Extraordinary similarities exist between infection control and medication error prevention

There is much to learn from infection control efforts in the US. Last month, when Robert Gaynes, MD, spoke at a meeting of the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP), many similarities between medication error reduction and infection control became apparent. For example, nosocomial infections and medication errors are both prevalent and quite costly in both human and financial terms. In either case, one must distinguish between preventable and non-preventable events and, with rare exceptions, there are no silver bullets to eliminate problems. Both require targeting the multiple system-based causes. Throughout the presentation, it became clear that those committed to error reduction could benefit from the vast body of knowledge, research, and experience gained through infection control efforts. Over a decade ago, research confirmed that hospitals with the lowest nosocomial infection rates had BOTH strong surveillance programs AND prevention/control programs.¹ Today, regulatory, accrediting, and other infection control advisory bodies recommend that hospitals employ specifically trained, dedicated practitioners to identify the presence of nosocomial infections AND coordinate an effective infection control plan.

Typically, infection control surveillance is not hospital-wide. It's focused on high priority areas with increased risk of serious infections, such as intensive care units, surgical patients, or those with invasive devices. In turn, CDC no longer recommends the use of overall nosocomial infection rates from hospital-wide surveillance for interhospital comparisons.² Such broad determinations are left to researchers. Trained infection control practitioners collect data on nosocomial infections in a uniform manner from multiple sources, rather than relying on information that may be readily available through self-reports or medical records abstractors. This includes review of patient records and other indications of infection, which consumes almost half the practitioner's time. The remaining time is devoted to analysis of the data, implementation of infection control strategies, evaluation of their effectiveness, and dissemination of the information to all who need to know. Emphasis is placed on the dual importance of evaluating internal nosocomial events as well as an ongoing review of the literature to identify proactive measures to avoid the spread of infection.

Wouldn't our medication error reduction efforts be more productive if: 1) we employed specially trained and dedicated practitioners to uniformly identify the presence of medication errors through a variety of sources, rather than depending primarily on self-reporting programs; 2) our error detection efforts were followed by thorough analysis of the data, review of the literature, implementation of system-based error reduction strategies, and candid dissemination of information to all those who need to know; 3) our efforts were more focused on high alert drugs and other predictors of serious medication errors; and 4) we, along with the regulatory, accrediting, and advisory bodies, placed less emphasis on determining overall error rates for comparison and left such to the researchers? We should open our eyes to the evidence provided by infection control efforts in the US and recognize the immense value of employing trained, dedicated practitioners for the sole purpose of medication error surveillance and proactive error control plan-ing.

Ref.: 1. Haley RW, et al. Am J Epidemiol 1985; 121:182-205. 2. NNIS System. Nosocomial infection rates for interhospital comparison. Limitations and possible solutions. Infect Control Hosp Epidemiol 1991; 12:609-21.