Impact of Emerging Technologies on Medication Errors and Adverse Drug Events

Eyal Oren, Ellen R. Shaffer, B. Joseph Guglielmo

Am J Health Syst Pharm. 2003;60(14)

Abstract and Introduction

Published evidence on the effects of computerized physician order entry (CPOE), automated dispensing machines (ADMs), bar coding, and computerized medication administration records (CMARs) on medication errors and adverse drug events (ADEs) were reviewed.

Emerging technologies have been recommended as potential mechanisms for reducing medication errors. Critical evaluations of the impact of these new technologies on medication errors and other adverse outcomes are lacking. PubMed was searched to identify all peer-reviewed publications linking four technologies (CPOE, ADMs, bar coding, and CMARs) with reductions in medication errors and ADEs and secondary endpoints. All controlled studies that assessed the impact of the technologies were evaluated. The appropriateness of the use of these technologies was also examined.

Few studies were identified that evaluated the technologies' impact on these endpoints. Of the evaluated technologies, CPOE was the most studied; however, investigations were limited to selected medical centers. The appropriateness of use of the technologies was evaluated even more infrequently.

A literature review revealed a paucity of controlled, generalizable studies confirming the benefits of technologies intended to reduce medication errors and ADEs. Very little evidence on the appropriateness of the use of these technologies was found.

In 1999 the death rate associated with medication errors was estimated at 7000 per year.^[1] Of medication errors considered preventable, over half result in adverse drug events (ADEs).^[2] ADEs are defined as "any response to a drug which is noxious, unintended, and which occurs at doses normally used in humans for the prophylaxis, diagnosis, or therapy of disease."^[3] A recent meta-analysis found a 6.7% incidence of serious adverse drug reactions in hospitals.^[4] In the Medical Practice Study, ADEs accounted for 14.1% of all seriously disabling adverse events.^[5] Classen et al.^[6] calculated the excess cost of hospitalization attributable to an ADE to be $2013, while others suggest the figure to be even greater, particularly for preventable ADEs.^[7]

An estimated 28-56% of ADEs are considered preventable.^[6,7,8,9] Medication errors due to illegible handwritten prescriptions, overlooked allergies and drug interactions, and incorrect dosages often result in ADEs. Consequently, technology-based interventions have been recommended as a key mechanism for reducing the likelihood of medication errors and ADEs.^[10] Computerized physician order entry (CPOE) has been endorsed as one of three initial methods that should be widely adopted by hospitals to reduce prescribing and transcription errors.^[11] Other studies have investigated the impact of technologies on medication errors.^[12,13,14] With the exception of a recent publication commissioned by the Agency for Healthcare Research and Quality,^[15] critical reviews summarizing the impact of new technologies on medication errors and ADEs are lacking.

Several factors may influence the appropriate use of particular technologies. The complexity of the hospital workplace, limitations in the number of care components that can be automated, and the technologies' interaction with human factors can determine their success or failure. If a technology is not used as intended, increased inefficiency and medical errors may result. Consequently, in addition to demonstrating the value of a new technology with outcomes evidence, it is important to investigate whether the technology is being used appropriately and to identify barriers to its appropriate use.

We critically reviewed four technologies that have been proposed to reduce medication errors: CPOE, automated dispensing machines (ADMs), bar coding, and computerized medication administration records (CMARs). Clinical decision support systems is another commonly used technology; however, it involves multiple individual technologies, and there is considerable heterogeneity among systems, which often include both CPOE and alert systems. Therefore, we did not evaluate clinical decision support systems.

We decided to focus on these four technologies because a review of the contemporary literature indicated that they are commonly used and are most likely to influence patient safety.^[13,15,16] The aims of this study were to identify published studies that assessed the effects of the given technology, especially with respect to medication errors and ADEs, and to identify published studies that assessed the appropriateness of use of the technology.

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Sidebar: Appendix A - Excluded Articles Pertaining to Computerized Physician Order Entry

Ahmad A, Teater P, Bentley TD et al. Key attributes of a successful physician order entry system implementation in a multi-hospital environment. J Am Med Inform Assoc. 2002; 9:16-24.
Allen S, Johannes R, Brown C et al. Prescription-writing with a PC. Comput Methods Programs Biomed. 1986; 22:127-35.
Ash J, Gorman P, Hersh W. Physician order entry in U.S. hospitals. Proc AMIA Annu Fall Symp. 1998; 235-9.
Ash J, Gorman P, Hersh W et al. Perceptions of house officers who use physician order entry. Proc AMIA Annu Fall Symp. 1999; 471-5.
Ash J, Gorman P, Lavelle M et al. Investigating physician order entry in the field: lessons learned in a multi-center study. Medinfo. 2001; 10(pt. 2):1107-11.
Ash JS, Gorman PN, Lavelle M et al. Multiple perspectives on physician order entry. Proc AMIA Symp. 2000; 27-31.
Bates D, Kuperman G, Teich J. Computerized physician order entry and quality of care. Qual Manage Health Care. 1994; 2:18-27.
Bates D, Shu K, Narasimhan D et al. Comparing time spent writing orders on paper and physician computer order entry. Proc AMIA Annu Fall Symp. 2000; 965.
Bates DW, Cohen M, Leape LL et al. Reducing the frequency of errors in medicine using information technology. J Am Med Inform Assoc. 2001; 8:299-308.
Bates DW, O'Neil AC, Boyle D et al. Potential identifiability and preventability of adverse events using information systems. JAMA. 1994; 1:404-11.
Birkmeyer J, Birkmeyer C, Wennberg D et al. Leapfrog safety standards: potential benefits of universal adoption. Washington, DC: Leapfrog Group; 2000.
Bodenheimer T. The American health care system: the movement for improved quality in health care. N Engl J Med. 1999; 340:488-92.
Broverman C, Clyman J, Schlesinger J et al. Clinical decision support for physician order-entry: design challenges. Proc AMIA Annu Fall Symp. 1996; 572-6.
Brown C, Allen S, Songco D. A computerized prescription writing program for doctors. Methods Inf Med. 1985; 24:101-5.
Burke J, Pestotnik S. Antibiotic use and microbial resistance in intensive care units: impact of computer-assisted decision support. J Chemother. 1999; 11:530-5.
Canfield K. Priming intelligent split menus with text corpora for computerized patient record data-entry. Int J Biomed Comput. 1995; 39:263-73.
Chin H. Winning support for physician order entry. Health Data Manage. 1999; 7(5):54-6,60,62-3.
Chin H, Krall M. Implementation of a comprehensive computer-based patient record system in Kaiser Permanente's Northwest region. MD Comput. 1997; 14(1):41-5.
Chin H, Wallace P. Embedding guidelines into direct physician order entry: simple methods, powerful results. Proc AMIA Symp. 1999; 221-5.
Classen D, Pestotnik S, Evans R et al. Computerized surveillance of adverse drug events in hospital patients. JAMA. 1991; 266:2847-51.
Classen D, Pestotnik S, Evans R et al. Description of a computerized adverse drug event monitor using a hospital information system. Hosp Pharm. 1992; 27: 774,776-9,783.
Collen M. General requirements for a medical information system (MIS). Comput Biomed Res. 1970; 3:393-406.
Computerized provider order entry systems. Health Devices. 2001; 30:323-59.
Computerized provider order entry systems. Not a panacea for medical errors. Health Devices. 2001; 30:321-2.
Dambro M, Weiss B, McClure C et al. An unsuccessful experience with computerized medical records in an academic medical center. J Med Educ. 1988; 63:617-23.
Donald J. On line prescribing by computer. BMJ. 1986; 292:937-9.
Dorodny VS. Security and confidentiality of health information systems: implications for physicians. Physician Exec. 1998; 24(3):32-7.
East T, Morris A, Wallace C. A strategy for development of computerized critical care decision support systems. Int J Clin Monit Comput. 1991; 8:263-9.
Evans R, Classen D, Pestotnik S et al. Improving empiric antibiotic selection using computer decision support. Arch Intern Med. 1994; 154:878-84.
Evans R, Pestotnik S, Classen D et al. Preventing adverse drug events in hospitalized patients. Ann Pharmacother. 1994; 28:523-7.
Evans R, Pestotnik S, Classen D et al. Prevention of adverse drug events through computerized surveillance. Proc Annu Symp Comput Appl Med Care. 1992; 437-41.
Fabrey RH II. Physician computer order entry in a hospital setting. Physician Exec. 1996; 22(4):31-3.^a
Geissbuhler A, Miller RA. A new approach to the implementation of direct care-provider order entry. Proc AMIA Annu Fall Symp. 1996; 689-93.
Geissbuhler A, Miller RA. Clinical application of the UMLS in a computerized order entry and decision-support system. Proc AMIA Symp. 1998; 320-4.
Glaser J, Teich J, Kuperman G. Impact of information events on medical care. In: Proceedings of the Healthcare Information and Management Systems Society Annual Conference. Vol. 2. San Francisco: Jossey-Bass/Pfeiffer; 1996:1-9.
Goverman IL. Orienting health care information systems toward quality: how Group Health Cooperative of Puget Sound did it. Jt Comm J Qual Improv. 1994; 20(11):595-605.
Grams S, Grieco A, Williams R. Physician use of the TDS medical information system provides major benefits and savings to New York University Medical Center. New York: New York University; 1986.
Hawkins HH, Hankins RW, Johnson E. A computerized physician order entry system for the promotion of ordering compliance and appropriate test utilization. J Healthc Inf Manage. 1999; 13(3):63-72.
Johnston M, Langton K, Haynes R et al. Effects of computer-based clinical decision support systems on clinician performance and patient outcome: a critical appraisal of research. Ann Intern Med. 1994; 120:135-42.
Kaplan B. Reducing barriers to physician data entry for computer-based patient records. Top Health Inf Manage. 1994; 15(1):24-34.
Kawahara NE, Jordan FM. Influencing prescribing behavior by adapting computerized order-entry pathways. Am J Hosp Pharm. 1989; 46:1798-801.
Khorasani R. Computerized physician order entry and decision support: improving the quality of care. Radiographics. 2001; 21:1015-8.
Kuperman GJ, Teich JM, Gandhi TK et al. Patient safety and computerized medication ordering at Brigham and Women's Hospital. Jt Comm J Qual Improv. 2001; 27:509-21.
Larson R, Blake J. Achieving order entry by physicians in a computerized medical record. Hosp Pharm. 1988; 23:551-3.
Larsen R, Evans R, Burke J et al. Improved perioperative antibiotic use and reduced surgical wound infections through use of computer decision analysis. Infect Control Hosp Epidemiol. 1989; 10:316-20.
Lee F, Teich J, Spurr C et al. Implementation of physician order entry: user satisfaction and self-reported usage patterns. J Am Med Inform Assoc. 1996; 3:42-55.
Lee YL, Hsu CY, Hsieh D et al. Development and deployment of a Web-based physician order entry system. Int J Med Inf. 2001; 62(2-3):135-42.
Lepage E, Gardener R, Laub R et al. Improving blood transfusion practice: role of a computerized hospital information system. Transfusion. 1992; 32:253-9.
Levit F, Garside D. Computer-assisted prescription writing. Comput Biomed Res. 1977; 10:501-10.
Litzelman D, Dittus R, Miller M et al. Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols. J Gen Intern Med. 1993; 8:311-7.
Lobach D, Hammond W. Computerized decision support based on a clinical practice guideline improves compliance with care standards. Am J Med. 1997; 102:89-98.
Luxenberg SN, DuBois DD, Fraley CG et al. Electronic forms: benefits and drawbacks of a World Wide Web-based approach to data entry. Proc AMIA Annu Fall Symp. 1997; 804-8.
Marino R. CPOE systems not ready yet. Hosp Health Netw. 2001; 75(9):12,14.
Massaro T. Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior. Acad Med. 1993; 68(1):20-5.
Massaro T. Introducing physician order entry at a major academic medical center: II. Impact on medical education. Acad Med. 1993; 68(1):25-30.
Murff H, Kannry J. Physician satisfaction with two order entry systems. J Am Med Inform Assoc. 2001; 8:499-509.
Norris PR, Dawant BM, Geissbuhler A. Web-based data integration and annotation in the intensive care unit. Proc AMIA Annu Fall Symp. 1997; 794-8.
Ogura H, Sagara E, Yamamoto K et al. Analysis of the online order entry process in an integrated hospital information system. Comput Biol Med. 1985; 15:381-93.
Ogura H, Yamamoto K, Furutani H et al. On-line prescription order and prescription support in an integrated hospital information system. Med Inform (Lond). 1985; 10:287-99.
Overhage J, Tierney W, McDonald C et al. Computer-assisted order entry: impact on intern time use. Clin Res. 1991; 39:794. Abstract.
Overhage JM, Mamlin B, Warvel J et al. A tool for provider interaction during patient care: G-CARE. Proc Annu Symp Comput Appl Med Care. 1995; 178-82.
Paterno M, Teich J, Seger D et al. A practical method for presenting drug interactions to clinicians. Proc AMIA Annu Fall Symp. 1996; 20:872.
Payne TH. The transition to automated practitioner order entry in a teaching hospital: the VA Puget Sound experience. Proc AMIA Symp. 1999; 589-93.
Pestotnik S, Classen D, Evans R et al. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med. 1996; 124:884-90.
Pestotnik SL, Classen DC, Evans RS et al. Prospective surveillance of imipenem/cilastatin use and associated seizures using a hospital information system. Ann Pharmacother. 1993; 27:497-501.
Physician order entry system cuts error rate, improves path compliance, tracks data. Health Care Cost Reeng Rep. 1997; 2(10):152-7
Pryor T, Gardner R, Clayton P et al. The HELP system. J Med Syst. 1983; 7:87-102.
Raschke R, Golihare B, Wunderlich T. A computer alert system to prevent injury from adverse drug events: development and evaluation in a community hospital. JAMA. 1998; 280:1317-20.
Reynolds R, Heller E. An academic medical center experience with a computerized hospital information system: the first four years. Proc Annu Symp Comput Appl Med Care. 1980; 4:3-16.
Schiff G, Rucker T. Computerized prescribing: building the electronic infrastructure for better medication usage. JAMA. 1998; 279:1024-9.
Schiff G, Wisniewski M, Bult J et al. Improving patient antibiotic prescribing: insights from participation in a national collaborative. Jt Comm J Qual Improv. 2001; 27:387-402.
Schneider R, LaBatt E. Computerized system for physician order entry. Am J Health-Syst Pharm. 1995; 52:2184-6.
Schroeder C, Pierpaoli P. Direct order entry by physicians in a computerized hospital information system. Am J Hosp Pharm. 1986; 43:355-9.
Schumock GT, Marwaha TR, McBride JM et al. Automated order-entry mechanisms to influence prescribing. Top Hosp Pharm Manage.1994; 14(3):21-9.
Shu K, Boyle D, Spurr CD et al. Comparison of time spent writing orders on paper with computerized physician order entry. Medinfo. 2001; 10(pt. 2): 1207-11.
Sittig D, Stead W. Computer-based physician order entry: the state of the art. J Am Med Inform Assoc. 1994; 1:108-23.
Spillane M, McLaughlin M, Ellis K et al. Direct physician order entry and integration: potential pitfalls. Proc Annu Symp Comput Appl Med Care. 1990; 14:774-8.
Teich J, Glaser J, Beckley R. Toward cost-effective quality care: the Brigham Integrated Computing System. Proc Second Nicholas E. Davies CPR Recog Symp. 1996; 3-34.
Teich J, Hurley J, Beckley R et al. Design of an easy-to-use physician order entry system with support for nursing and ancillary departments. Proc Annu Symp Comput Appl Med Care. 1992; 16:99-103.
Teich J, Schmiz J, O'Connell E et al. An information system to improve the safety and efficiency of chemotherapy ordering. J Am Med Inform Assoc. 1996; 3(suppl):498-502.
Teich J, Spurr C, Flammini SJ et al. Response to a trial of physician-based inpatient order entry. Proc Annu Symp Comput Appl Med Care. 1993; 17:316-20.
Teich JM, Glaser JP, Beckley RF et al. The Brigham Integrated Computing System (BICS): advanced clinical systems in an academic hospital environment. Int J Med Inf. 1999; 54:197-208.
Teich JM, Spurr CD, Schmiz JL et al. Enhancement of clinician workflow with computer order entry. Proc Annu Symp Comput Appl Med Care. 1995; 459-63.
Tierney W. Computerizing guidelines: factors for success. Proc AMIA Annu Fall Symp. 1996; 459-62.
Tierney W, Overhage J, McDonald C et al. Medical students' and housestaff's opinions of computerized order-writing. Acad Med. 1994; 69:386-9.
Tierney W, Overhage J, Takesue B et al. Computerizing guidelines to improve care and patient outcomes: the example of heart failure. J Am Med Inform Assoc. 1995; 2:316-22.
Weiner M, Gress T, Thiemann DR et al. Contrasting views of physicians and nurses about an inpatient computerbased provider order-entry system. J Am Med Inform Assoc. 1999; 6:234-44.
Weir C, Lincoln M, Roscoe D et al. Successful implementation of an integrated physician order entry application: a systems perspective. Proc Annu Symp Comput Appl Med Care. 1995; 790-4.
Weir C, McCarthy C, Gohlinghorst S et al. Assessing the implementation process. Proc AMIA Symp. 2000; 908-12.
Wilson G, McDonald C, McCabe G. The effect of immediate access to a computerized medical record on physician test ordering: a controlled clinical trial in the emergency room. Am J Public Health. 1982; 72:698-702.
Young D. CPOE reduces number of steps in medication-use process. Am J Health-Syst Pharm. 2001; 58:1170,1173.
Zimmerman M. Provider order entry: it can work! J Emerg Nurs. 1997; 23:463-6.

^aExcluded because of unobtainability.

Sidebar: Appendix B - Excluded Articles Pertaining to Automated Dispensing Machines

Barker KN. Ensuring safety in the use of automated medication dispensing systems. Am J Health-Syst Pharm. 1995; 52:2445-7.
Barker KN, Harris JA, Webster DB et al. Consultant evaluation of a hospital medication system: implementation and evaluation of the new system. Am J Hosp Pharm. 1984; 41:2022-9.
Barker KN, Harris JA, Webster DB et al. Consultant evaluation of a hospital medication system: analysis of the existing system. Am J Hosp Pharm. 1984; 41:2009-16.
Barker KN, Harris JA, Webster DB et al. Consultant evaluation of a hospital medication system: implementation and evaluation of the new system. Am J Hosp Pharm. 1984; 41:2022-9.
Barker KN, Harris JA, Webster DB et al. Consultant evaluation of a hospital medication system: synthesis of a new system. Am J Hosp Pharm. 1984; 41:2016-21.
Botwin K, Chan J, Jacobs R et al. Impact of a 24 hour stop and restricted access to automated dispensing machines upon duration of surgical antibiotic prophylaxis. Am J Health-Syst Pharm. 2001; 58: 797-9.
Hurley D. Automated medication system -- benefits for nursing. Proc Annu Symp Comput Appli Med Care. 1994; 51:1050.
Ishizuka H, Waki Y, Horizuti M et al. Development and evaluation of a new automated dispensing system. Int J Biomed Comput. 1995; 38(2):167-76.
Joint Commission on Accreditation of Healthcare Organizations. Surveying medication use related to automated dispensing machines. www.jcaho.org (accessed 2001 Apr 18).
Jones DG, Crane VS, Trussell RG. Automated medication dispensing: the ATC 212 system. Hosp Pharm. 1989; 24: 604,606-10.
Landis NT. Automated dispensing systems vary by function, location. Am J Hosp Pharm. 1993; 50:2242-4,2247-8.
Magnus GH. Preparing for automated dispensing devices. Am J Health-Syst Pharm. 1995; 52:2406-8.
Morrill TS. Automated pharmacy systems: avoiding the pitfalls. Hosp Mat Manage Q. 1982; 4(2):79-85.
Novek J, Bettess S, Burke K et al. Nurses' perceptions of the reliability of an automated medication dispensing system. J Nurs Care Qual. 2000; 14(2):1-13.
Novek J, Rudnick W. Automatic drug dispensing help or hindrance? Can Nurse. 2000; 96(4):29-33.
Oren E, Griffiths LP, Guglielmo J. Characteristics of antimicrobial overrides associated with automated dispensing machines. Am J Health-Syst Phar. 2002; 59:1445-8.
Padilla N. Current status of automated dispensing system. Am J Hosp Pharm. 1994; 51:704.
Perini VJ, Vermeulen LC Jr. Comparison of automated medication-management systems. Am J Hosp Pharm. 1994; 51:1883-91.
Rich D. Automated dispensing machines. Hosp Pharm. 2000; 35:666-70.
Ringold DJ, Santell JP, Schneider PJ. ASHP national survey of pharmacy practice in acute care settings: dispensing and administration -- 1999. Am J Health-Syst Pharm. 2000; 57:1759-75.
Survey of automated dispensing shows need for practice improvements and safer system design. Huntingdon Valley, PA: Institute for Safe Medication Practices; 1999 Jun 16.
Vrabel RB, Mackowiak L. Automation in pharmacy: two institutions' experiences with novel distribution systems. Hosp Formul. 1995; 30(2):106-13.
Wong BJ, Rancourt MD, Clark ST. Choosing an automated dispensing machine. Am J Health-Syst Pharm. 1999; 56:1398-9.

^aExcluded because of unobtainability.

Sidebar: Appendix C - Excluded Articles Pertaining to Bar Coding

Barhyte D. Bar coding. A new tool for researchers. West J Nurs Res. 1989; 11:347-51.
Beer E, Becker R. Specimen collection made easier with bar codes. CAP Today. 1995; 9(19):62,64.
Chin T. Identifying new uses for bar coding technology. Health Data Manage. 1999; 7(8):66-8,70-1.
Darby P. Bar coding technology in inventory control. Can J Hosp Pharm. 1988; 41:313-6.
Ferkovic T. Inventory control systems in the hospital pharmacy. Hosp Mater Manage. 1983; 5(2):70-7.
Gandy J. Managing purchasing and inventory with bar codes. Part II. Hosp Mater Manage. 1986; 11(4):8-12.
Gandy J. Designing and implementing a bar code system. Hosp Mater Manage. 1986; 11(3):3-9.
Garza D, Murdock S, Garcia L et al. Bar codes in the clinical laboratory. Clin Lab Sci. 1991; 4(1):23-5.
Hakanson W. Inventory and billing processes using bar coding. J Healthc Mater Manage. 1988; 6(6):57-60.^a
Hokanson JA, Guernsey BG, Bryant SG et al. The feasibility of barcode-based dispensing quality assurance programs. Drug Intell Clin Pharm. 1984; 18:76-8.
Hokanson JA, Keith MR, Guernsey BG et al. Potential use of bar codes to implement automated dispensing quality assurance programs. Hosp Pharm. 1985; 20:327-9,333,337.
Jenis E. Bar codes magnify efficiencies at Millard Fillmore. Healthc Inform. 1992; 9 (3):56,58.
Jensen NJ, Crosson JT. An automated system for bedside verification of the match between patient identification and blood unit identification. Transfusion. 1996; 36:216-21.
Kaplan R. Materials management with a bar code reader. J Clin Eng. 1990; 15:219-25.
Kasten B. What are all those lines and spaces? Understanding bar code technology. MLO Med Lab Obs. 1992; 24(12):25-7.
Kasten B, Schrand P, Disney M. Joining the bar code revolution. MLO Med Lab Obs. 1992; 24(12):22-5.
Learn H. Bar coding in the microbiology lab. MLO Med Lab Obs. 1995; 27 (5):52-3.
Lefkowitz S, Cheiken H, Barnhart MR. A trial of the use of bar code technology to restructure a drug distribution and administration system. Hosp Pharm. 1991; 26:239-42.
Longe K. Bar coding. The inventory manager. J Healthc Mater Manage. 1987; 5(4):37-40.
Longe KM. Bar codes in health information management: status, standards, and selections. Top Health Rec Manage. 1992; 12(3):12-9.
Longe KM. The status of bar coding in hospitals: a survey report. Hosp Technol Ser. 1989; 8(5):1-42.
Maffetone MA, Watt SW, Whisler KE. Automated sample handling in a clinical laboratory. Comput Healthc. 1988; 9(9):48-50.
Maine C. Bar code tracking system boosts performance of labour management system. Health Estate J. 1994; 48(9):3-4.^[a]
Martin E. Barcode is better, bar none. Healthc Inform. 1995; 12(3):88,90.
Mudie D. Bar coding in a medical records department: a case study. Hosp Technol Ser. 1988; 7(11):1-15.
Noordegraaf G, Bouman J, van den Brink E et al. Development of computer-assisted patient control for use in the hospital setting during mass casualty incidents. Am J Emerg Med. 1996; 14:257-61.
Paul N. Admission to discharge. Tracking a patient's progress using wireless bar coding. Health Manage Technol. 2001; 22(2):30,32.
Post C. Can bar codes manage EMS inventory? Emerg Med Serv. 2000; 29(11):100.
Puckett F. Medication-management component of a point-of-care information system. Am J Health-Syst Pharm. 1995; 52:1305-9.
Renner SW, Howanitz PJ, Bachner P. Wristband identification error reporting in 712 hospitals. A College of American Pathologists' q-probes study of quality issues in transfusion practice. Arch Pathol Lab Med. 1993; 117:573-7.
Ritt E, Agase E. Bar coding makes its hospital debut. Nurs Manage. 1988; 19(7):44-5.
Schmaus D. The basics of bar code technology. AORN J. 1991; 53:1542-8.
Scott M, McElnay J, Burnett K. Using bar-code technology to capture clinical intervention data in a hospital with a stand-alone pharmacy computer system. Am J Health-Syst Pharm. 1996; 53:651-4.
Shimkus J. Quick scan . . . bar codes deliver the goods. Mater Manage Health Care. 1997; 6(10):26-8.
Swift T. Bar coding. Cornerstone of information collection and processing. Comput Healthc. 1985; 6(13):29-30.
Tilzer LL, Jones RW. Use of bar code labels on collection tubes for specimen management in the clinical laboratory. Arch Pathol Lab Med. 1988; 112:1200-02.
Weilert M, Tilzer L. Putting bar codes to work for improved patient care. Clin Lab Med. 1991; 11:227-38.
Zarowitz BJ, Petitta A, Mlynarek M et al. Bar-code technology applied to drug-use evaluation. Am J Hosp Pharm. 1993; 50:935-9.
Zarowitz BJ, Petitta A, Rudis MI et al. Bar code documentation of pharmacotherapy services in intensive care units. Pharmacotherapy. 1996; 16:261-6.

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Impact of Emerging Technologies on Medication Errors and Adverse Drug Events

Abstract and Introduction

Tables

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Appendix

Sidebar: Appendix A - Excluded Articles Pertaining to Computerized Physician Order Entry

Appendix

Sidebar: Appendix B - Excluded Articles Pertaining to Automated Dispensing Machines

Appendix

Sidebar: Appendix C - Excluded Articles Pertaining to Bar Coding

Appendix

Sidebar: Appendix D - Excluded Articles Pertaining to Computerized Medication Administration Records

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