Extraordinary similarities exist between
infection control and medication error prevention
From the November 17, 1999 issue
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.