Reducing the Risk of Adverse Drug Events

[HuckleB]

http://www.sciencebasedmedicine.org/index.php/reducing-the-risk-of-adverse-drug-events/#more-18509

"Critics of mainstream medicine often point to the dangers of drugs. I previously wrote about “Death by Medicine,” where I explained the fallacy of fixating on harmful effects of drugs without putting them into perspective with all the good drugs do. Yes, patients have died from severe allergic reactions to penicillin, but penicillin has also saved countless lives.

A recent article in The New England Journal of Medicine looks at emergency hospitalizations for adverse drug events in elderly Americans. It confirms that adverse reactions are a serious problem, but some of its findings are surprising.

...

It is conceivable that the biggest problem drug could entirely drop off the list and 33% of drug-related hospitalizations could be prevented if only doctors managed Coumadin dosing more effectively and if patients complied better with instructions about medication and diet. At my local hospital (Madigan Army Medical Center), all patients on anticoagulation are managed by a Coumadin Clinic run by an experienced clinical pharmacologist using rigorous procedures and guidelines; I don’t have any figures, but I think that approach is much better than having individual doctors manage their own patients.

A pharmacist, Robert Steven Gold, has written a book with specific proposals for reducing medication risks. The title is Are Your Meds Making You Sick? The title led me to expect a typical anti-establishment rant about evil Big Pharma poisons. It is anything but. The format is engaging: it presents a series of mini-mystery case reports and challenges the reader to detect which drug is the culprit.

..."

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It's a short piece with good links to further pieces on this issue. I would recommend checking into those links as well as perusing this short piece. This is information that could make discussion on the health forum far more fruitful, at least in my opinion.

[cbayer]

1. IMHO, this is a huge problem.

One of the most frequent causes of ADE's is the lack of accurate information being shared by various medical caregivers.

It is rare that a patient has an accurate record of their current meds and even rarer that a medical provider will contact other providers to get that information.

And the older and sicker one gets, the more this becomes a problem.

Patients often leave the hospital with prescriptions from half a dozen doctors, many of whom have not really looked at what else the patient is being given.

[Scuba]

3. You're correct about disjointed records, and patients (people) should be...

...taking responsibility for making sure their physician knows about ALL their meds, because no one else can, at least for now.


Still, in To Err is Human the Joint Commission blamed handwriting errors for 50% of ADE fatalities, which they put at over 100,000 a year in the US.

Automated systems can eliminate handwriting problems and provide reasonability checking for age, sex, body weight, etc., all of which can help.

Making sure nurses have enough time to do their jobs with the care it deserves is another matter.

[cbayer]

4. Excellent points all around. That is why we are in such desperate

need of a uniform, computerized medical records system (and universal, single payer healthcare).

It was the Institute for Healthcare Improvement that started the 100,000 Lives project after the startling Institute of Medicine report, To Err is Human. That number was attributed to a list of recurring medical errors, adverse drug events being on that list. Addressing the handwriting issues, as well as other fairly easily implemented new systems, became their goal.

Hospitals that participated saw significant decreases in avoidable adverse events across the board. However, relatively few hospitals participate.

Had Don Berkowitz, who spearheaded this program, been allowed to stay in place at HHS, I think we would have seen a great broadening of it's utilization and effect. But, alas, he is gone.

Although I think the Joint Commission plays an important role, I think they have not been aggressive enough at looking at the IOM report and integrating it's findings into their standards. It is a highly political and bureaucratic body and it is quite difficult to get them to make major changes, imo.

[Scuba]

5. First, thanks for the correction. It was of course the IOM, not the Joint....

... that published To Err is Human.


Implementing "automated provider entry" systems is no cheap or easy task. Trying to get one system in place nationally would actually be easier than sharing data across the current disparate and technically unique systems in place today.

Still, we can't let perfection be the enemy of progress. Huge gains have been made in patient safety in the last 20 years, and we have not yet picked all the low-hanging fruit.

[cbayer]

6. Sounds like you are a positive cog in the wheel, Scuba.

Thank you for that.

I totally agree that progress has been made and there is so much more to do.

[Scuba]

7. Past tense....

... I'm retired now, but I was a healthcare CIO before the term was invented.

As such, improving patient safety was always the first measurable on my list.

I had a hand in implementing provider order entry in three different hospitals at the end of my career. Challenging, yet rewarding work.

[Warpy]

2. That list is what I saw in years of practice.

I know I'm on a handful of drugs. I stagger out in the morning and swallow them and there have been times I've wondered later whether or not I've taken them all.

Instead of overdosing, I just wait a few hours. If I haven't taken something, I generally know by then.

The best strategy and one I'll eventually have to adopt is the weekly pill dispenser, something available at most pharmacies. When I'm fully awake, I just portion out the day's drugs in each compartment for the week, clearly labeled. Down the line when I get foggier, I'll definitely make the three dollar investment in my health since this is the sort of thing that stops overdosing completely. I only wish they'd been something we could have given our most at risk patients at discharge. It could have stopped them from coming back in a few weeks with another accidental overdose. The problem that brought them into the hospital, forgetfulness, is the same problem that caused them to forget the pill dispenser when they went to the pharmacy.

[Odin2005]

8. People forget that the "natural remedies" have side effects, too.

If it is a drug, not matter what it's source, it will have side effects for rather basic biochemical and physiological reasons.