Pharmacists must involve patients to reduce ADEs

A study by the Institute of Medicine (IOM) says pharmacists and other health care professionals must allow and encourage patients to take a more active role in their own medical care if the number of adverse drug events (ADE) is to be reduced.

One of the most effective ways to reduce medication errors, the report says, is to move toward a model of health care where there is more of a partnership between patients and health care providers. Patients should understand more about their medications and take more responsibility for monitoring those medications, while providers should take steps to educate, consult with, and listen to patients, the IOM said.

Such a paradigm shift is needed because medication errors are "surprisingly common and costly to the nation," according to the report. It said that in hospitals, errors are common during every step of the medication process — procuring the drug, prescribing it, dispensing it, administering it, and monitoring its impact — but they occur most frequently during the prescribing and administering stages. "When all types of errors are taken into account," the IOM said, "a hospital patient can expect on average to be subjected to more than one medication error each day. However, substantial variations in error rates are found across facilities."

The report said there are few estimates of how often preventable ADEs occur, but it estimated at least 1.5 million such preventable ADEs in the United States each year, and the true number is likely much higher. There also are few estimates of the cost of preventable ADEs. One study found that each hospital preventable ADE added about $8,750 to the cost of the hospital stay. Assuming a conservative 400,000 events a year, the total annual cost would be $3.5 billion in this one group. Another study looked at preventable ADEs in Medicare enrollees aged 65 and older, and found an annual cost of $887 million for treating medication errors in this group. "Unfortunately, these studies cover only some of the medication errors that occur each year in this country, and they look at only some of their costs — they do not take into account lost earnings, for example, or any compensation for pain and suffering," IOM said.

Three steps to prevent ADEs

The report suggested three steps for preventing medication errors. The first step is to allow patients to take a greater role in their own care. To make such a change work, according to the IOM, pharmacists, doctors, nurses, and other providers must communicate more with patients at every step of the way and make that communication a two-way street, listening to patients as well as talking to them. Professionals should inform patients about the risks, contraindications, and possible side effects of the medications they are taking and what to do if they experience a side effect. And they should be more forthcoming when medication errors do occur and explain the consequences.

For their part, patients and those helping or representing them should take a more active role in the process. They should be keeping careful records of all medications they are taking and take responsibility for monitoring the medications, including double-checking prescriptions from pharmacies and reporting any unexpected changes in how they feel after starting a new medication.

From a broader perspective, the health care system should be doing a better job of educating patients and providing ways for patients to educate themselves. The IOM said patients should be given opportunities to consult about medications at various stages in their care such as during consultations with providers who prescribe their medications, at discharge from the hospital, at the pharmacy, etc. And there should be a concerted effort to improve the quality and accessibility of medication information provided to consumers.

The second step in reducing medication errors is to make greater use of information technologies in prescribing and dispensing medications. The IOM said prescribers should be using point-of-care reference information accessed over the Internet or through a personal digital assistant to get detailed information about the drugs they prescribe and get help in deciding which drugs to prescribe.

Even more promising, the report said, is the use of electronic prescriptions that can avoid many of the mistakes that accompany handwritten prescriptions. Also, e-prescriptions can be linked to a patient's medical history so that prescribers can check for things such as drug allergies, drug-drug interactions, and overly high doses. And once an e-prescription is in the system, it will follow the patient from the hospital to the doctor's office or from the nursing home to the pharmacy, avoiding many common hands-on errors.

The IOM's third recommendation is to ensure that drug information is communicated clearly and effectively to providers and patients. Noting that some errors occur simply because two different drugs have names that look or sound very similar, it recommended that the drug industry and federal agencies work together to improve drug nomenclature, including not just drug names but abbreviations and acronyms. And the information sheets that accompany drugs should be redesigned, taking into account research that identifies the best methods for communicating information about medications.

ASHP supports IOM recommendations

The American Society of Health-System Pharma-cists (ASHP) said it supports the report's recommendations because they "help draw attention to this important patient safety issue." ASHP executive vice president and CEO Henri Manasse Jr., PhD, ScD, said safe medication use starts with team-based care, more effective use of information technology, better patient and practitioner education, engagement of practitioners and patients at all levels, and continuity of care among all health care settings. He said IOM's recommendations aligned closely with ASHP's pharmacy policy and advocacy efforts and said ASHP had already established policy, initiatives, and advocacy efforts for all the IOM recommendations.

(Editor's note: More information is available on-line at www.iom.edu/CMS/3809/22526/35939.aspx.)