Getting Meds Right
Problem: Medication errors Proposal: Review all drugs at admission and whenever a patient is moved to a new setting Possible lives saved: 2,000
Medication errors get considerable press. And with good reason. Such mistakes kill thousands of hospital patients--7,000 every year, according to the 1999 Institute of Medicine report--and the solution seems so obvious: Put everything on computers. Make doctors enter all drug orders using the hospital's computer network. Add some bar coding and barcode scanning to make sure patient and drug match and the dose is right, and you're home free. No scribbles to decipher, no uncertainty about giving patients the wrong drugs. No more adverse drug events (ADE), the jargon term for drug goofs.
The trouble with this high-tech answer is that first, it costs millions of dollars, and second, as laid out in a study published in May in the Archives of Internal Medicine, it doesn't necessarily work very well. When researchers examined a sample of patient records at a teaching hospital in Salt Lake City that relies heavily on computers for processing medications, they found significant ADE s, such as drug interactions, in over half the admissions.
For the 100K campaign, IHI decided to focus on transition points, when patients move from one setting to another--from home to hospital, operating room to surgical intensive-care unit, patient room to a lab for tests, and ultimately hospital to home. Nearly half of medication errors have been found to occur at these points.
So if hospitalization could start with a clean, accurate list of a patient's medications, if the list could be updated continually as needed, if it moved with the patient as if attached by a chain, and if the medications she was told to take when discharged had been carefully reviewed by her physician, many errors could be avoided. IHI calls this ongoing verification process "medication reconciliation."
Hackensack's Regina Berman, director of performance improvement, says that of the six 100K initiatives, this one is the hardest to accomplish. "Patients come in with different conditions--they might be barely conscious, with limited ability to remember the drugs they're taking," Berman says. (This makes a strong case for carrying a list of current medications and their dosages in your wallet or purse at all times.) The hospital now details nurses to make calls to a patient's pharmacy if necessary.
Knowing that they're still not going to get a complete initial drug list for every patient, however, the hospital has elected to concentrate on what happens during the stay. Whenever a drug is started--or stopped--the action is entered into the system, generating a new drug list, and that updated list always travels with the patient. The rate of ADE s has dropped from 3.5 per 1,000 doses at the beginning of 2003 to 1 per 1,000 for the first quarter of 2005.
McLeod has a pharmacist review patients' medications when they are admitted. And every day, whether or not there has been a medication change, a fresh list is printed out and placed at the front of the patient chart. Doctor and nurses can also download charts into their handheld computers.
This story appears in the July 18, 2005 print edition of U.S. News & World Report.