Two reports show promise of computers, pharmacists for proper prescribing
MONDAY, April 27 (HealthDay News) -- Medication errors and adverse drug reactions cost lives and dollars each year in the United States, but two new reports suggest ways hospitals and pharmacists can work to reduce these mistakes.
Medication errors are one of the most common medical errors, affecting at least 1.5 million people every year and costing the health-care system between $77 billion and $177 billion annually, researchers point out in the April 27 issue of the Archives of Internal Medicine.
In the first report, researchers led by Dr. Jeffrey L. Schnipper, of Brigham and Women's Hospital and Harvard Medical School, used a computer system to keep track of the medications patients were taking when they were admitted to the hospital and the medications they were taking when they were discharged.
"It turns out that we commit about 1.5 errors per patient either for the admissions orders in the hospital or, much more commonly, in the discharge orders, which is kind of appalling," Schnipper said. "These are errors with potential for patient harm. There are about three times as many errors without potential for patient harm."
For the study, Schnipper's team randomly assigned 322 patients from two hospitals to have their medications entered into a computer program at admission that was designed to reconcile those medications with the ones they were taking when they left the hospital. In addition, the researchers tried having different people take the patient's medication history and keep track of all the medications they were taking. These included doctors, nurses and pharmacists.
Among the 162 patients in the program, there were 1.05 medication errors per patient compared with 1.44 errors among patients receiving usual care -- a 28 percent reduction in errors.
Of the errors, 43 among patients in the program had the potential to cause serious harm compared with 55 among patients in the usual-care group.
The problem of medication error starts when patients are asked what drug they are taking when they come into the hospital, Schnipper said. "Patients don't know what they are taking. You have got to carry your current accurate medication list in your wallet," he advised.
Since the initial study, error rates have continued to drop as people got used to the system and the "culture" in each hospital changed to accommodate the program, Schnipper said. "Preliminarily, it looks like we are down to half an error per patient," he said.
The Joint Commission on Accreditation of Healthcare Organizations has made medication reconciliation a national priority. Medication reconciliation is identifying the most accurate list of all medications a patient is taking, and using this list to give correct medications for patients anywhere within the health-care system.
Matthew Grissinger, a medication safety analyst at the Institute for Safe Medication Practices, believes the study is a good model for hospitals to follow to help reduce medication errors.
The most important feature of the system was developing a method for taking patient's medication history on admission. "Standardizing the process of who is going to do what in regard to medication reconciliation in hospital admission and discharge is really the biggest challenge organizations have," he said.
In a second report, a team led by Michael D. Murray, chair of the department of pharmaceutical policy and evaluative sciences at the University of North Carolina at Chapel Hill, found that among outpatients with high blood pressure, when pharmacists, doctors and patients communicate, medication errors decrease.
"By working closely with doctors and nurses, pharmacists can help people avoid problems with their medication for chronic diseases like high blood pressure and heart failure," Murray said. "This has favorable effects on health and health-care costs."
For the study, Murray's group looked at the effect of having pharmacists involved in medication decisions in cutting down on medication errors and adverse drug effects among 800 patients with high blood pressure. Included among these patients were some with heart failure or other heart conditions. The researchers used a computer program to identify adverse drug reactions among the patients.
Patients assigned pharmacists intervention received instructions on using their medications. In addition, the pharmacists monitored the patients' drugs and communicated with both the patient and the patient's primary-care doctor to help improve adherence to medication regimens.
The researchers found that patients receiving pharmacists' interventions had fewer medication errors and adverse drug reactions compared with the other patients. In fact, there was a 34 percent lower risk of any event, including a 35 percent lower risk of an adverse drug reaction and a 37 percent lower risk of medication error.
"There are way in which pharmacists can work collaboratively with the other members of the health-care team to improve patient safety in the outpatient setting," Murray said.
"This study shows the importance of having a pharmacist actively involved in asking about how the patient is doing, what type of side effects is the patient having, and is the patients taking the medication," Grissinger said. "That is as important as the initial consultation."
For more information on medication error, visit the Institute for Safe Medication Practices.
SOURCES: Michael D. Murray, Pharm.D., M.P.H., chair, department of pharmaceutical policy and evaluative sciences, University of North Carolina at Chapel Hill; Jeffrey L. Schnipper, M.D., M.P.H., associate physician, Brigham and Women's Hospital, assistant professor, medicine, Harvard Medical School, Boston; Matthew Grissinger, medication safety analyst, Institute for Safe Medication Practices, Horsham, Pa.; April 27, 2009, Archives of Internal Medicine
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