A new study shows that despite increased efforts by hospitals and pharmacists, half of all new prescriptions, on average, contain at least one error.
NEW STUDY: MEDICATION ERRORS LINKED TO HALF OF ALL PRESCRIPTIONS
The prestigious Institute of Medicine estimates that at least 1.5 million medication-related cases of injury or illness, also known as adverse drug events (ADEs), occur each year in the United States, and that, on average, hospitalized patients can expect to experience at least one medication error per day. Because of this very large number of ADEs, and their potential to cause serious harm to patients, several strategies for reducing ADEs have been recommended, including improved communication between doctors, pharmacists and patients; the use of electronic medical records and “e-prescriptions” that incorporate medication screening software; and improved drug labeling and packaging practices.
Despite these recommended strategies for reducing ADEs, a newly published prospective, randomized, controlled clinical research study suggests that even more effective strategies need to be identified, and implemented, if we are to significantly reduce ADEs caused by medication errors. This new clinical study appears in the current issue of the Annals of Internal Medicine.
In this new study, two large teaching hospitals in the United States randomized patients being discharged after admission for heart-related illnesses into one of two groups. One group, the “control” group, had their discharge medications prescribed and monitored in the usual manner. The other group, the “intervention” group, had their discharge medications managed using an enhanced approach to medication prescribing and monitoring, including having a pharmacist directly review patients’ preadmission and discharge medications, one-to-one patient counseling by a pharmacist regarding their medications while patients were still in the hospital, the provision of extra counseling and assistance for patients with literacy challenges, and individual patient follow-up by telephone after their discharge from the hospital. All patients in the intervention group were provided these enhanced services for 30 days from the date of their discharge by these two well known academic medical centers.
The results of this important prospective clinical study were, unfortunately, rather discouraging. Among the 851 volunteers who participated in this study, 432, or 51 percent, experienced one or more clinically significant medication-related errors, 23 percent of which were assessed to be serious errors, and 2 percent of which were considered to be life-threatening errors. Regarding ADEs, specifically, 30 percent of the patients in this study were confirmed to have experienced an adverse physical reaction or complication associated with their medications, while another 30 percent experienced abnormal symptoms or side effects that were deemed to be “potential” ADEs. When the researchers compared the two groups of patient volunteers in this study, they found that the intervention group patients, who had received extra medication prescribing and monitoring safeguards, had the same incidence of overall medication errors and confirmed ADEs as the control group patients, unfortunately.
The findings of this clinical study are, needless to say, very disappointing. Despite the best efforts of these two large teaching hospitals in taking multiple extra measures to drive down the number of medication errors and ADEs, these enhanced efforts appeared to have had no significant beneficial effects. Indeed, half of the patients participating in this clinical research study experienced one or more medication errors, and proactive health-literacy-directed and pharmacist-delivered interventions appeared to have no impact on this very high incidence of medication-related errors. (You can also bet that the incidence of medication errors and ADEs are likely to be much higher in many hospitals and pharmacies that are not closely following their patients within a rigorous prospective clinical research study, such as this study.)
The findings of this important prospective clinical study strongly suggest that currently available recommendations for addressing the ongoing high rate of medication-related errors and ADEs are likely to be inadequate, particularly for patients who are transitioning from the hospital to home. This study’s results also indicate that additional new strategies need to be quickly identified and implemented. At this time, I urge all patients to proactively review both their current and new prescriptions with their health care providers, and with their pharmacists, in an effort to detect potentially serious medication-related errors before they can cause any ADEs. Moreover, every one of us who take medications (including vitamins and supplements) should carry an updated list of all medications, and a list of any allergies or sensitivities to medications, with us at all times.
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Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity
Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author
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