Strategies to Reduce Medication Errors in Ambulatory Practice
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.
A medication error, defined by the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP), is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient or consumer. Such events may be related to professional practice, healthcare products, procedures and systems, including prescribing, order communication, product labeling, packaging, nomenclature, compounding, dispensing, distribution, administration, education, monitoring and use. The IOM urges physicians and hospital authorities to begin to put into place those systems and processes that help reduce errors. The recent attention being paid to medical errors is important. Attempts to prevent drug-related errors within hospitals should occur concurrently with efforts being made by primary care physicians to prevent medication-related mishaps in the outpatient setting. canadian pharmacy generic viagra
The high costs associated with drug-related morbidity and mortality among outpatients in the United States is another important reason for primary care providers to increase their awareness of issues surrounding medication errors. Johnson and Bootman calculated that problems associated with pharmaceutical agents in the outpatient setting accounted for 116 million extra visits to the doctor per year, 76 million additional prescriptions, 17 million emergency department visits, 8 million admissions to hospital, 3 million admissions to long-term care facilities and 19,000 additional deaths. The total cost was estimated by the authors to be $76.6 billion. These costs will continue to rise as more patients are seen in the outpatient setting. In a survey of nonfederal, office-based physicians, there were 756.7 million office visits during 1999, a 19% increase in the number of visits since 1985.4
Outpatient medication errors may be on the rise. This is suggested by one of the few studies to investigate medication-related deaths. An examination of U.S. death certificates during a 10-year period ending in 1993 found that fatal medication errors had increased from 2,876 deaths in 1983 to 7,391 in 1993, representing a 2.57-fold increase. This study also noted an 8.5-fold increase in outpatient medication error deaths. Another important finding was the fact that between 1983 and 1993, the number of outpatient visits in the United States increased by 75%, and the number of inpatient days fell by 21%. The increase in outpatient visits implies that more patients are taking pharmaceutical agents in the outpatient setting without supervision from hospital-based staff. buy antibiotics online without prescription
What steps can physicians in primary care ambulatory practice take to reduce medication errors? This question is important because prescription-error related malpractice lawsuits are the second most frequent and the second most expensive types of suits filed against physicians. The majority of these claims are against internal medicine and family practice physicians. In addition, ProMutual Group, a Massachusetts-based medical malpractice insurer, recently issued a report that showed within 1,085 office claims, 121 claims were for alleged negligence in prescribing or administering of medications, and 44 of these claims resulted in indemnity payments totaling $11.2 million.
This article discusses strategies that can be adopted in the outpatient setting to minimize medication errors and reduce ADR.
