Preventing Perioperative Medication Errors and Adverse Drug Events Through the Use of Clinical Decision Support

In the United States alone, approximately 15.75 million medication errors occur annually in operating rooms. Almost half of these lead to patient harm, with the remainder having the potential for harm. While not yet widely used in operating rooms, clinical decision support (CDS) systems have been shown to prevent medication errors and their associated harm in other patient care areas and have the potential to prevent more than 50 percent of medication errors and 95 percent of adverse drug events in the operating room.

This research, funded under a Mentored Clinical Scientist Research Career Development Award, used iterative user-centered design principles to develop and evaluate a real-time perioperative CDS software platform.

The specific aims of this project were as follows:

• Design, prioritize, and tier evidence-based CDS rules for the perioperative setting.
• Build and implement a perioperative CDS tool that interfaces with existing electronic health records (EHRs).
• Evaluate whether the CDS system reduces the incidence of perioperative medication errors and preventable adverse drug events.

The research team used a modified Delphi approach to create, validate, and prioritize CDS software algorithms using algorithms that were derived from previous work. Using user-centered design principles, the team built and iteratively revised and tested a fully integrated real-time CDS software prototype for the operating room. Finally, the team evaluated the CDS software prototype in a simulation study: comparing time to complete tasks, mouse clicks, and total distance traveled on the screen in pixels to the standard medication administration and documentation workflow in the Anesthesia Information Management System (AIMS), software that generates the medical record for an anesthesia encounter, including the preoperative, intraoperative, and postoperative documentation. Because medication data are sent from the CDS software to the patient’s anesthesia record for automated documentation in real time via an interface that is supported by the EHR, the need to manually document the medication in AIMS was eliminated.

The perioperative CDS software platform outperformed the standard medication administration and documentation workflow by improving efficiency and quality of care while receiving higher usability ratings from clinicians. Specifically, the CDS software resulted in 20 percent faster task time, greater than 50 percent fewer mouse clicks, and fewer pixels traveled on the monitor. The research team also found that the CDS software’s System Usability Scale score was excellent compared to industry benchmarks.