Verbal medical order errors reduced to zero

Hospitals have spent millions of dollars on computerized physician order entry systems to reduce medical errors, but a simple change in the way verbal orders are entered in the system -- so simple that it cost nothing to implement -- has reduced errors to zero, according to a new Cincinnati Children's Hospital Medical Center study.

"By simply having the resident read back the order before he or she entered it into the computer, we reduced verbal order errors from 9.1 percent to zero," says Michael Vossmeyer, M.D., a pediatrician at Cincinnati Children's and the study's main author. "Although this was a small study, these results are very encouraging."

At Cincinnati Children's, rounds are conducted inside patients' rooms to make care more family-centered, and orders are entered into the computer system right at the bedside. The attending physician or chief resident verbally communicates the order and a resident physician enters it into the system.

For the study, the team on rounds took 70 consecutive orders. After rounds, they examined the orders for errors. They discovered errors in 9.1 percent of all orders. Most of the errors were in dosages that would not have affected safety. In two instances, however, the intern wrote down the wrong drug.

Dr. Vossmeyer and his research colleagues instituted a process of order read back: Before leaving a patient's room, the resident reads back the order entered to verify its accuracy. The attending physician or chief resident then verifies its accuracy. After instituting this process, the researchers examined 75 orders for errors. There were none. Moreover, the process added only seconds to each visit to a patient's room, so it did not slow down the process of physician rounding.

"We're doing a follow-up study to determine if the results are sustainable and the process is reliable," says Dr. Vossmeyer, "but they appear to be very generalizable. That's particularly important for tertiary patients, such as children with organ transplants, where proper doses mean so much."

The study was conducted on a general, acute pediatric inpatient unit. Cincinnati Children's is now spreading the read back process to family-centered rounds throughout the organization.