Survey reveals seniors at-risk for medication errors in hospitals

TIPS

Here are some safety tips for hospital patients and medications; * Ask to review the medications ordered for you. Be sure you are asked to identify yourself before you are given any medication. * Always offer your wrist bracelet for identification, and ask the nurse to identify each medication by name before you take it. * If your medication has not been given at its regular time, ask for an explanation from the nurse. * Always tell your health-care provider about allergies to medications and foods, and about health conditions that can affect the usage of certain medications. * Create a list of all medications, dietary supplements and over-the-counter medications you are taking. The list should include the drug name, dosage, directions for taking it and how often, and what liquids or foods that are being taken with the medication.

"As the senior population continues to increase, USP is calling for hospitals to focus on reducing medication errors among seniors," said Diane Cousins, vice president of the patient safety center with the organization. "Seniors and their families need to become more involved in their care."

The patient safety advocacy group has prepared tips for seniors to make sure their medications are correct and administered correctly during a hospital stay.

The organization started a database four years ago so hospitals can anonymously report medication errors, enabling the information to be analyzed to understand causes and to help hospitals improve patient safety standards. The anonymous reporting reflects a shift away from a punitive-focused system to a blame-free focus, with the intent of improving reporting.

All told, 482 hospitals throughout the United States took part last year and reported 192,477 errors, the fourth annual report shows. On a positive note, about 48 percent of the mistakes were caught and never made it to patients, according to the study.

Regarding seniors, they received 32,463 of the medication errors but there no harmful consequences, the study shows.

On the other hand, seniors accounted for 36 percent, or 1,157, of the total 3,213 errors that did harm patients, either requiring a longer hospital stay or intervention to save their lives.

Moreover, 11 of the total 20 deaths that occurred involved patients 65 or older, said Sherrie Borden, a USP spokeswoman.

The most harmful mistakes to seniors occurred when the medication was given incorrectly, such as a tube-feeding given intravenously, followed by concentrated medications not being diluted as required, the study found. Patients did not receive the medication at the right time in 43 percent of the cases, and improper dosage accounted for 18 percent of the errors.

The hospitals cited a number of reasons, pointing to workforce distraction as the primary factor, followed by staff shift changes and workload increases.

Last year, 368 hospitals reported 105,603 medication errors for 2001, in which 2,539 errors harmed the patients. No information was readily available regarding how many of the errors involved the elderly.

Many hospitals are moving into electronic or computerized dispensing of medications but that doesn't eliminate errors entirely, Borden said. Mistakes with computer dispensing systems was ranked fourth this year as causing mistakes, while a few years ago it was ranked 10th as a factor, she said.

Barbara Bixby, patient safety officer and clinical risk manager for the NCH Healthcare System, which is phasing in to a computerized system, agrees such an approach won't solve all the problems.

At present, NCH has a robot that prepares the medication, but the robot is only involved in about five of the 18 steps of the entire process, which starts with a physician writing a prescription order to it being administered to the patient.

One safety measure NCH instituted about 10 years ago is having pharmacists assigned on patients' floors to help coordinate with staff, said Jerry Nunn, NCH's director of pharmacy.

"It is of tremendous value and the physicians really appreciate it," he said. "On any given day, there are nine or 10 pharmacists on the floors."

Bixby agreed with the USP report that workforce distraction is a primary reason why medication errors occur.

"The (medical/surgical) floor is most challenging for distractions," she said.

NCH has been following the trend of converting to a blame-free culture so errors are reported more accurately, enabling the focus to be on determining causes rather punishing those involved, she said. That's been working much better for improving patient safety.

"If a serious error occurs, whether it gets to the patient or not, we do a root cause analysis," she said. "We get the team together."

In addition, counseling is provided to the staff involved, she said.

Patients are given safety brochures and advised to be more involved.

"Patients are absolutely encouraged to ask questions," she said.