Vigilance may help reduce drug errors

Medical Matters

September 08, 2006|By Judy Foreman | Judy Foreman,Special to the Sun

Every year, more than 1.5 million Americans are harmed by medication errors - preventable mistakes that cost the country well in excess of $3.5 billion to treat, according to a report this summer by the Institute of Medicine, a group of scientists that advises the government.

And that number is just the people believed to be injured by drug errors.

Nobody knows how many deaths are caused by medication errors. And countless others are not harmed but could have been. That's because they took, or were given, the wrong drugs, the wrong dose of the right drug, or drugs that were appropriate but less-safe than alternatives.

The report also estimated that the average hospitalized patient experiences one medication error every day.

Many of the group's recommendations to reduce errors are things that individual consumers can't do much about. They include processing all prescriptions electronically by 2010, making drug labels and inserts more intelligible, standardizing drug information and improving access to it through the Internet and a 24-hour national telephone hot line.

"Nothing that patients can do by themselves will make them truly safe," said Dr. Albert Wu, a professor at the Johns Hopkins Bloomberg School of Public Health and a co-author of the report. "But they can start doing things that can make them safer."

The most important - to keep doctors from prescribing inappropriate drugs - is to make a list of all your medications, including vitamins, herbal remedies and dietary supplements, keep it up-to-date, and take it with you to the doctor's office or the hospital.

Many people see multiple doctors, and it's often only the patient or a family member who knows all the drugs involved.

Keeping on top of medications is especially important in the hospital. "It's critical for patients - or family members - to be involved as much as they can to make sure the patient gets the right medications at the hospital," said Dr. David Bates, chief of the Division of General Internal Medicine at Brigham and Women's Hospital in Boston and another co-author.

This means paying attention every time a nurse gives a medication, said Dr. Tom Rosenthal, chief medical officer for University of California, Los Angeles Health Care, which runs three hospitals.

Nurses should match not just your name, but also your birth date and patient ID number with the information on the medication order. And family members should ask which medication is being given.

Just as important for family members and doctors is keeping track of hospital patients' kidney and liver function. Lying in bed for several days reduces blood flow to the kidneys and affects kidney function. A dose that is safe in someone with good kidney function may be too high in someone with poor kidney function. The same goes for liver function.

At the time of discharge, get a written list of your drugs and go over it with a nurse or doctor to make sure newly prescribed drugs won't interact adversely with drugs you are already taking.

Take notes. Similarly, when you pick up drugs at the pharmacy, or open a package of mail-order medications, check right away that these are the correct medications and doses.

If you are unsure, ask the pharmacist. Sometimes druggists substitute one drug for another, which may be fine, but you should notice - and ask - if you are suddenly getting a green triangular pill instead of the little white one you are used to.

At the doctor's office, ask the nurse or doctor to write down the name of any newly prescribed medication, what you are taking it for, and how often to take it.

In a larger, political sense, too, there's more that all of us can do, including lobbying for the systemic changes that could do the most to reduce medication errors.

Obviously, said Dr. Brent James, vice president for medical research at Intermountain Healthcare in Salt Lake City, we can't all go to the three hospitals that he deems best at reducing medication errors - Brigham and Women's, the LDS Hospital in Salt Lake City (which is in his hospital network) and the Royal North Shore Hospital in Sydney, Australia.

But we can push our own hospitals to implement the most promising changes. For one thing, he said, we can ask hospital personnel how they are doing on medication errors.

The good hospitals, he said, often report the highest error rates simply because they are keeping diligent track of such things. Over time, James said, these rates typically go down if the hospital works to correct errors.

Another change worth lobbying for is making sure that every dose of every drug prescribed is ordered by a doctor on a computer. Only about 15 percent of hospitals do this now, Bates said.

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