Error reporting increases, as does the risk to seniors

More than one-third of hospital medication errors that reach the patient involve seniors, making them an especially vulnerable population in U.S. health care facilities, according to the most recent data on adverse events collected by the United States Pharmacopeia (USP), a nonprofit organization in Rockville, MD.

The group’s fourth annual national report summarizes the data collected by MEDMARX, the anonymous national medication error-reporting database operated by USP. The data show a significant increase in the number of errors reported — up 82% over the previous year — but that is a positive trend that indicates more diligent reporting and not necessarily any increase in the number of errors, says Diane Cousins, RPh, vice president of the Center for the Advancement of Patient Safety at USP. "We are seeing a strong upsurge in the number of medication errors in the database," she says. "This increase is a positive step toward identifying and eliminating medication errors and ensuring the safety and well-being of all hospital patients."

Cousins says the latest report is based on 192,477 medication errors voluntarily reported by 482 hospitals and health care facilities nationwide. MEDMARX is the nation’s largest database of medication errors, containing more than 530,000 released records and by the end of the third quarter of 2004, she notes that the number of records in the MEDMARX database will approach 1 million.

"The report data revealed that more than one-third of the medication errors reaching the patient involved a patient aged 65 or older," she says. "As the senior population continues to increase, USP is calling for hospitals to focus on reducing medication errors among seniors. Seniors and their families need to become more involved in their care."

Specifically with reference to the senior population, the MEDMARX data report revealed these significant findings:

  • A majority, 55%, of fatal hospital medication errors reported involved seniors.
  • When medication errors caused harm to seniors, 9.6% were prescribing errors.
  • The next most common errors when harm occurred were wrong route (7%), such as a tube feeding given intravenously, and wrong administration technique (6.5%), such as not diluting concentrated medications.
  • When considering overall errors including those that did not necessarily cause harm, the most common types were omission errors (43%), improper dose/quantity errors (18%), and unauthorized drug errors (11%).

Cousins notes that the vast majority of reported errors were corrected before causing harm to the patient. However, 3,213 errors, or 1.7% of the total, resulted in patient injury. Of this number, 514 errors required initial or prolonged hospitalization, 47 required interventions to sustain life, and 20 resulted in a patient’s death. Compared with the previous year’s data, a smaller percentage of reported errors resulted in harm to the patient (1.7% vs. 2.4%).

The latest MEDMARX data report also found that incorrect administration technique continues to be responsible for the largest number of harmful medication errors (6.2%). This occurs when medications are either incorrectly prepared or administered, or both. Examples include not diluting concentrated medications, crushing sustained-released medications, wrong eye application of eye drops, and using incorrect IV tubes for medicine administration.

Health care facilities attributed medication errors to many reasons and often cited workplace distractions (43%), staffing issues such as shift changes and floating staff (36%), and workload increases (22%), as contributing factors.

A limited number of high-alert medications continue to cause the most severe injury to patients when an error is committed. For example, three of the top medications frequently involved in harmful errors were insulin, heparin, and morphine.