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Tuesday, December 22, 2009

How medication mistakes happen in the hospital

What a great idea -- give patients a list of their medications not only at discharge but everyday while in the hospital!

Originally published in MedPage Today

by Katrina Woznicki, MedPage Today Contributing Writer

Hospitalized patients were often clueless when asked about their medications, with almost all of them unable to name all their medications and many leaving out as many as a half-dozen drugs they have been prescribed, according to a small survey of patients in a Colorado hospital.

Ninety-six percent of the 50 patients surveyed left out at least one drug when they were asked to list their medications, and, on average, patients omitted 6.8 medications, Ethan Cumbler, MD, of the University of Denver, and colleagues reported in the Dec. 10 issue of Journal of Hospital Medicine.

Moreover, 44% of the patients thought they were taking a medication that had not been prescribed.

The researchers conducted the patient survey as part of a larger project examining a potential role for patients in reducing medication errors and improving patient safety.

"This study is a first for raising the questions How involved should patients be in their hospital medication safety?' and How do you involve them?'" Cumbler told MedPage Today.

"We don't live in a perfect healthcare system and errors do occur. If you have a patient who wants to be involved in their medication safety, you have to let him or her know what they're taking and to let them be an active participant."

Among scheduled medications, patients commonly omitted several important therapeutics, including antibiotics, cardiovascular drugs, and antithrombotics.

When asked about PRN medications, patients were most likely to omit analgesics and gastrointestinal medications.

"The patient, as the last link in the medication administration chain, represents the final individual capable of preventing an incorrect medication administration," Cumbler et al wrote in the journal article.

But if the survey reflects the average hospital patient, this is a weak link.

The majority of the participants, 81%, said seeing a hospital medication list would improve their satisfaction with the care they received; however, only 28% reported that they saw such a list.

A total of 50 participants answered questions about their outpatient and inpatient medications and described their attitudes about hospital medications and level of interest in patient involvement in hospital safety.

The findings, Cumbler added, only provide a snapshot of one small group of inpatients at one hospital.

The average age of participants was 54, 46% were men, and 74% were non-Hispanic white.

Patients were on an average of 5.3 outpatient prescription medications, 2.2 over-the-counter medications, and 0.2 herbal remedies.

Age did prove to be a factor in patients' ability to accurately identify their hospital medications. Patients age 65 and younger omitted 60% of their PRN medications, whereas patients 65 and older failed to report 88% (P=0.01).

Hospital organizational culture and the complexity of medicine itself pose challenges for inpatients to keep track of their medications, said Ruth S. Day, PhD, Director of the Medical Cognition Laboratory and Associate Professor of Psychology and Neuroscience at Duke University, who was not involved in the study.

"People have trouble perceiving, pronouncing, and remembering medication names even under the best of circumstances," Day said in an interview.

Protocols for outpatient medication monitoring have garnered a lot of attention, added Derung Mimi Tarn, MD, PhD, Assistant Professor of Family Medicine at the University of California at Los Angeles Medical Center, who was not a part of the study.

However, there has been very little focus on the inpatient setting, and it is not routine to give patients medication lists in the hospital. The issue, Tarn said in an interview, warrants further investigation.

Moreover, whether patients could even be effective at reducing hospital medication errors is uncertain.

Patients with dementia or delirium or those in the ICU may not prove helpful in ensuring hospital medication safety, said Tang. "However, there are definitely patients in the hospital who could serve as a valuable stopgap for example, obstetrics patients and parents of pediatric patients," she said. "The level of patient participation would need to be individually based."

Cumbler agreed that "one solution will not work for all," and that approaches to inform inpatients may have to be customized depending on factors such as condition and age.

The study, he added, was only designed to assess whether patients were informed about their hospital medications and whether they were interested and prepared to be more active participants in their care.

Visit MedPageToday.com for more hospital news.

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