Report: Medication errors common in nursing homes
Adverse events are common in long-term care facilities due to medication errors at the ordering and monitoring stage, according to a report in a recent issue of the American Journal of Medicine. Serious errors are more likely than less-threatening errors to be preventable, the researchers say.
The conclusions come from Jerry Gurwitz, MD, of the University of Massachusetts Medical School in Worcester. He and his colleagues obtained self-reports from nursing home staff and periodically reviewed records of all long-term care residents of 18 community-based nursing homes in Massachusetts.
From those data, they identified 546 adverse drug events and 188 potential adverse drug events. The event rates were 1.89 and 0.65, respectively, per 100 resident-months. Half of all the events were classified as preventable. One event was fatal, and 6% were life-threatening. Thirty-eight percent were serious, and 56% were significant. Of the 238 fatal, life-threatening, or serious events, 72% were judged to have been preventable, compared with only 34% of the 308 significant adverse events.
Anticoagulants and psychoactive drugs were the medications most commonly associated with preventable adverse drug events. The most common type of preventable event was neuropsychiatric, the researchers say.
Gurwitz writes that "errors resulting in preventable adverse drug events occurred most often at the stages of ordering and monitoring." In a hospital setting, they say, prevention strategies that correct underlying systems problems are more effective than strategies that focus on individual providers or rely on inspection alone. They suggest a systems-based approach to preventing ordering and monitoring errors in nursing homes. n
New rules developed to protect patient records
The Institute of Medicine (IOM) of the National Academy of Sciences has recommended several steps for sponsors of clinical research and institutional review boards (IRBs) to take in order to protect the privacy of patients’ medical records.
The 12-member committee, headed by Bernard Lo, MD, of the University of California at San Francisco, suggests that investigators involved with health services research "should have all health services research reviewed by an institutional review board or other review board with sufficient expertise in privacy or confidentiality protection."
Investigators also should "educate themselves to be aware of the best available techniques for confidentiality protection, including being careful to collect and retain only those fields that are truly needed."
Adequate funding is necessary
Institutions funding or sponsoring such research should "have comprehensive policies, procedures, sanctions, and structures to protect health data confidentiality throughout the organization when personally identifiable health information is used for research or other purposes," the committee recommends. Research sponsors also should "ensure adequate administrative support and funding for their IRBs."
The committee says that carrying out valuable health services research and protecting patient confidentiality requires adequate funding "to support dedicated, trained IRB members and staff, to establish organizational confidentiality policies and electronic security practices, to educate researchers, and to provide statistical and computer expertise."
The IOM committee advises research sponsors to "provide more specific guidance to IRBs, clarifying the range of discretion that local IRBs have to interpret federal regulations."
Among other suggestions, the report recommends that sponsors "encourage holders of personally identifiable health information to make this information available to researchers as public use files after suitable application of techniques to minimize the risks of identifiability."
They also should "ensure that the data provided for health services research use are prepared in a manner that protects confidentiality adequately, including covering the cost of preparing government-held personally identifiable health information, so that confidentiality can be adequately protected in health services research."
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