Cyrus Dugger

Preventing Medication Errors

Here’s the introduction to a recent report from the Institute of Medicine on the high rate and high cost of medication errors.

Almost everyone in the modern world takes medication at one time or another. According to one estimate, in any given week four out of every five U.S. adults will use prescription medicines, over-the-counter drugs, or dietary supplements of some sort, and nearly one-third of adults will take five or more different medications. Most of the time these medications are beneficial, or at least they cause no harm, but on occasion they do injure the person taking them. Some of these “adverse drug events [ADEs],” as injuries due to medication are generally called, are inevitable—the more powerful a drug is, the more likely it is to have harmful side effects, for instance—but sometimes the harm is caused by an error in prescribing or taking the medication, and these damages are not inevitable. They can be prevented. Against this background, the Centers for Medicare and Medicaid Services requested that the Institute of Medicine study the prevalence of such medication errors and formulate a national agenda for reducing these errors. The resulting report, Preventing Medication Errors, finds that medication errors are surprisingly common and costly to the nation, and it outlines a comprehensive approach to decreasing the prevalence of these errors. This approach will require changes from doctors, nurses, pharmacists, and others in the health care industry, from the Food and Drug Administration (FDA) and other government agencies, from hospitals and other health-care organizations, and from patients.

THE UNACCEPTABLE COSTS OF MEDICATION ERRORS

In hospitals, errors are common during every step of the medication process—procuring the drug, prescribing it, dispensing it, administering it, and monitoring its impact—but they occur most frequently during the prescribing
and administering stages. When all types of errors are taken into account, a hospital patient can expect on average to be subjected to more than one medication error each day. However, substantial variations in error rates are found across facilities.

An ADE arising from an error is considered preventable. It is difficult to get accurate measurements of how often preventable ADEs occur. One study estimated 380,000 preventable ADEs in hospitals each year, another estimated
450,000, and the committee believes that both are likely to be underestimates.

The numbers are equally disturbing in other settings. One study calculates, for example, that 800,000 preventable ADEs occur each year in long-term care facilities. Another finds that among outpatient Medicare patients there occur 530,000 preventable ADEs each year. And the evidence suggests that both of these numbers are likely to be underestimates as well. Furthermore, none of these studies includes errors of omission—failures to prescribe medication in cases where it should be. Taking all of these numbers into account, the committee concludes that there are at least 1.5 million preventable ADEs that occur in the United States each year. The true number may be much higher.

These medication errors are undoubtedly costly—to patients, their families, their employers, and to hospitals, health-care providers, and insurance companies—but there are few reliable estimates of that cost. One study found that each preventable ADE that took place in a hospital added about $8,750 (in 2006 dollars) to the cost of
the hospital stay. Assuming 400,000 of these events each year—a conservative estimate— the total annual cost would be $3.5 billion in this one group. Another study looked at preventable ADEs in Medicare enrollees aged 65 and older and found an annual cost of $887 million for treating medication errors in this group. Unfortunately,
these studies cover only some of the medication errors that occur each year in this country, and they look at only some of their costs—they do not take into account lost earnings, for example, or any compensation for pain and suffering.

What is most striking about these statistics is that much of this harm is preventable, since a variety of strategies and techniques exist for reducing medication errors. Many of these approaches have already been tested and shown to work in practice, while others seem promising but will require further development. Given this situation,
the committee concluded that the current state of affairs is not acceptable and it recommended a series of steps that should be taken to prevent medication errors. (download report brief)

Posted at 12:20 PM, Jan 22, 2007 in Permalink | Comments (0) | TrackBack (0)