Medical Inspection – Health Blog

Enlist the help of local pharmacists and encourage patients to ask pharmacists about their medications and ADR

Physicians should remember that they have a good source of drug information in local pharmacists. Patients as well as physicians should actively interact with pharmacy personnel to obtain drug information. Physicians should work with local pharmacists to minimize medication errors. This becomes especially important in patients who see other physicians and use multiple pharmacies. Physician-pharmacist interaction should be made to work for the good of our patients.

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Take a drug history/document drug allergy

A poor drug history may lead to a failure to detect unintended drug effects. A drug history should include the use of alternative medicines or herbal medications, supplements and other over-the-counter (OTC) medications. A recent study indicated that review and documentation of nonprescription substances are uncommon in primary practice. Of 655 physician respondents, only 47% documented herbal and other alternative treatments in the medical record. Physicians should always ask patients about allergies to drugs and should make sure the allergy history has been clearly documented and prominently displayed on the front of the patient’s chart. When a doctor prescribes a new medication, he/she should always be sure to ask if the patient has used the drug before and if any unpredictable reaction occurred. Physicians should encourage patients with serious allergic reactions to wear medic alert bracelets or necklaces.

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Update knowledge of therapeutics

Three key factors were listed by the IOM that contribute to prescribing error: 1) using the wrong drug name, 2) incorrect dosage calculations, and 3) atypical or unusual and critical dosage frequency. It is very easy to use the wrong drug name when prescribing, because so many new drugs enter the market every year. The FDA Center for Drug Evaluation and Research (CDER) approved 98 original new drugs in 2000. There are more than 17,000 trade and generic names for pharmaceuticals marketed in North America. Keeping up-to-date and being ready to address drug-related questions posed by patients is becoming increasingly challenging.

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INTRODUCTION

In the United States, an estimated 44,000 to 98,000 deaths annually may be caused by medical errors. These figures were provided in a report by the Institute of Medicine (IOM). The report documents the fact that medication errors are a major problem in our hospitals and that adverse drug reactions (ADR) remain an important cause of morbidity and mortality. The IOM report estimates that medication errors account for 7,000 deaths per year in the United States.

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We studied a unique population from a large public hospital that serves an ethnically diverse and underserved population. Our cohort had greater race and age diversity than other population studies.

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Table 1 presents the characteristics of the cohort. Age, gender, and race status were available in 99.9% of the cohort. The four preselected racial groups (Caucasian, Hispanic, African-American, and Asian) comprised 97% of the cohort. Nearly 60% of the subjects were Hispanic. The mean age (SD) of the cohort was 62.3 (15.1) years. Nearly 28% of the cohort were younger than 55 years; 29.6%, 55-64 years; 19.9%, 65-74 years; 15.1% 75-84 years. The African-American group had the youngest mean age. The difference in mean age was significant between African-American and Caucasian subjects. Neither Hispanic nor Asian subjects were different from Caucasian subjects in mean age. Forty-four percent of the overall cohort were women; in the Hispanic group, women had a slight majority (51% vs. 49%). The Caucasian group had the most uneven distribution of gender. Medicaid and Medicare accounted for 65.9% of the cohort’s medical liability, while private insurance accounted for 3.5% of the cohort and 30.6% were uninsured.

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Population

Records of patients with electrocardiogram (ECG) diagnosis of AF were examined from LAC+USC Medical Center’s Marquette ECG database for the 1999 calendar year. This ECG database included records of both inpatients and outpatients. The automatically interpreted ECGs generated for that calendar year were previously reviewed, corrected when necessary, and confirmed by the hospital’s cardiologists. Of 80,021 over-read ECGs in the Marquette database, 3,955 had a diagnosis of AF, comprising 904 distinct subjects. Since the number of ECGs per subject was variable, the first ECG manifesting AF during the hospitalization was used in the study. The hospital’s discharge record database was queried for patients with a diagnosis of AF during the calendar year 1999. The discharge record of the hospital admission that was matched to the index ECG was analyzed. A total of 737 subjects were matched; the remaining 167 unmatched subjects had only outpatient ECGs and were excluded from the study. Seventeen hospitalized subjects did not have an admission period that included the date of the index ECG. The first ECG manifesting AF was paired with the closest hospital admission for each of these subjects.

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