Going to the hospital could kill ya!

[Delphinium]

http://www.latimes.com/features/heal...la-home-health
From the Los Angeles Times
Panel: Medication Errors Hazardous to Your Health
A major study lists confusion over names and wrong doses among the mistakes, and urges more use of computers in prescribing drugs.
By Thomas H. Maugh II
Times Staff Writer

July 21, 2006

At least 1.5 million Americans are injured or killed every year by medication errors at a direct cost of billions of dollars, according to a report issued Thursday by the prestigious Institute of Medicine in Washington, D.C.

For hospitalized patients, the report said that on average, one medication error per day was caused by confusion in drug names, wrong doses, failure to deliver drugs or a host of other problems.

The study is a follow-up to a 1999 report from the institute, which is part of the National Academies, that outlined all medical errors and claimed that as many as 98,000 people were killed each year as a result of medical errors — 7,000 of them as a result of medication errors.

"We were initially quite surprised by the number of mistakes, but the more we heard, the more convinced we were that these are actually serious underestimates," said panel member Dr. Kevin Johnson of Vanderbilt University School of Medicine.

The study lays out a detailed series of recommendations for new procedures and research to minimize the risk of future medication errors, emphasizing computerization of prescribing and administering drugs and data acquisition.

Betsy Lehman, a health reporter for the Boston Globe, was one patient who was killed as a result of such errors, according to the report. The 39-year-old wife and mother of two was being treated for breast cancer in an experimental program at Boston's Dana-Farber Cancer Institute in 1994. A medical fellow wrote a prescription for the cancer drugs, citing the total amount she was to receive over four days, the report said. Lehman died when nurses administered that total each day, overwhelming her system.

The hospital had no system to monitor dosages, and her family argued that staff did not pay attention to her complaints about the effects of the overdose, according to the report.

Such mistakes happen all too frequently, the report said. Each year, there are an estimated 400,000 preventable drug-related injuries in hospitals, costing at least $3.5 billion.

There also are 800,000 medication-related injuries in nursing homes and other long-term care facilities, and about 530,000 among Medicare recipients in outpatient clinics. The report provided no estimate on the cost of the errors in those facilities.

"We've made significant improvements since 1999 … but we still have a long way to go," said J. Lyle Bootman of the University of Arizona College of Pharmacy, who co-chaired the panel.

"The current process by which medications are prescribed, dispensed, administered and monitored is characterized by many serious problems that threaten both the safety and positive outcomes of patients."

With more than 4 billion prescriptions being written each year in the United States, even a very small error rate can translate into a large number of problems.

Among the drugs most commonly associated with errors in hospitals are insulin, morphine, potassium chloride, and the anticoagulants heparin and warfarin, which have a high risk of patient injury when dispensed incorrectly, the report said. It cited a 2002 study from the United States Pharmacopeia that found these five drugs accounted for 28% of all errors that resulted in extended hospitalizations. Insulin alone accounted for a third of that total.

The panel cited a variety of causes for the problems.

One is unexpected drug interactions. With more than 15,000 prescription drugs in use and 300,000 over-the-counter products, "it is virtually impossible for a human to track all the interactions any more," said Dr. Wilson W. Pace of the University of Colorado.

Another is the similarity between drug names, which often results in the wrong drug being given. For example, the osteoporosis drug Fosamax could be mistaken for Flomax, which is given to improve urination in patients with an enlarged prostate.

Other problems cited by the panel include the legendary bad handwriting of physicians, nurses giving patients drugs meant for another patient, pharmacists dispensing the wrong drugs and patients not understanding how to take the drugs.

The report cites one middle-aged man who was not helped by his new asthma inhaler. Demonstrating how he used it, the man puffed the inhaler into the air in front of him and inhaled — just as his doctor had done. Because the man was illiterate, he was not able to read the package instructions, which said to puff it directly into his lungs.

"If you are not sure of something, ask," said panelist Dr. Albert W. Wu of Johns Hopkins University. "It may be a little bit of an annoyance to providers, but we will get used to it."

The report said patients also share some of the blame, frequently withholding information about supplements and herbal medications that they are taking — some of which can have serious interactions with prescription drugs. The panelists also noted studies showing that only about 55% of patients take all their drugs.

Some problems have simple fixes. Panel member Michael R. Cohen, president of the Institute for Safe Medication Practices in suburban Philadelphia, noted that concentrated lidocaine and dilute lidocaine used to be sold in similar syringes. Nurses treating heart patients would occasionally inject the concentrated solution — meant for use in IV bags — directly into patients with lethal results, resulting in more than 50 deaths in California alone. That product was removed from the market and the problem disappeared, he said.

For many of these problems, an electronic prescribing and data system is the best hope, the report said. Four previous reports from the institute have noted the role this technology will eventually play and, "as the information overload gets worse, there is really no other solution that is tenable," Johnson said.

Electronic prescribing — now used in fewer than 20% of hospitals — should eliminate most confusion produced by bad handwriting and by similar-sounding drug names that are easily confused. The system also would alert the physicians to errors in dosage and point out potential interactions with other drugs being used by the patient.

Many physicians in small practices argue they cannot afford such sophisticated systems. The panel noted that some kind of government or industry subsidies might be necessary to help them. In Michigan, for example, Blue Cross is funding the installation of information technology systems in small practices "because they believe that, in the long run, it will save them money," Wu said.

Bar coding of drugs also will cut down on mistakes in hospitals. Beginning in January the Food and Drug Administration required that all medications have a bar code on the drug container. Unfortunately, however, different manufacturers use different bar codes.

"We need to standardize the process," just as supermarkets have, Bootman said.

[DirtyPool]

I wonder how many go unreported. what worries me is the mishandling of psychotropic drugs. the shrinks out there are nuttier than outhouse rats and they don't seem to have to be accountable for anything.

[burnt_toast]

The husband of a good friend has MAJOR heart issues, he has more computers in his chest then I have on my desk (and I have two), he's also a type II Diabetic! She carries a typed list of his medications and dosages with her at all times and has caught these kind of errors many times when he's been in the hospital. She says if it wasn't for that list he'd have been killed years ago!

It's astounding and horrifying how dangerous the current system (or lack thereof) is.

[tictac]

My sister is a pharmacist in a major cancer hospital and she says even with all of their systems they have in place to prevent mistakes, it still happens. She even filled a potentially fatal prescription for a chemotherapeutic drug once, but caught it at the last minute. Scary.

[SVZ]

I think part of the problem is that it has to go through so many people before the drugs actually get to the patient. Does that makes sense? I mean you have the doctor, then the nurse, then the pharmacy and then finally the patient. That's 3 chances for an error to made concerning the drug itself, and then you have the patient.

[Pandora]

My grandmother (dad's mother) actually died after going to the DENTIST. This was 45 years ago, and basically she had a bad tooth, treated that and the dentist gave her penicillin. She collapsed right when she stepped on the side walk, was rushed to the hospital (my mom's dad owned the hospital and he was her attending doctor) across the street, but there was nothing my grandpa could do: she had a fatal heart attack and passed away.

When I was a baby, I almost died because of an allergic reaction to penicillin too.

[Delphinium]

i think the under-staffing of hospitals is a big part of the problem also. i was in the hospital for 3 days to have surgery. i rarely ever saw a nurse unless i called for one (and then i had to wait quite awhile). there was one med error i'm aware of. i was given a soma to chew up instead of simethicone. and when i spat it out and said it was the wrong med the nurse tried to convince me otherwise. they also put anti-nausea medication thru the IV without diluting it, which sclerosed the vein which has never returned to this day. And of course i had a perforated bowel from the surgery, which i was told with a "kidney infection" until i darn near died.

health care is scary nowadays.

[DirtyPool]

holy shit delphinium i would've grabbed that nurse by the collar and given her a gut check and a double fisted knuckle sandwich to her face but then some say i have anger issues. seriously, did you file any reports and what came of it if you don't mind sharing. i knew a lady who died after a back surgery because the incompetent doctor left a tool or something inside of her and she developed a fatal infection. She left behind a husband and two young kids. I get enraged when i think about that.

[Delphinium]

honestly I was so sick I didn't really process it all at the time. But in retrospect I should've done something.

[pacific breeze]

Suing doctors is incredibly labour-intensive. I once reported on a trial where a woman was admitted to a very good hospital with intense pain in her abdominal region and she was there three days. She kept telling them she thought she had appendicitis but no one listened. They perked up when her appendix burst, but by then it was too late, and the infection killed her.

Her husband -- left with three children under the age of 7 -- sued the hospital and the doctors, and every single smug doc lied on the stand and defended the other docs. The judge was disgusted, and so was I. In the end, he got $40,000 and that didn't even cover his legal bills. Damages are traditionally low in Canada but that was ridiculous.

Even writing about this makes me angry and it happened nearly 20 years ago. Mistakes can be made but three days to diagnose appendicitis?

[AliceInWonderland]

^ that is a sick sad story PB, how incredibly unfair and sad....

but THIS REPORT is so freakin' scary; they say hospital infections/superbugs kill more americans than AIDs and Cancer combined! I'm never going to the hospital again!!!

[Grimmlok]

Hah, my GP could have killed me faster than a hospital!

That little incident where he was obviously cracked out on something and almost gave me a booster shot of AIR?

Yeah, he's taken a year long leave for personal health reasons. Gee, maybe because he was on METH?

I hope Betty Ford is nice! Fucktard!

[Lobelia]

I've met some damn near retarded nurses the past couple of years, which worries me a little. I always thought nurses had some sense, which surely most of them DO, but apparently there's a tard here & there passing out pills & sticking people.

My cousin is a pharmacist, and she always drives to work wacked out on oxycontin and multiple other pain drugs. I can't figure out how she hasn't killed anybody yet.

A well-known local businessman went to the hospital here last year for knee surgery & left in a bodybag. Something about an infection, you know how that goes.

[UndercoverGator]

Originally Posted by Delphinium

i think the under-staffing of hospitals is a big part of the problem also. i was in the hospital for 3 days to have surgery. i rarely ever saw a nurse unless i called for one (and then i had to wait quite awhile). there was one med error i'm aware of. i was given a soma to chew up instead of simethicone. and when i spat it out and said it was the wrong med the nurse tried to convince me otherwise. they also put anti-nausea medication thru the IV without diluting it, which sclerosed the vein which has never returned to this day. And of course i had a perforated bowel from the surgery, which i was told with a "kidney infection" until i darn near died.

health care is scary nowadays.

I think it depends on the hospital and the doctors. I had major surgery about three years ago and had any entire ward to myself because they had no deliveries in the maternity wing that week, 4 nurses at my beck and call. Having all that care made a huge difference between my usual hospital experience where you're ignored 99% of the time by the staff. They even got me up to shower and completely helped me with my hygiene that night. I bleieve it helped me recover much faster.

[chuckpony]

Barcoding is not necessarily the solution. I used to work in a hospital with bar coding. This hospital recently had a death of a young girl because the nurse chose not to scan the medication per the hospital policy. Docs have horrible handwriting, yes, but as a rule, whenver I cannot read the writing, or the pharmacist is unsure, I always call the doc to clarify the order. And just because you have a barcode system , does not mean you can ignore the 5 Rights of med administration. That is a mistake people make. Check, check and check again, and even if you think it is right, check again!
It is not always about understaffing. Where I live and work all hospitals are well staffed and there is no real shortage of nurses. Nurses are overworked though and with all the new technology which is supposed to make things convenient and decrease error, it can be quite time consuming and take away from patient care. There are too many nurses pulling too many double shifts, mandatory overtime, etc.... I think it is dangerous when you have a nurse or doc who is too inexperienced or too confident. Either can be a set up for tragic mistakes. But, even the best of medical professionals, with the best of intentions can make a tragic mistake. I am not talking about the crooked, crazy people, they are a whole other breed.