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Prevalence Of Drug Error

Written Testimony Submitted by Marty R. McKay Rph

Medication error is a huge problem in the United States today, causing patient deaths and injury and costing the United States billions of dollars each year.

As you know, the Institute of Medicine (IOM) released a report in November 1999, which concluded that anywhere from 44,000 to 98,000 deaths occur each year in hospitals due to medical errors. This study estimates that the increased hospital cost alone of preventable adverse drug events in hospitals is over $2 Billion per year. I believe that this study may only reveal the tip of the iceberg. This figure probably greatly underestimates the cost because it does not include indirect costs (such as loss of productivity of the patient, increased insurance costs, or long-term increased medical costs of the patient). Also, adverse drug events occur in places other than hospitals, such as nursing homes, retail pharmacies, home health care, prisons, outpatient clinics, and doctors' offices. A study released in the March/April Journal of the American Pharmaceutical Association estimates that drug misuse costs the economy more than $177 Billion each year and the estimated number of patient deaths due to drug misuse both in and outside hospitals has increased from 198,000 in 1995 to 218,000 in 2000.

To illustrate how the scope of this problem extends beyond hospitals, please consider nursing homes. There are about 1.6 million patients in the more than 17,000 nursing homes and other long-term care facilities in the United States. Patients in long-term care facilities routinely receive many doses of many different medications each day and nursing homes have fewer nurses per patient than do hospitals. Also, nursing homes are staffed with lesser-trained nurses than are hospitals. Just from these basic facts, you can see how the problem of medication errors in long-term care facilities could be significant.

Although there has been relatively little research on medication errors in nursing homes, a recent study (Gurwitz, et al) reported in the August 1, 2001 issue of the American Journal of Medicine, concluded that about 350,000 adverse drug events occur in nursing homes annually, of which 20,000 are fatal or life-threatening. Most of the preventable errors found in this study occurred in the ordering and monitoring stages of care. The pharmacist and technology can help prevent many of these errors in hospitals, nursing homes, and all other areas of patient care in a cost-effective manner.

A major reason for these errors is that many hospitals, and most nursing homes, and other in-patient and outpatient health care facilities use simple, pen-and-paper medication prescribing and medical charting systems. Most medications are manually delivered without any automated verification technology such as bar code readers. Once a prescription drug leaves a pharmacy, there is more sophisticated technology used to determine if you are charged the right price for a gallon of milk at a supermarket than is typically used to make sure that a patient is getting the right dose of a potentially fatal drug.

Please also note that some medications have been discontinued and new medications have been added by hand written instructions. These changes occurred because the doctor changed the patent's medication. Such changes are typically hand-written by the nurse pursuant to the doctor's instruction and are telephoned to the pharmacy by the nurse. Not only are the discontinued medications often then destroyed (one 1994 study estimates that 6.7% of all medications dispensed to long-term care facilities are destroyed), this process is rife with the opportunity for error. Although all pharmacists use sophisticated computer software to check for drug interactions, drug allergies, and proper drug utilization, all that technology may be meaningless if the nurse sends the pharmacy the wrong information or if the pharmacist does not have access to critical patient information. Often, by the time the mistake is caught, it is too late and a patient has been harmed or even died. This problem will only worsen, as the shortage of nurses and pharmacists becomes more acute (it is estimated that the United States currently has a shortage of 12,000 pharmacists and 20% of nurses plan to leave the field within the next 5 years).



This information came from a
US Senate online article.

*** Any law, statute, regulation or other precedent is subject to change at any time ***

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