Rx for costly medication errors

One of the report's more shocking findings is that in hospitals, every patient is exposed to at least one medication error a day, on average — for an estimated total of 400,000 preventable mistakes each year.

And when an error occurs, it adds $6,000, on average, to a patient's hospital bill.

"The good news is, all of these types of injuries are preventable, using different strategies," said J. Lyle Bootman, UA pharmacy dean and chairman of the committee that produced the report for the national Institute of Medicine.

"Some we can implement tomorrow morning and begin to see success," he said Thursday. "Others will take a longer investment."

One of the report's top recommendations is for all prescriptions to be written and transmitted electronically, to eliminate illegible handwriting and signal potential drug reactions.

But patients also must take a more active role in safeguarding their health, making sure they have a current list of medications with them whenever they go to a clinic or hospital, the authors recommend.

"I was shocked and surprised at just how serious a problem this is. I think we need to wake up and take this problem seriously," said Dr. Albert Wu of Johns Hopkins University, a co-author of the report.

Medication errors can be harmless or fatal, a mild dizziness from the wrong blood-pressure drug to a life-threatening allergic reaction to an antibiotic.

They can happen anywhere in the health-care system, but are most common in hospitals and nursing homes where lots of people take lots of drugs.

Those errors add up to $3.5 billion a year in added hospital costs, the report concluded.

Electronic prescribing, revising prescription labeling to make it more consumer-friendly and financial incentives for doctors and hospitals that reduce medication mistakes are strategies that will cost money, Bootman said.

"But we know there is serious cost associated with medication errors," he said. "And we know that many of them are preventable, and with solutions that we believe are cost-effective and will save large sums of money in the long run."

University Medical Center installed an electronic-prescribing system six years ago at a cost of about $10 million.

But the hospital and its patients got a good return on the investment: UMC has since reduced medication errors 95 percent, said Karin Toci, UMC's quality control director.

More recently, UMC installed less-extensive electronic-prescribing systems to serve 25 doctors at two outpatient clinics. The cost was about $100,000, said Kevin Burns, the hospital's chief financial officer.

Electronic prescribing is "absolutely worth the investment," said UMC's Dr. Andreas Theodorou, a children's critical-care doctor.

"It certainly takes away anything that would have been a handwriting problem," Theodorou said. "It takes away anything like a decimal in the wrong place."

Tucson Medical Center plans to install electronic prescribing next year, a spokeswoman said.

St. Mary's and St. Joseph's hospitals have the systems in their emergency departments.

The "Preventing Medical Errors" report follows a 1999 Institute of Medicine study that said up to 98,000 hospital patients were dying each year from preventable mistakes, including about 7,000 deaths from medication errors.

The new report does not try to calculate deaths. It looks at medication errors only, and in clinics, nursing homes and other health-care settings, as well as hospitals.

The report offered recommendations for government's role in reducing medication errors, including a $100 million annual investment in research on how to prevent them.

The Food and Drug Administration also should revise the rules for patient-information leaflets included in drug packaging, the report said, because most are written in language difficult to understand.

Theodorou, a member of the Arizona Hospital and Healthcare Association's patient safety committee, is a big advocate of electronic prescribing and other preventive strategies.

They include a simple list that a person carries around in his wallet. "If a person can walk into the hospital with a nice list that says, 'These are my medicines, these are the doses I take,' they're already off to a better start," Theodorou said.

Last September, the hospital association, the Arizona Medical Association and other groups began distributing The Med Form — available online at www.themedform.com — to hospitals and doctors' offices and at health fairs.

"Thousands and thousands" have been handed out, in English and Spanish, said Adda Alexander of the hospital association. "That's really good for consumers."

How to protect yourself

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● Take these steps to reduce your risk of medication errors:

1. Keep a current list of all the medications you take: prescription drugs, over-the-counter drugs, dietary supplements and herbal medicines. Include the dose of each drug, how often you take it, and what it's for.

2. Add to your list any drug allergies or other allergies you have.

3. Keep the list handy. Take it with you to every appointment with a doctor or other health-care professional and ask him or her to review it with you. Give a copy to family members in case of an emergency.

4. When you get a new prescription, make sure you understand how the drug is to be taken.

5. Be sure to get an explanation of possible side effects, and what to do if they occur.

6. Be sure to go over any new prescription with your pharmacist. You can ask the same questions — what to do if you experience side effects, for example — that you asked the doctor who prescribed it. Repeating information helps reduce errors.

7. You also can ask your pharmacist to review your list of medications with you — even those medications you have taken for a while.

8. When you pick up a refill, if the pill is a different shape or color, check to make sure it's not a mistake. It probably means the pharmacy has changed manufacturers, but check to be sure.

9. Be sure to give your list of current medications to the person who admits you.

10. Be sure the person who gives you your medications tells you what you are getting and why.

Source: Preventing Medication Errors, Institute of Medicine