Pharmacist on rounds can help reduce errors
IOM report on errors raises concerns
Since December, the Society of Critical Care Medicine’s (SCCM) Web site has featured the findings of a landmark study that suggests the importance of having a pharmacist on hand during physician rounds as a way to curb the incidence of medical errors in the ICU.
The study, "Pharmacist Participation on Physician rounds and Adverse Drug Events in the Intensive Care Unit," first appeared in the July 1999 issue of the Journal of the American Medical Association. (The study can be retrieved by logging on to the SCCM Web site, www.sccm.org.)
The study has received widespread attention in critical care following an Institute of Medicine (IOM) report on sentinel events released last November and remarks by President Clinton.
According to the IOM report, medical errors are responsible for up to 98,000 patient deaths annually at an estimated cost to the health care industry of as much as $29 billion. The Washington, DC-based agency criticized its findings as "simply unacceptable."
In critical care, the issue has assumed greater urgency in light of rapid pharmaceutical and technological advancements.
ICUs face higher error risk
"There are newer drugs and [more complex] technologies on the scene," asserts Jeanette Ives Erickson, RN, MSN, one of the researchers of the pharmacist study. "We need to keep looking for solutions," says Erickson, senior vice president of patient care services at Boston’s Massachusetts General Hospital.
The study shows that the presence of a pharmacist during daily rounds helped cut preventable cases of adverse drug events (ADEs) by as much as 66% in the controlled study.
ADEs fell to 3.5 cases per 1,000 patient days from 10.4. During the study period a pharmacist made 366 recommendations related to drug ordering. In 362 of the cases, the recommendations were accepted by a physician.1
However, the researchers also noted that in most cases ADEs do not result in life-threatening conditions, and it is also correctable.
"This is a fixable situation," according to Harold J. Demonaco, MS, RPh, director of drug therapy management at Mass General and one of the study’s co-authors.
However, "hospitals should not sit idly by and wait for someone else to come in and fix things," Demonaco adds.
Demonaco cites additional research, which suggests that computerized medication order entry and careful review of orders by experienced pharmacists, can help curb ADEs.
Initially, hospitals will have to rethink their attitude about pharmacists from the current view of materials manager to full participants in the patient care process, Demonaco tells Critical Care Management.
In recent years, there has been a groundswell of concern over the incidence of medical errors. According to reports, the vast majority of incidents are downplayed or go unreported.
Regulatory agencies, the Joint Commission on Accreditation of Healthcare Organizations for one, have been pressing hospitals to be more forthcoming in reporting medical errors.
The hope has been to learn more about sentinel events by encouraging providers to come forth in a nonpunitive atmosphere, according to Patricia Staten, a Joint Commission official based in Oakbrook Terrace, IL.
(Editor’s note: For additional information on ADEs, see CRM, September 1999, p. 98.)
Reference
1. Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999; 282:267-270.
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