Q&A: Medication Errors in the United States (web article)

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On July 20, the Institute of Medicine (IOM) issued a report on the prevalence of medication errors in the United States. The report is the fifth of the IOM’s Quality Chasm Series examining the consequences of medical mistakes.

Tim Parsons, with the Office of Communications and Public Affairs, spoke with Albert Wu, MD, a member of the IOM committee that issued the report and a professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, about the report’s recommendations for reducing medication errors.

Question: What is a medication error?

Answer: A medication error is a breakdown or failure at any point in the medication use process: the long chain of events that is necessary for a medication to be prescribed and used effectively by a patient. There could be problems in choosing the drug prescribed, in ordering the drug, dispensing it, administering it or monitoring the drug once it’s taken. There could also be problems when the patient does not take the drug as directed.

Question: What were some of the conclusions of the report?

Answer: The numbers were pretty surprising. At least 1.5 million Americans are injured every year by medication errors. On average, every hospital patient is probably subjected to at least one medication error every day. Fortunately, many of these errors do not cause harm. There may be as many as 7,000 people who die every year from medication errors, but that is more difficult to quantify. The costs these errors create are staggering. Over $3 billion dollars annually goes toward treating the consequences of medication errors, which does not even include lost wages and worker productivity.

What I think is more important than the figures is the fact that medication errors are common and that they can happen to all of us. We all—from patients to providers to policy makers—need to take this issue more seriously so that we can make medication use as safe as we would like it to be and as safe as it deserves to be. This is something we should all be very concerned about. We are a medication-taking society. Four out of five Americans take at least one medication every week and a third of Americans take at least three medications every week. Over 4 billion prescriptions are filled every year and so it’s not surprising there are many things that go wrong.

Question: Does the report make any recommendations for reducing medication errors?

Answer: This report is full of recommendations for virtually all stakeholders and parties involved in medication use, including patients, physicians, health care institutions, insurers, regulators, educators and the Food and Drug Administration. There are steps that can be taken today and then there are some recommendations that are more long term. This is certainly not a problem that is amenable to a short-term fix.

Question: What can patients do to reduce medication errors?

Answer: First, patients should be aware that while medications can be helpful and even life-saving, there are risks. Realizing that there are risks as well as benefits can help patients use medications safely and more effectively. The bottom line for patients is that they need to become an active member of the health care team. On average, patients are too deferential to their physicians and health care providers. They take too much for granted in that no news is good news. They may say, “Even if I don’t understand anything about this medicine, how I’m supposed to take it and what it’s supposed to do, I’m sure the doctor knows.” The fact is that confusion can creep in at virtually any point in this long chain of the medication-use process. What patients can do is make sure they know what medications they are taking, why they are taking them and how to take them.

In the IOM report, there is a list of some of the things patients can do, which include making a list of all the medications you are taking. Include on that list allergies you may have, important health problem you have, and make sure all the doctors you see know what’s on your list. You as a patient have information that is crucial, perhaps the most crucial, in helping you obtain and take medications successfully.

Also, be aware of what is going on around you. If you are not sure what the prescription is, get it in writing. If you are not certain about an instruction, ask your doctor, nurse or pharmacist for more information. For patients in the hospital, I recommend having a family member stay with the patient as much as possible and ask questions for the patient.

Question: Could electronic medical records and prescription software reduce medication errors?

Answer: Other than faulty communication, a lack of information at the time when the prescription is ordered is perhaps one of the most important contributing factors in medication errors. There are perhaps 20,000 drugs that can be prescribed and no one can keep track of all of these medications, dosage recommendations and possible interactions.

We recommended that physicians use electronic information resources and electronic decision-making aids that could help them to prescribe medications more safely. Rather than scratching a prescription onto a piece of paper, physicians could type the medication, dosage and instructions they want to prescribe into a computer. The computer program, which would have information about the patient and about other medications the patient might be taking, could pop up a warning about any potential drug interactions. It might also make recommendations for alternative drugs. What it can really do is make the prescribing physician a little bit smarter.

Electronic records could also give physicians information about all of the other health care providers a patient is seeing. However, this is still a vision of the future. While there are good electronic patient record keeping and prescribing programs, the computer systems between many institutions are simply not capable of communicating with one another.

For more information on the IOM report "Preventing Medication Errors: Quality Chasm Series," visit http://iom.edu/CMS/3809/22526/35939.aspx.