Nexus - 1105 - New Times Magazine-pages

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medical errors, said that "The full magnitude of their threat to the * giving doctors more time to spend with patients: very American public is unknown". She added that "Gathering valid effective, 78%; and useful information about adverse events is extremely diffi- * requiring hospitals to develop systems to avoid medical errors: cult". She acknowledged that the fear of being blamed and the very effective, 74%; otential for legal liability played key roles in the under-reporting * better training of health professionals: very effective, 73%; of errors. The Psychiatric Times noted that the American Medical * using only doctors specially trained in intensive care medicine Association is strongly opposed to mandatory reporting of med- on intensive care units: very effective, 73%; ical errors. And if doctors aren't reporting, what about nurses? * requiring hospitals to report all serious medical errors to a In a survey of nurses, they also did not report medical mistakes state agency: very effective, 71%; for fear of retaliation.” * increasing the number of hospital nurses: very effective, 69%; Standard medical pharmacology texts admit that relatively few * reducing the work hours of doctors-in-training to avoid doctors ever report adverse drug reactions to the Food and Drug fatigue: very effective, 66%; Administration.* The reasons range from not knowing such a * encouraging hospitals to voluntarily report serious medical reporting system exists to fearing being sued because they errors to a state agency: very effective, 62%. rescribed a drug that caused harm.*® However, it is this tremendously flawed system of voluntary reporting from doctors DRUG IATROGENESIS that we depend on to know whether a drug or a medical Drugs comprise the major treatment modality of scientific intervention is harmful. medicine. With the discovery of the "germ theory", medical Pharmacology texts will also tell scientists convinced the public that doctors how hard it is to separate drug infectious organisms were the cause side effects from disease symptoms. of illness. Finding the "cure" for Treatment failure is most often attrib- If hospitals admitted to these infections proved much harder uted to the disease and not to the drug than anyone imagined. or the doctor. Doctors are warned the actual number of errors From the beginning, chemical that "Probably nowhere else in pro- and mistakes which is about drugs promised much more than they ws op . . ' fessional life are mistakes so easily delivered. But far beyond not work- hidden, even from ourselves".*° It 20 times what is reported, ing, the drugs also caused incalcula- may be hard to accept, but not diffi- ble side effects. The drugs them- cult to understand, why only one in they would come under selves, even when properly pre- 20 side effects is reported to either intense scrutiny. scribed, had side effects that could hospital administrators or to the FDA2!3" If hospitals admitted to the actual number of errors and mistakes, which is about 20 times what is reported, they would come under intense Medication Errors scrutiny.” Jerry Phillips, associate director of the Office of Post- A survey of a 1992 national pharmacy database found a total of Marketing Drug Risk Assessment at the FDA, confirmed this 429,827 medication errors from 1,081 hospitals. Medication number: "In the broader area of adverse drug reaction data, the —_ errors occurred in 5.22% of patients admitted to these hospitals 250,000 reports received annually probably represent only 5% of each year. The authors concluded that a minimum of 90,895 be fatal, as Lazarou's study! showed. But human error could make the situ- ation even worse. the actual reactions that occur."* Dr Jay Cohen, who has exten- atients annually were harmed by medication errors in the country sively researched adverse drug reactions, commented that because as a whole.” only 5% of adverse drug reactions are being reported, there are, in A 2002 study showed that 20% of hospital medications for reality, five million medication reactions each year.* atients had dosage mistakes. Nearly 40% of these errors were It remains that whatever figure you choose to believe about the considered potentially harmful to the patient. In a typical 300- side effects from drugs, all the experts agree that you have to mul- patient hospital, there were 40 errors per day.* tiply that by 20 to get a more accurate estimate of what is really Problems involving patients’ medications were even higher the occurring in the burgeoning "field" of iatrogenic medicine. following year. The error rate intercepted by pharmacists in this A 2003 survey is all the more distressing because there seems study was 24%, making the potential minimum number of to be no improvement in error reporting, even with all the atten- atients harmed by prescription drugs 417,908.” tion on this topic. Dr Dorothea Wild surveyed medical residents at a community hospital in Connecticut. She found that only half | Recent Adverse Drug Reactions of the residents were aware that the hospital had a medical error More recent studies on adverse drug reactions show that the reporting system, and the vast majority didn't use it at all. Dr number may have increased compared with the 1994 figure (pub- Wild said this does not bode well for the future. If doctors don't ished in Lazarou's 1998 JAMA article). A study published in learn error-reporting in their training, they will never use it. And — February 2003 [Ann. Int. Med.] followed 400 patients after dis- she added that error reporting is the first step in finding out where charge from a tertiary care hospital (hospital care that requires the gaps in the medical system are and fixing them. That first highly specialised skills, technology or support services). baby step has not even begun.* Seventy- six patients (19%) had adverse events. Adverse drug + BAO * giving doctors more time to spend with patients: very effective, 78%; * requiring hospitals to develop systems to avoid medical errors: very effective, 74%; * better training of health professionals: very effective, 73%; * using only doctors specially trained in intensive care medicine on intensive care units: very effective, 73%; * requiring hospitals to report all serious medical errors to a state agency: very effective, 71%; * increasing the number of hospital nur: very effective, 69%; * reducing the work hours of doctors-in-training to avoid fatigue: very effective, 66%; * encouraging hospitals to voluntarily report serious medical errors to a state agency: very effective, 62%. If hospitals admitted to the actual number of errors and mistakes, which is about 20 times what is reported, they would come under intense scrutiny. Medication Errors A survey of a 1992 national pharmacy database found a total of 429,827 medication errors from 1,081 hospitals. Medication errors occurred in 5.22% of patients admitted to these hospitals each year. The authors concluded that a minimum of 90,895 patients annually were harmed by medication errors in the country as a whole.” A 2002 study showed that 20% of hospital medications for patients had dosage mistakes. Nearly 40% of these errors were considered potentially harmful to the patient. In a typical 300- patient hospital, there were 40 errors per day.* Problems involving patients’ medications were even higher the following year. The error rate intercepted by pharmacists in this study was 24%, making the potential minimum number of patients harmed by prescription drugs 417,908.” Recent Adverse Drug Reactions More recent studies on adverse drug reactions show that the number may have increased compared with the 1994 figure (pub- lished in Lazarou's 1998 JAMA article). A study published in February 2003 [Ann. Int. Med.] followed 400 patients after dis- charge from a tertiary care hospital (hospital care that requires highly specialised skills, technology or support services). Seventy-six patients (19%) had adverse events. Adverse drug events were the most common at 66%. The next most common events were procedure-related injuries at 17%.” In an NEJM study [April 17, 2003], an alarming one-in-four patients suffered observable side effects from the more than 3.34 billion drug prescriptions filled in 2002. One of the doctors who Public Suggestions on latrogenesis In a [2002] telephone survey, 1,207 adults were asked to indi- cate how effective they thought the following would be in reduc- ing preventable medical errors that resulted in serious harm:* NEXUS = 21 AUGUST — SEPTEMBER 2004 www.nexusmagazine.com