WASHINGTON, July 21 -- An estimated 1.5 million people in the United States are harmed by preventable drug errors each year, according to a report issued by the National Academy's Institute of Medicine here.
Treatment of drug-related injuries adds at least $3.5 billion annually to the nation's health care bill, not counting indirect costs such as lost income and ancillary health and home care services, wrote members of the IOM Committee on Identifying and Preventing Medication Errors, in a report called Preventing Medication Errors.
According to most studies, at least a quarter of all adverse drug reactions are caused by preventable errors, the authors wrote. "Moreover, many efficacious error-prevention strategies are available, especially for hospital care. In the hospital setting, there is good evidence for the effectiveness of computerized order entry with clinical decision-support systems, for clinical decision-support systems themselves, and for pharmacist participation on hospital rounds."
Other preventive measures such as the use of bar-coding and scanning of drug labels and so-called "smart" IV pumps, which check programmed settings against the hospital's guidelines for the use of specific drugs in specific patients, may also help to reduce dangerous drug errors, but are still being evaluated for efficacy, they noted.
The report recommended specific actions that consumers, clinicians, and health care institutions can take to help reduce drug errors.
"For example, consumers should maintain careful records of their medications, providers should review a patient's list of medications at each encounter and at times of transition between care settings (for example, hospital to outpatient care), and the federal government should seek ways to improve the quality of pharmacy leaflets and medication-related information on the Internet for consumers," the committee members wrote.
Hospitals and medical practices throughout the United States are using a combination of technology, training, and organizational change to achieve the goal of fewer medication errors.
At Johns Hopkins Hospital in Baltimore, for example, implementation of a computerized drug-ordering system reduced the likelihood that a child would get the wrong daily chemotherapy dose by 74%, and virtually eliminated the risk of dose calculation errors.
In addition, the use of a web-based infusion calculator reduced the number of orders containing errors by 83%, wrote Christopher U. Lehmann, M.D., of Johns Hopkins, and colleagues, in studies published in May in Archives of Pediatric & Adolescent Medicine and Pediatric Critical Care Medicine.
But as Daniel R. Longo, Sc.D., and colleagues, of the University of Missouri-Columbia reported last December in the Journal of the American Medical Association, while 74% of hospitals surveyed have implemented a written patient safety plan, nearly 9% have no such plan.
Furthermore, while nearly all hospitals have systems in place to reduce medication errors, only 34% of hospitals reported full implementation of computerized physician-order entry systems for medications, Dr. Longo and colleagues said.
The IOM report stressed that patients and providers need to form partnerships in which lines of communication remain open, and that patients must be kept informed when a medical error is made.
Among the specifics steps the report recommends for patients are:
Keep a list of prescriptions, over-the-counter drugs, vitamins, and supplements they are taking, and bring the list to each health care visit.
Ask the prescriber to write down or provide published material spelling out the trade and generic names of the drug, its indications, dosage, instructions about how to take it, contraindications, and other pertinent details.
Ask about the side effects of the drug and what to do if they experience a side effect.
Verify that the drug name, quantity and dosage furnished by the pharmacy are the same as the prescriber intended.
For providers, including doctors, nurses, and pharmacists, the authors recommended reviewing the patient's medication list both routinely and during care transitions, and discussing with patients different treatment options, the name and purpose of the selected medications, when and how to take them, side effects, interactions (drug-drug, drug-food, and drug-disease), and the patient's or surrogate role in ensuring appropriate medication use.
They also pointed out that the he underlying knowledge base is constantly changing, creating a situation in which it is almost impossible for health care providers to have current knowledge of every medication they prescribe.
The Cochrane Collaboration is one such possible resource. In addition, many software applications are being developed that provide decision support for prescribing clinicians. Applications of this type are typically available via the Internet or on personal digital assistants (PDAs). All prescribers should use point-of-care reference information, the report said.
"Health care providers in all settings should seek to create high-reliability organizations that constantly improve the safety and quality of medication use," they wrote. "To this end, they should implement active internal monitoring programs so that progress toward improved medication safety can be accurately demonstrated."
The committee members also called on the National Library of Medicine to act as a clearinghouse for online health information for consumers, and to work with other groups to evaluate other sources of online health information.
In addition, the report recommended that the National Library of Medicine, FDA, and the Centers for Medicare and Medicaid Services jointly set up multilingual telephone help lines for consumers without Internet access.
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