Be a patient advocate to prevent medication errors

Report calls for increased patient communication

As a hospital case manager, you can have an important role in your hospital's efforts to prevent medication errors, which harm at least 1.5 million people every year at a conservatively estimated cost of $3.5 billion, according to a report from the Institute of Medicine (IOM) of the National Academies.

"The report recommends having patients become a more active member of the health care team, but when patients are in the hospital, they are sick and sometimes confused. They need someone, like a case manager, to step in and become the patient's advocate on the health care team," says Albert Wu, MD, MPH, professor of health policy and management at Baltimore's School of Public Health at John Hopkins University, attending physician at Johns Hopkins University Hospital, and a member of the IOM committee.

The report, Preventing Medication Errors, issued in July, sets out a comprehensive series of actions for health care organizations, government agencies, pharmaceutical companies, and patients to prevent medication errors, which are common at every stage of the medication use process, beginning with prescription and administering the drug and monitoring the patient's response.

The report cites estimates that there is at least one medication error per hospital patient per day.

"The rate of medication errors and the frequency of adverse events from medication are unacceptably high," Wu says. "It's actually possible that the number of errors is going up because the number of prescriptions has increased dramatically over the past 10 years to at least 4 billion prescriptions a year."

In addition to recommending that all prescriptions be written electronically by 2010 and suggesting ways to improve the naming, labeling, and packaging of drugs to reduce confusion and prevent errors, the report recommends a paradigm shift in the patient-provider relationship so that patients take a more active role in their own medical care.

"One of the most effective ways to reduce medication errors is to move toward a model of health care where there is more of a partnership between the patients and health care providers," the report concludes.

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 the patients, the report says.

That's where case managers can be valuable members of the health care team, Wu says.

Case managers should make sure that all of the information they have collected about the patients, particularly a list of all medications, allergies, and medical problems, is available to the treatment team, he suggests.

"They should have a role in reconciling current medication at the time of discharge from the hospital with the medications that patients were taking at home before admission," Wu says.

Medication errors encompass mistakes that involve over-the-counter products, vitamins, mineral and herbal supplements, as well as prescription drugs. That's why case managers should make sure that everything a patient has been taking and intends to resume taking after discharge is in the patient record, he adds.

There's a lot of confusion among patients about medication given in the hospital vs. what they were taking at home, Wu says.

Case managers should go over the medication with the patient and make sure that the patient understands what to take after discharge and what to discard, checking with the physician for clarification as necessary.

When patients receive educational materials or other information from the pharmacy or hospital, the case managers should make sure that they are written in a language that patients understand.

"Patients need to understand medication adherence, side effects, conditions related to food or drink, and interactions with other medications. Information on all of this can be collected and presented to the patient at a time when he or she can understand it," he adds.

Another important role for case managers is to ask questions of the attending physician if the patient isn't clear on his or her treatment regime and relay the answers in a language the patient can understand.

"Treatment recommendations and discharge instructions can also be confusing. As an advocate for the patient, case managers can make sure they understand," he adds.

As they visit their patients, case managers should proactively ask them if they are having symptoms that could be a side effect of medication, even if it is not their responsibility.

"This may be a little redundant, but it's something that other staff may forget to do," he says.

Help your patients prepare for a visit from the doctor so they can have better and more efficient discussions during the limited time the physician has.

"It's important for the patient to have goals for the encounter to make sure that things that are most important to them get addressed," he adds.

For more information, visit the Institute of Medicine web site: