@ Medication Use

MONDAY, April 27 (HealthDay News) -- Medication errors and adverse drug reactions cost lives and dollars each year in the United States, but two new reports suggest ways hospitals and pharmacists can work to reduce these mistakes.

Medication errors are one of the most common medical errors, affecting at least 1.5 million people every year and costing the health-care system between $77 billion and $177 billion annually, researchers point out in the April 27 issue of the Archives of Internal Medicine.

In the first report, researchers led by Dr. Jeffrey L. Schnipper, of Brigham and Women's Hospital and Harvard Medical School, used a computer system to keep track of the medications patients were taking when they were admitted to the hospital and the medications they were taking when they were discharged.

"It turns out that we commit about 1.5 errors per patient either for the admissions orders in the hospital or, much more commonly, in the discharge orders, which is kind of appalling," Schnipper said. "These are errors with potential for patient harm. There are about three times as many errors without potential for patient harm."

For the study, Schnipper's team randomly assigned 322 patients from two hospitals to have their medications entered into a computer program at admission that was designed to reconcile those medications with the ones they were taking when they left the hospital. In addition, the researchers tried having different people take the patient's medication history and keep track of all the medications they were taking. These included doctors, nurses and pharmacists.

Among the 162 patients in the program, there were 1.05 medication errors per patient compared with 1.44 errors among patients receiving usual care -- a 28 percent reduction in errors.

Of the errors, 43 among patients in the program had the potential to cause serious harm compared with 55 among patients in the usual-care group.

The problem of medication error starts when patients are asked what drug they are taking when they come into the hospital, Schnipper said. "Patients don't know what they are taking. You have got to carry your current accurate medication list in your wallet," he advised.

Since the initial study, error rates have continued to drop as people got used to the system and the "culture" in each hospital changed to accommodate the program, Schnipper said. "Preliminarily, it looks like we are down to half an error per patient," he said.

The Joint Commission on Accreditation of Healthcare Organizations has made medication reconciliation a national priority. Medication reconciliation is identifying the most accurate list of all medications a patient is taking, and using this list to give correct medications for patients anywhere within the health-care system.

Matthew Grissinger, a medication safety analyst at the Institute for Safe Medication Practices, believes the study is a good model for hospitals to follow to help reduce medication errors.

The most important feature of the system was developing a method for taking patient's medication history on admission. "Standardizing the process of who is going to do what in regard to medication reconciliation in hospital admission and discharge is really the biggest challenge organizations have," he said.

I think one of the understated benefits of EHRs (+ CPOE) is the streamlining of the medication reconciliation process.