Drug Errors Hurt 1 In 15 Kids, Study Says

[OhioChick]

Source: AP

Number Higher Than Earlier Estimates
POSTED: 8:25 am EDT April 7, 2008
UPDATED: 8:59 am EDT April 7, 2008

CHICAGO -- Medicine mix-ups, accidental overdoses and bad drug reactions harm roughly one out of 15 hospitalized children, according to the first scientific test of a new detection method.

That number is far higher than earlier estimates and bolsters concerns already heightened by well publicized cases like the accidental drug overdose of actor Dennis Quaid's newborn twins last November.

"These data and the Dennis Quaid episode are telling us that ... these kinds of errors and experiencing harm as a result of your health care is much more common than people believe. It's very concerning," said Dr. Charles Homer of the National Initiative for Children's Healthcare Quality. His group helped develop the detection tool used in the study.

Researchers found a rate of 11 drug-related harmful events for every 100 hospitalized children.

Read more: http://www.newsnet5.com/health/15811277/detail.html

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This should not be happening... :(

[trotsky]

1. Staffing cuts, overworked nurses, an explosion of different meds

(many of which are poorly labeled), all are factors.

[wtmusic]

2. Surprised it isn't higher

Happened in our family. Although I don't buy the "understaffed" argument, I do buy the "overpaid" and "careless" argument.

[enki23]

4. "overpaid and careless"? are you f**king serious?

.

[unapatriciated]

5. You do realize most nurses work a 12 hour shift.

My son spent over ten years in and out of CHLA, some stays as long as three months. He did experience two drug related mistakes and one that was prevented. The first two were minor mix-ups of dosage between prednisone and lasix (the medications look very similar). The third was caught by the hospital (over paid :sarcasm:) pharmacist that would have sent my son into cardiac arrest. I found most of the staff really cared about my child but they were indeed overworked and underpaid. My HMO doctor and my Insurance company are another story, they actively withheld treatment that put my son in critical condition and disabled him for life. IMHO the insurance industry are the ones who are overpaid.

[eilen]

15. I'm sorry about your son's disability

I firmly believe that doctors and hospitals should give needed care and therapies regardless of the insurance company. I have worked in other states and realize that treatment is often withheld d/t insurance denials or even because of no insurance and I was pretty shocked. I am in NY and worked in a state teaching hospital-- we didn't see that happen too often. Most of the stuff that was withheld had to do with outside the hospital system-- homecare etc. Also, for people who had no money and no medicaid or insufficient medicaid-- their prescriptions were half-filled for some expensive drugs by our foundation. The foundation, in order to help the most people had to do this. Also, we gave out samples in our clinic based upon need. People with insurance would complain about $30/month copays but there were others who had no copay and were charged hundreds of dollars but it was hard to explain this to the insured. I used to ask the Dr.-- please please don't write a script for fentanyl patches if there was not allergy to morphine. They are so expensive and drain a pt's allowable benefit quickly--esp. medicare.

What does CHLA stand for?

Some drug "mistakes" -- are not mistakes. For example, drug reactions -- if there is no known allergy, if a reaction occurs, it is not a mistake per se. Some drugs have a higher risk of reaction like amphotericin. I think an issue develops when there is a drug that has been developed that is known to produce signficantly less reactions but the hospital will not allow the physician to order it without trying the one that has the higher risk because of cost. Some drugs almost always cause a reaction but there is no other alternative-- like Rituxan or IVIG. The mixing up of dosages may be easier in a pediatric area than adult as all the dosages are much smaller. In an adult area, they are pretty standard (it would be unlikely to get the prednisone and Lasix confused in an adult area simply due to the dosages of prednisone we gave were much higher as they were part of the chemotherapy and lasix rarely went over 40 mg IV or by mouth.) Everything had to be labeled going into the room as well. However, I found it was important to name the drug and dosage you were giving and if the patient had a question, I would always hold on to the med and recheck it again (recheck the orders-- a new one might have been made.

Also, when doctors went on rounds, they would tell patients they would order this or that but they almost never order anything until all their rounds are over, and than can be an hour or two after they see the patient. They might tell me-- "she needs lasix or more pain meds", but if they don't order it (write it or put it in the computer), I can't do anything. Almost all medications are locked up in a machine that is attached to the computer. When the pharmacy checks the order and authorizes the computer to let me take it out, it will come up on the patient's profile and then I can access it and bring it to the patient. There is a list of meds that are like emergency or stat meds we can access like epi or decadron in which time is of the essence. If a nurse collects meds for more than one person at a time, she can run the risk of mixing them up.

I hope your son is happy now despite his disability and I am very glad he is alive and with us. I did not work with children very often (only in acute rehab) although will be starting to assist with art therapy once a month on the pediatric oncology unit this month. I am looking forward to it. I felt I would not be able to handle it emotionally as I have a child and was concerned about transference. In a state hospital, you see some very harsh, ugly things in the social aspect and that kind of negativity is not something I could handle.

[unapatriciated]

16. Art Therapy is great.

OT was my son's favorite when he was in Children's Hospital in Los Angeles (CHLA). He spent a lot of time on 6th north an acute rehab floor. I hope the person upthread reads what what you posted regarding meds, because that is mostly the type of problems we encountered. You gave a much better explanation than I did. I was just trying to point out that my son spent a lot of time in the hospital and there were only three drug mistakes. The one that could have been fatal was due to a doctor prescribing the wrong amount of percardia. The majority of nurses and staff were great and became family to us. They worked very long shifts and due to cutbacks were also understaffed. I know what you mean regarding the cost of drugs, I had three months lasp of coverage when I lost my job during my son's illness. I was shocked at the cost of just one of his meds, Cylclorsporin about $600.00 and he was on about eight bringing total med cost over a thousand a month.

My sister works in a state hospital in Oregon, it's a very hard job, she also advocates for her patients and reform.


My son is now married to a wonderful woman. He attends the San Francisco Art Institute, in hopes of getting off of disability and working as a graphic artist. He volunteers at Children's in Oakland, leaning magic as well as art not only helped him emotionally but improved his fine motor skills as well. He finds the children do not judge him on his appearance and he loves making them laugh.

[eilen]

17. I so dislike that term "disability"

in regard to needing supplemental income due to business/employer's limitations (of vision, imagination, heart and flexibility). Many people on disability wish they could work and could work on jobs but they may need some different accommodation that many employers are unwilling to make-- like being able to sit down, stand up--not stay in the same position all the time, some lifting restrictions-- I have a friend who had a TBI, he can't carry heavy things --but he could do other physical tasks (he likes moving around) but employers are not willing to see how a personable young man might be an asset, they only see liability and (right now) it can really play on his feelings of worth.

I am glad your son is happy and creative!

It sounds like you raised a wonderful human being. He is such a great gift to everyone-- what we granola crunchers call a light-worker.

[AdHocSolver]

8. You obviously know NOTHING about the operation of hospitals.

Back in the 1970's, I worked for several years in a large hospital in a nonmedical capacity. It was an eye-opener.

The nursing staff, especially the new nurses starting out, were the most dedicated, selfless, hardworking group of employees you ever hoped to meet. I was truly amazed.

However, after two or three years on the job, something happened to them. Many became temperamental and difficult to deal with. It did not take long to understand why.

The reasons, stated in no particular order of significance, are:

1. Many patients treat the nurses, the people in the hospital with whom the patients have the most frequent contact, like menial servants. The relatives and friends who visit the patients are often worse.

2. Many Doctors often treat the nurses like menial servants as well. I have no doubt that nurses are the scapegoat for doctors' mistakes. I had a doctor friend who was doing his residency at another hospital who described his residency as being like a fraternity hazing. Heavy patient loads and extended shifts, among other reasons, drove him to exhaustion so that many times he got patients and their medications confused. He said that he was thankful that he realized in time what the problem was (maybe a nurse told him) so that, as far as he knew, he never had harmed a patient.

3. Hospital administrations often abuse nurses by making them work rotating shifts, extended shifts, and yes, there are nurse shortages. A ward in a large hospital may have as many as 100 patients resident. There may be no more than four nurses on the ward at any one time. When you consider that many of these patients may need help or direction to do just about anything, that is not a lot of nurses to take care of a ward. I have heard people complain about the length of time it took for a nurse to respond when they called. That is seldom the nurse's fault, but the hospital administrations' for operating on purpose in an understaffed situation.

There were nurse shortages thirty years ago, but nobody realized it since there were still a lot of young people going to nursing school. The shortages were due to the high drop out rate. The nursing profession is not as popular an option for young people today as it was back then.

[eilen]

13. Thank you.

I am no longer working as a nurse. I think if I were to accept a job offer (they do keep calling), I would probably vomit. I was a nurse for 10 years. No one wants this job, really. It is very hard work with unbelievable responsibility, especially in a teaching facility. The only area I think I can sanely work in now might be hospice. I worked in oncology, hematology, med/surg, rehab and sub-acute and even worked a little in long term care reimbursement--an office job. I used to fantasize about having a job taking orders for pizza. The worst that might happen is the pizza might get cold, much less stress.

I worked 12 hour shifts, 16 hour shifts, night shifts, day shifts, 11-11 shifts, had mandatory overtime, on call, weekends, holidays, worked without breaks. I have had some patients throw absolute temper tantrums that their need for another lunch tray were not met --even after apologizing and explaining the patient next door was coding and not able to breathe. And where exactly do I take the person we had to admit to the hallway to the bathroom--what bathroom--the one by the elevator? I am tired of being expected to get a 500 lb person up out of bed three times a day--and they are not helping, won't even move their legs and having to argue FOR a foley catheter to be placed because they won't roll for the bedpan or to get cleaned up--it takes 6 nurses to do this (two to hold legs, two to hold up the abdominal folds, one to hold up the folds below that and one to place the foley. It takes the same number to clean this size individual up when they miss the bedpan or don't use the bedpan. It is hard to do when you only have 4 nurses on the floor. Someone goes home with a back injury every time we got this kind of admission.

Of course med errors happen. Any given morning I would be interrupted counting meds to get a phone call, to take someone to xray, some resident has a question, a stat blood draw is needed, someone has a fever, and because family members wanted to know what was going on-- and I am not allowed to give any info out over the phone and this infuriates them causing me to get f-bombed. I am just surprised they don't happen more often. Plus, people are so incredibly ill. I often had 3 leukemics on reverse isolation with hourly iv antibiotics, antivirals, antifungals and transfusions in addition to 3 other patients admitted for various reasons because the authorities found longer stays with patients transferred in house so our ER admits (no matter how inappropriate) never left the floor even though we were supposed to be a cancer treatment floor. I could end up with an orthopedic surgery patient even though I have not taken care of one since nursing school. And to couple that with the fact that people don't want to swallow their meds when you bring them or they're mad you didn't bring them at exactly 8 o'clock or you should have brought the one pill before they got breakfast or they can't take them till after breakfast or they can't possibly swallow these with water, they need apple juice or pudding or this needs to be broken in half and coated with applesauce and it can't be warm or cold or the pill is too small to swallow..... most of these are pills they take every day!

And we are supposed to train the residents, precept random nursing students, adapt to new paperwork daily, document, constantly check for new orders on the computer--if you can get to a computer (no one tells you anymore and none of the people at the nurse's station are actually nurses--they are in the halls running their asses off) and answer the frigging phone on top of our main duties which are to maintain an therapeutic and healing presence to our patients and every new rule and protocol in the hospital seems intent on keeping you out of the room. Then we have to be very understanding of the aides and techs and do two of their baths because they are hopelessly overworked. Physical therapy comes by and scolds you for not walking people when you can't even keep up with the breakfast trays for your insulins. Case Management pulls you aside to reinforce that you need to teach family members how to (give a shot, do a dressing, change an ostomy appliance, flush a central line-- whatever)--then they show up and say "I can't do that".

And through all this I am cheerful, I am your cheerleader, you will get through this and have your life back soon and I will bring you your pain meds and dutifully check back to see if it worked, ask you to rate it and write it down in 3 different places. And I haven't been able to go pee in the past 10 hours which I guess is okay because I'm also dehydrated and have been running on hershey kisses left at the desk all day.

Now I am going to end this post and do some yogic breathing.

[unapatriciated]

14. Thank you

My son (read up-thread) spent many years in and out of CHLA (JDMS) and the overwhelming majority of nurses who cared for him did a great job.

[superconnected]

11. I'll back you up on that one. Seen it several times first hand.

[Juche]

3. Better Information Technology will help

http://www.rand.org/pubs/research_briefs/RB9136/index1.html

http://www.rand.org/pubs/research_briefs/RB9052/index1.html

I think all 3 presidential candidates are talking about improving HIT to cut medical errors.

[AdHocSolver]

9. When you consider computer vote counting, I am not so optimistic about medical IT improving anything

I worked for several years in the computer programming field. I spent one year working in the data processing department of a large hospital. This IT department handled billing, facility and doctor scheduling, patient information, etc.

On a scale of one to ten, ten being the best, I would rank the quality of the software at this hospital about a three. The problem was not the programmers. Three of the finest programmers I ever met worked at this place. The problem was the almost the worst management I ever met in the business. (Actually, there are several contenders for worst management, but I would have to spend more time thinking about it.)

Numerous bugs in the software, errors in the database information, errors in the code that performed calculations, you name it, it was there. Errors were corrected by running other computer programs to "manually" correct the errors in the database.

The problem with computers are threefold (at least).

1. Errors are often compounded, that is, a small error can be multiplied hundreds or thousands of times.

2. Once an error is found, fixing it can be a monumental task. The people running the system have to track the error and its successors through a labyrinth of programs and databases to correct the data. Even with a system that is well documented, it could take hours or days to make a correction. Unfortunately, few systems are of a high enough quality to make this an even moderately easy task. Most systems are so convoluted, making all the necessary corrections could be impossible.

3. Most software "out there" is "mediocre" at best, horribly bad would be more accurately descriptive. Most programmers spend most of their time fixing bugs and errors in processing. Some of the errors I fixed over the years (for example, for a bank I worked for) were in the software for years before they were fixed. This repair effort together with user requested changes (which itself can introduce new bugs) is termed software maintenance and can comprise 80 percent or more of most IT department's efforts.

Having worked in the field for years, any time I hear someone touting the benefits of computerization, I envision a long, dark road to hell.

Think of it this way. Computerizing medicine the way these guys promote it as a panacea, could create MORE errors than occur now, and the system could INCREASE costs substantially. Many times, computer solutions are a means of providing another layer of excuses for incompetence. "It is the computer's fault. There is nothing we can do to fix it."

[jeanruss]

6. childhood cancer

When my 13 year old daughter was getting chemo, it was a comedy of errors(of course not funny for us). We felt the whole business was just using kids as guinea pigs. The cancer business is just that, a business. The child's welfare was way down on that list. Our treatment ran $25,000.00 a week and the poor kid didn't even have a decent mattress. Someone is getting filthy rich wnile young kids suffer.

[Orsino]

7. Remind me why we arrest drug pushers again?

I mean, the non-corporate pushers?

[BlueIris]

10. K&R& Holy shit.

[galledgoblin]

12. not surprised... I'm curious, though:

how many issues are related to relying on computerized files?

I'm hardly a Luddite, but too much reliance on the system leads to a number of mistakes in any workplace. someone hits the wrong key, clicks the wrong box, etc and you're handing out patient "A"'s drugs to patient "B".

my parents used to use a mail-order pharmacy service which relied heavily on computerized files... until one day my younger sister became sick after she was sent and used epilepsy drugs. now they're back to the local pharmacist, who, although more expensive, is much more reliable... and may in the end be cheaper if it means avoiding hospitalization from poisoning.