Every day patients spend in a hospital bed. they risk harm from at least one preventable medication error. This disturbing finding is cited in a recent report on medication errors undertaken by the Institute of Medicine (IOM) at the behest of Congress. While many such errors cause only minor problems, a significant number result in permanent injury or death.
The IOM estimates that a total of 1.5 million preventable injuries occur each year as a result of lapses in medication safety. Almost half of these befall residents of nursing homes or other long-term care facilities, about 400,000 afflict hospital patients, and the rest occur in outpatient settings. Injuries to hospital patients alone are said by IOM to generate $3.5 billion in extra medical costs. Given that many drug-related injuries go undetected and/or unreported, the report concedes that the estimate of 1.5 million injuries is likely too low.
While listening to the press conference announcing the report’s release last month, I was reminded of Yogi Berra’s famous line—“it’s like déjà vu all over again.” As a co-author of the 1999 IOM report on medical errors, “To Err is Human,” I found that much of what this latest report had to say was not new. In fact, I became angry at what I was hearing during the press conference—namely that preventable medication errors were still out of control, despite the urgent warnings we had sounded six years earlier.
The 1999 report concluded, “...there is reasonable agreement about useful approaches” to prevent medication errors. Six years ago we thought that our recommendations for tackling the prevention of medication related errors would be put into practice relatively quickly. In fact the 1996 report challenged the health care system to reduce all varieties of medical mistakes by 50% within five years. But while stories of individual efforts to improve medication safety may abound, the new IOM report suggests that systemwide, the risks remain serious and widespread.
The 1999 report recommended use of computers to prescribe and dispense medicines in all hospitals. The new report recommends that medication prescribing and dispensing should be done electronically by 2010 in all settings, yet, at most, one out of five hospitals and a much smaller proportion of clinics and doctor’s offices now have that capability.
The new report’s number one recommendation for safer prescribing, dispensing and use of medications is that health care providers engage consumers in “activities and behaviors that promote their health, well-being and safety.” More specifically, it recommends that patients become better informed, ask more questions about their medications and keep an up-to-date list of the drugs they take. (For more: www.iom.edu/CMS/3809/22526/35939/35945.aspx)
Similar advice has been handed out to consumers for at least several decades, but considering the continuing epidemic of medication error-related harm detailed by IOM, I question how effective this has been has been as a prevention strategy.
I don’t disagree that becoming your own first line of defense makes good common sense, given the high risk of being hurt due to the slow pace of safety improvements in prescribing and dispensing edications. But I worry that placing too much responsibility for error prevention on patients excuses providers from accountability for the safety of care they render. We don’t approach airline safety by advising passengers to inspect the airplane for air worthiness before they board or to bring a list of questions to ask pilots about their flight plan - passengers expect flying to be safe. I suggest that medication users should someday have the same expectation—that medication use is safe—and we should hold providers accountable for meeting that standard.
For now, the best advice I can give readers is to favor health care providers who demonstrate they are serious about improving medication safety. Ask if a hospital is using computerized physician order entry; ask whether an outpatient clinic or doctor’s office can electronically prescribe and transmit prescriptions; and ask whether a pharmacy can receive electronically transmitted prescriptions from your health care provider.
Arthur A. Levin, MPH, Center for Medical Consumers ©, August 2006
