Clinical decision support software prevents 95% of OR medication errors
MASSACHUSETTS, UNITED STATES — A recent study conducted by Massachusetts General Hospital has revealed that clinical decision-support software can prevent 95% of medication errors in the operating room.
The findings, published in the journal Anesthesia & Analgesia, underscore the potential of technology to enhance patient safety during surgical procedures significantly.
“Medication errors in the operating room have high potential for patient harm,” stated Dr. Karen C. Nanji, senior author of the study and a physician investigator in the Department of Anesthesia, Critical Care, and Pain Medicine at Massachusetts General Hospital.
“Clinical decision support involves comprehensive software algorithms that provide evidence-based information to clinicians at the point-of-care to enhance decision-making and prevent errors.”
Study methodology and findings
The study analyzed safety reports involving medication errors documented by anesthesia clinicians for surgical procedures from August 2020 to August 2022. Two independent reviewers classified each error by its timing, type, association with patient harm, severity, and preventability by clinical decision support algorithms.
Out of 127 safety reports involving 80 medication errors, the reviewers found that 76 (95%) of the errors could have been prevented by clinical decision support. Errors such as wrong medication and wrong dose were particularly likely to be preventable by these algorithms.
Emerging guidelines and future research
“Our results support emerging guidelines from the Institute for Safe Medication Practices and the Anesthesia Patient Safety Foundation that recommend the use of clinical decision support to prevent medication errors in the operating room,” said Dr. Nanji.
She highlighted that Massachusetts General Hospital has developed a comprehensive intraoperative clinical decision-support software platform called GuidedOR, which is currently implemented at their hospital and being adopted at additional Mass General Brigham sites.
Dr. Nanji emphasized the need for future research, suggesting that “large multi-center randomized controlled trials are necessary to more precisely measure the effect of clinical decision support on medication errors in the operating room.”
Early adoption stage and broader implementation
“While clinical decision support improves both efficiency and quality of care in operating rooms, it is still in the early stages of adoption,” added first author Lynda Amici, DNP, CRNA, of Cooper University Hospital, who was at Massachusetts General Hospital at the time of the study.
The study’s findings advocate for the broader implementation of clinical decision support software in operating rooms to safeguard patients’ health and improve surgical outcomes.
