Improving medication safety: the measurement conundrum and where to start

The use of medication remains the most common intervention in health care. The complexity of both medication use and the medication management process, especially in the in-patient setting, create a significant risk for hospitalized patients. Despite the widespread recognition of the hazards that medication use poses to patients, there are no widely accepted or standardized methods to measure the safety of medication use. Where to focus measurement in medication safety is the subject of ongoing debate. Various groups have suggested measuring error-prone aspects of the medication use process such as errors in administration of medications or errors in dispensing of medications. Other groups have suggested measuring adverse drug events as a measure of the safety of medication use. Many studies in this area have outlined the great difficulty associated with getting clinicians to report either medication errors or adverse drug events voluntarily. In response to these challenges, yet more groups have developed non-voluntary reporting methods based on the use of "triggers", in either a chart review or electronic format. Medication safety is a complex process and measurement of it needs to be a core component throughout the whole process. With the introduction of computerized analysis of patient information, measurement becomes much easier and potentially more powerful and achievable than either incident reporting or chart reviews for purposes of accountability, prevention, and ongoing improvement of both process and clinical practice. This paper reviews approaches to measuring medication safety from the perspective of both harm and error, and outlines a strategy that combines both approaches in the electronic era.