Thousand Oaks, California, 1994.
England, I., The status of health I.T. expenditure: A qualitative study of senior executives with regard to I.T. investment. Proc. 9th Natl Health Inform. Conf. Health Informatics Society of Australia, Canberra, Australia, pp. 31–32, 2001.
National Centre for Policy Analysis Idea House, US Spending on Prescription Drugs. Available from http://www.ncpa.org/oped/bartlett/sep0400.html
Viagra a tough Call for Health Minister (Editorial), The Age Newspaper, David Syme Publications, January 18, 2002.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lederman, R.M., Parkes, C. Systems Failure in Hospitals—Using Reason’s Model to Predict Problems in a Prescribing Information System. J Med Syst 29, 33–43 (2005). https://doi.org/10.1007/s10916-005-1102-2
Issue Date:
DOI: https://doi.org/10.1007/s10916-005-1102-2