A Third of Medication Errors Relate to EHR Usability: It’s Time to Leverage Digital Dosing Technology

by | Dec 3, 2018

Thermometers. X-Rays. Aspirin.

What else do these three items have in common besides being found in every hospital in the world? They were all rejected when first introduced.

In the 1700’s, Daniel Fahrenheit’s “temperature sensor” was dismissed since physicians of the time felt numerical differences in body temperature were unimportant. The New York Times referred to the introduction of the X-Ray as “an alleged discovery of a method to photograph the invisible.” The head of Bayer’s Pharmaceutical Institute rejected Felix Hoffman’s invention of aspirin as “worthless.”

Digital dosing technology – a method of simplifying medication administration to ensure patients get the right dosage of a drug at the right time – is similarly being held at arm’s length by many in the hospital community. But based on the horrific findings of a recent study connecting pediatric medication safety reports with EHR usability, it’s time to rethink the luke-warm reception to this simple, yet valuable technology.

Extensive study reveals EHR usability issues [1]

The study of medication safety in pediatric settings published in Health Affairs magazine analyzed 9,000 safety reports submitted between 2012-17 from three different health care institutions that were likely related to EHR use. Of the 9,000 reports, 3,243 noted usability issues as the cause of the medication event and 609 of those likely caused harm.

The Health Affairs study revealed that one of every three pediatric medication errors related to usability issues involving the EHR. Of those, one child out of every six might have suffered harm. The most common medication error was improper dosing and the prevalent cause was usability challenges associated with system feedback and the visual display of the EHR. In other words, clinicians administering medication were confused or didn’t receive sufficient information from their EHR to safely deliver medication. Overall in the three sites, these issues resulted in wrong dosing, accounting for 84.5 percent of the safety issues.

Children are at high risk

Pediatric patients are particularly susceptible to medication dosing errors because of the variation in physical characteristics, lower body weight, and less developed immune systems. In most facilities, pediatric emergencies make up a tiny percentage of day-to-day cases. As a result, clinicians don’t deal with many pediatric emergencies, so they simply don’t have the same learned expertise as they do with adult patients.

Unlike with adults, there are no fixed doses for kids. Clinicians rely on patient weight to establish proper dosing and must perform math calculations to determine the appropriate dosage and dilution – often right at the point of care. Additionally, pharmacist support and IT systems often lack pediatric safety features. And all this often takes place in the chaos of an ED.

That’s where technology can be a valuable resource to help clinicians perform safely during both frenzied and routine times. EHRs promised to be powerful, all-knowing computer systems that would solve the well-known problems with medication dosing and administration. Although EHRs have proven to be a valuable addition to the safe care of patients, when it comes to getting the right information quickly regarding the dilution, dosing, delivery, and dangers of medication for children, the study shows that current solutions are failing spectacularly.

Hospital leaders need to look beyond relying totally on their native EHR functionality to solve their medication administration issues. There is a better way: digital dosing technology.

The power of a digital dosing solution

Digital dosing solutions like SafeDose provide clinicians with the information they need at the point of care to make sure every patient receives the correct dose at the right administration rate. It simplifies the medication administration process and provides clinicians with the confidence that they are doing the right things when it comes to delivering needed drugs.

SafeDose, our web-based, mobile-enabled, digital dosing application, is purpose built as a visual-based tool to safely and immediately deliver accurate dosing information every time seamlessly from your EHR. It specifically addresses the four main usability problems identified in the Health Affairs study.

System Feedback
Simply by receiving the patient’s weight and a scan of the medicine vial bar code, SafeDose automatically determines the correct dose in mg and ml, eliminating the need for clinicians to perform extensive manual math calculations. For medications that require it, SafeDose provides the proper dilution to ensure the correct preparation. It also offers administration information for each drug. In addition, it provides feedback if the ordered dose differs from the recommended dose. SafeDose serves as a valuable double check, guiding the clinician all the way.

Visual Display
SafeDose provides a clear display with the EHR, on the desktop, tablet, or smart phone providing information on dosing, dilution, delivery, and dangers of the drug being administered. It clearly communicates potential adverse reactions and contraindications for each medicine. There is no longer a need to scramble for printed manuals, or search reference websites to determine the crucial information needed for proper drug dosing.

Data Entry
SafeDose can be integrated with the EHR to eliminate manual data entry by collecting prep and administration data in real time and automatically entering it into the system with one click. Clinicians select the appropriate medication and click on SafeDose to verify the appropriate medication and dosage. There is minimal extra data entry required with SafeDose.

Workflow Support
One of the objections to early digital dosing solutions is the lack of connectivity to the EHR. That obstacle no longer exists. SafeDose is FHIR-enabled and is already integrated into many of the top EHR systems so it automatically encompasses the documentation function into medical administration workflow. SafeDose can be seamlessly integrated into any EHR with FHIR capability.

The Health Affairs study recommends that the Office of the National Coordinator for Health Information Technology include safety as a voluntary certification criterion and implement usability-related measures to assess EHR performance. It also encourages EHR vendors to explore more comprehensive design guidelines and develop more rigorous test-case scenario. Finally, it urges the Joint Commission to assess EHR safety as part of its hospital accreditation  program.

Those are all worthy suggestions. But as we wait for these to be implemented, our children are being harmed by incorrect dosing every day. There is no time for delay. The fastest way to stop the medication administration error epidemic, and eventually get to zero adverse drug events, is to take advantage of digital dosing technology now. No hospital would dare operate without thermometers, X-rays or aspirin. Hopefully the same will soon be said about digital dosing. Waiting any longer is inexcusable.


To learn how SafeDose® from eBroselow can help you “Get To Zero” by dramatically improving medication administration safety, click here to download the solution sheet.


[1] Identifying Electronic Health Record Usability And Safety Challenges in Pediatric Settings