Doctors make more med errors than nurses
Fatigue cited as main culprit for mistakes
Physicians make most of the medication errors in hospitals, even though nurses often get the blame, according to a panel of experts addressing medication errors at a forum in St. Louis.
The panel was convened by the Institute for Healthcare Improvement in Boston, a collaborative effort among 42 health care organizations to reduce errors in health care facilities.
Nurses often get the blame for medication errors, but overtired physicians are more likely are at fault, says Lucian Leape, MD, adjunct professor of health policy at the Harvard School of Public Health in Boston. Leape also is a pediatric surgeon and a frequent speaker on health care errors.
Health care providers are slow to acknowledge the connection between fatigue and errors, he says. Other speakers cited more problems that lead to medication errors, including distraction, poor lighting, bad handwriting, and abbreviations.
The way in which drug orders are written is another common problem cited by Michael R. Cohen, MD, president of the Institute for Safe Medication Practices in Boston. Abbreviations are dangerous and should never be used, he says. He also provides this list of especially hazardous medications that should be ordered with exceptional clarity:
• adrenergic agonists;
• amiodarone and amrinone;
• midazolam;
• intravenous calcium;
• chemotherapy agents;
• chloral hydrate for pediatric use;
• intravenous heparin;
• insulin;
• lidocaine;
• intravenous magnesium sulfate;
• all narcotics;
• neuromuscular blocking agents;
• intravenous potassium phosphate;
• intravenous potassium chloride;
• intravenous sodium chloride;
• theophylline.
Leape estimates that 10% of patients admitted to hospitals will experience an adverse drug event. A lower incidence at your hospital may mean you’re just not looking hard enough, he says, adding that reliance on self-reported errors and spot checking probably will yield a deceptively low percentage. Instead, he suggests using a more systematic combination of chart reviews and computer analysis of drug records.
Computerized order entry by physicians can reduce medication errors significantly, Leape and others at the forum say. The technology still is developing and is not available to many hospitals, but it should be considered a priority when available.
A computerized system was tested recently by Donald Goldmann, MD, epidemiologist and medical director of quality improvement at Boston’s Children’s Hospital. When he tried the system in use at Latter Day Saints Hospital in Salt Lake City, he found that it checked both the accuracy of the drug order and the rationality of placing the order at all. Such a system can save significant amounts of money by discouraging doctors from ordering drugs, including some antibiotics, that are prescribed more often than necessary.
Leape points out that a computerized system eliminates the reliance on memory when ordering medications. He calls ordering drugs from memory "one of the most pervasive and fundamental defects" in health care.
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