Such bad reactions to medications are called adverse drug events, and computerizing the prescription process is seen as key to helping prevent them.

But a new study by doctors at the Veterans Administration Healthcare System in Salt Lake City shows a high rate of medical error in drug ordering, dosage and monitoring can persist after computerization.

Published this week in the journal Archives of Internal Medicine, the study says researchers found no errors related to transcription, such as the misinterpretation of a handwritten prescription. But they discovered medical errors contributed to 27 percent of the adverse drug events suffered by patients over a 20-week period in 2000.

"People on the one hand expect computers to solve all problems," said lead researcher and VA Hospital physician Jonathan Nebecker. "They eliminated transcription problems, but the program was not designed to detect problems with drug choice and dosing."

Previous studies have shown that unintended injuries from drugs account for up to 41 percent of all hospital admissions and more than $2 billion a year in inpatient costs.

Nebecker and colleagues reviewed electronic records from 937 patients admitted to the VA hospital during a 20-week period in 2000. They found 483 significant adverse drug events; 25 percent of the hospitalizations had at least one.

Patients at VA hospitals are 90 percent male and tend to be older, sicker and poorer than patients at other facilities. While the number of adverse drug events discovered was higher than other studies have shown, researchers don't believe the patients' actual rate was higher. Instead, they credit the clarity of computerized records.

"It's not that there were more events, the measurements are better," Nebecker said. "We found that three-quarters of adverse drug effects were recognized by the computerized system."

The researchers found errors occurred at the following stages of care: 61 percent at the ordering of prescriptions, 25 percent during monitoring, 13 percent while drugs were given to patients and 1 percent at dispensing.

Some of the most common drugs patients encountered problems with were for pain, the heart and kidneys.

VA hospitals are recognized for their use of technology, including computerized patient records.

"Instead of having to run to the bedside to check paper charts, we now can look up patients' records on a computer from anywhere in the hospital," said John Hurdle, one of the study's authors.

One error that used to occur rather frequently involved the moving of patients to different rooms. Nurses would then give the new patient the medication intended for the previous occupant.

To avoid that potential catastrophe, VA hospitals have come up with bar-coded wrist bands to identify patients and their medications.

The VA's computers also raise a red flag when patients have allergies to medications, which has led to a significant reduction of reactions in that area.

Even so, Nebecker and Hurdle acknowledge more computer-sophisticated programming is needed to help eradicate prescription complications. Hospitals that want to reduce adverse drug events should seek programs that offer automated advice for choosing drugs, setting dosages and monitoring, their study said.

"Preventing harm is our focus," Hurdle said. "But prescription drugs are always inherently risky."

The study was supported by grants from the Veterans Administration Health Service Research and Development Service in Washington, D.C.; the Geriatric Research, Education and Clinical Center; the VA Cooperative Studies Program in Albuquerque, N.M.; and the Salt Lake Lake Informatics, Decision Enhancement and Surveillance Center.

chamilton@sltrib.com

Where the errors occurred:

Ordering:

61 percent

Monitoring:

25 percent

Administration:

13 percent

Dispensing:

1 percent

Computerized prescriptions don't eliminate errors

Studied:

Records from 937 patients admitted to the Veterans Administration hospital in Salt Lake City over a 20-week period in 2000.

Found:

448 Adverse reactions to drugs

35 Overdoses or underdoses.

Toll for patients:

438 were moderate

45 were serious, including 6 deaths.

Causes:

Medication errors contributed to 27 percent.