Reporting trends in a regional medication error data-sharing system

Area of Science:

• Healthcare Management
• Patient Safety
• Health Informatics

Background:

• Inter-organizational systems for sharing medication error data are crucial for patient safety.
• These systems aim to enhance voluntary error reporting and facilitate learning from errors.
• Limited research exists on the actual benefits of inter-organizational data sharing in healthcare.

Purpose of the Study:

• To examine developmental trends in medication error and corrective action reporting within a regional healthcare system.
• To assess the impact of a voluntary, inter-organizational data sharing system on hospital reporting practices.
• To identify potential disparities in reporting trends across participating hospitals.

Main Methods:

• Latent growth curve analysis was used to examine longitudinal trends over 12 months.
• Data from 25 hospitals in southwestern Pennsylvania participating in the Pittsburgh Regional Healthcare Initiative (PRHI) were analyzed.
• Medication error and corrective action reports (totaling 17,000) were analyzed quarterly, controlling for hospital size, teaching status, and accreditation.

Main Results:

• Hospital-wide medication error reporting showed a statistically significant increase over four quarters.
• Error reporting rates increased similarly across hospitals, despite initial differences.
• Reporting of corrective actions remained unchanged, with significant baseline differences persisting across hospitals.

Conclusions:

• Inter-organizational data sharing effectively promotes medication error reporting.
• Current systems may not adequately incentivize or capture data on corrective actions and process improvements.
• Future system designs should emphasize data collection on root-cause analysis and process improvement to foster comprehensive learning.