Remote order entry and video verification: reducing after-hours medication errors in a rural hospital

Hendry Regional Medical Center, a 66-bed facility, has 8.5 hours of pharmacy staffing daily. Review of two years of medication errors indicated that 34% of all medication errors involved selection of the wrong drug from stock after pharmacy hours.

During 2003 many changes were implemented in the medication management process to enhance medication safety. For example, a limited-access area of the pharmacy was established for night entry by the nursing supervisor. The hospital then implemented services with a newly licensed remote order-entry service. These steps decreased the rate of errors involving wrong drug selection to 15%. Subsequently, a medication error involving selection of the wrong drug at night prompted another look at the process.

The hospital began using a webcam to create a digital image of the medication selected for removal from the pharmacy stock by the nursing supervisor. This image is transmitted via e-mail. In six months, only one (recent) error resulting from selection of the wrong medication after normal pharmacy hours occurred; the medication selection process simply was not followed.

Results of medication error reporting indicated that using Webcam/e-mail image transmission and video verification by a pharmacist further improved patient safety in the medication selection process.