Half of heart patients make mistakes with their meds: study

Almost 23 percent of errors were deemed serious, researchers report.

08 july 2012-- Half of patients hospitalized for a heart attack or heart failure will make a mistake with their medications within a month of checking out of the hospital, new research shows.

These mistakes were as common among people who received counseling and guidance from a pharmacist as those who did not.

In the study, 50 percent of 851 participants had one or more medication error. Of these, about 23 percent were deemed to be serious and 1.8 percent were considered life-threatening. The findings appear in the July 3 issue of the Annals of Internal Medicine.

The study took place at Vanderbilt University Hospital in Nashville, Tenn., and Brigham and Women's Hospital in Boston. The patients tended to be highly educated, and yet they still had problems following instructions.

"This shows how vulnerable patients are in the transition from hospital to home," said Dr. Gregg Fonarow, a spokesman for the American Heart Association and a professor of cardiovascular medicine at the University of California, Los Angeles. "Many had thought that having pharmacist assistance, counseling and individual follow-up would reduce or even eliminate the likelihood of having an adverse drug event," he noted.

"Patients, caregivers and family members need to be knowledgeable about drug names, dosing and which medications should be discontinued, and which should continued, after hospitalization," Fonarow said. "This information should be given verbally and in writing to all involved parties. It needs to be recognized that even with all of these steps, there is still a potential for clinically important medical errors."

Dr. Adam Auerbach, director of inpatient cardiac services at North Shore University Hospital in Manhasset, N.Y., said that medication errors continue to be a big problem.

He noted that his hospital is in the process of starting some pilot programs to curb medication errors.

"We are looking at a 'teach-back' program where we each teach patients about their medications and then they teach it back to us," he said. "We are also rolling out a program where we go to a patient's house within 72 hours after discharge to make sure they are on the right medications."

According to Auerbach, there is definitely an economic aspect to the problem. Some people may skip doses or split pills to cut costs. Choosing generic medications, when possible, can help eliminate the cost factor.

Individuals with strong social support systems tend to do better as they have one or more caregivers looking over their shoulder. "There is a huge population who, for various reasons, don't fully understand their instructions and who don't have a support network, and those are the people we are trying to reach," he said, adding that he often asks patients to bring all their medications with them to follow-up appointments to make sure they are being taken correctly.

Allen Vaida, executive vice president of the Institute for Safe Medication Practices, in Horsham, Pa., said that "it is amazing that the numbers were that high at two institutions that have good systems in place. One way to reduce rates of medication errors and adverse drug events is to use only one pharmacy for all your prescription and medication needs. This way, any interactions or potential problems are more likely to get flagged. There are a handful of drugs that are more likely to cause problems, including blood thinners. Focusing our efforts on some of the drugs that we know may cause issues can also be helpful."

The most frequent error in medicine

INDIANAPOLIS, 09 mar 2010 – The most frequent error in medicine seems to occur nearly one out of three times a patient is referred to a specialist. A new study found that nearly a third of patients age 65 and older referred to a specialist are not scheduled for appointments and therefore do not receive the treatment their primary care doctor intended.

According to a new study appearing in the February 2010 issue of the Journal of Evaluation in Clinical Practice, only 71 percent of patients age 65 or older who are referred to a specialist are actually scheduled to be seen by that physician. Furthermore, only 70 percent of those with an appointment actually went to the specialist's office. Thus, only 50 percent (70 percent of 71 percent) of those referred to a specialist had the opportunity to receive the treatment their primary care doctor intended them to have, according to the findings by researchers from the Regenstrief Institute and the Indiana University School of Medicine.

The Institute of Medicine, in its seminal report "To Err is Human," defines a medical error as a "wrong plan" or a failure of a planned action to be completed.

"Patients fail to complete referrals with specialists for a variety of reasons, including those that the health care system can correct, such as failure of the primary care doctor's office to make the appointment; failure of the specialist's office to receive the request for a consultation—which can be caused by something as simple as a fax machine without paper – or a failure to confirm availability with the patient," said Michael Weiner M.D., M.P.H., first author of the study.

"There will always be reasons – health issues or lack of transportation, for example – why a referred patient cannot make it to the specialist he or she needs, but there are many problems we found to be correctable using health information technology to provide more coordinated and patient-focused care. Using electronic medical records and other health IT to address the malfunction of the referral process, we were able to reduce the 50 percent lack of completion of referrals rate to less than 20 percent, a significant decrease in the medical error rate," said Dr. Weiner.

The JECP study followed 6,785 primary care patients seen at an urban medical institution, all over age 65, with a mean age of 72. Nearly all (91 percent) of the patients were covered by Medicare.

"This is not necessarily the fault of patients or doctors alone, but it may take both working together – along with their health system – to correct this problem. Our study highlights how enormous a problem this is for patients who were not getting the specialized care they needed. Although our findings would likely differ among institutions, unfortunately overall trends are similar in other parts of the country" said Dr. Weiner.

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Dr. Weiner is director of the Regenstrief Institute's Health Services Research Program, director of the Indiana University Center for Health Services and Outcomes Research, and director of the VA Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice at the Roudebush VA Medical Center.

Co-authors of the study are Anthony J. Perkins, M.S., of the Regenstrief Institute and the IU Center for Aging Research, and Christopher M. Callahan, M.D., a Regenstrief Institute investigator and Cornelius and Yvonne Pettinga Professor in Aging Research at the IU School of Medicine. Dr. Callahan is founding director of the IU Center for Aging Research.

This study was supported by the National Institute on Aging.

Doctors Remove Cancer Patient's One Healthy Kidney By Mistake

ST. LOUIS PARK, Minn. -- Doctors at Methodist Hospital made a mistake when they removed a cancer patient's only healthy kidney, hospital officials said Monday.
An executive with Park Nicollet Health Services, which operates the suburban hospital, said it was making the error public because it's the right thing to do.
"This is a tragic error on our part and we accept full responsibility for this," said Dr. Samuel Carlson, chief medical officer for Park Nicollet.
Surgeons removed the patient's healthy kidney last week, believing it had a cancerous tumor. But the crucial error happened several weeks earlier when the kidney on the wrong side was identified on the patient's medical charts as potentially cancerous, Carlson said.
"The discovery that this was the wrong kidney was made the next day when the pathologist examined the material and found no evidence of any malignancy," Carlson said.
Hospital officials apologized to the patient and family, and "are working closely with them to support them in every way we can," he said.
The patient has chosen to remain at Methodist for follow-up care. Because of privacy laws and the family's request, Park Nicollet was not releasing other details about the patient, not even if the error involved a man or woman, adult or child.
The surgeon involved voluntarily stepped aside from any treatment of patients while the hospital conducts a "root cause analysis." No other staff member has been removed from duty.
Carlson said new procedures were put into place Monday requiring the surgical team to verify sites using diagnostic imaging before an operation begins.
Hospital officials would not say what treatment the patient is now getting or discuss what effect the error may have on the patient's chances of recovery. But they said that when a patient has only one kidney that may be cancerous, you either try to save it and beat the cancer, or you have to remove it and start dialysis or consider a transplant. In some cases, Carlson said, cancer could make someone ineligible for a transplant.
Carlson said many hospital staffers were taking it hard. It had been a point of pride at Methodist Hospital that Gov. Tim Pawlenty came to it four years ago to sign a bill requiring that hospital errors to be reported to the state.
Twenty-four wrong-site surgeries were reported to the Minnesota Department of Health between October 2006 and October 2007. Two were at Methodist, but Carlson said they were relatively minor compared with last week's error: a needle biopsy on the wrong lung, and a diagnostic exam of the wrong bronchial tube.
Kathleen Harder, a University of Minnesota researcher, said medical errors of this magnitude are rare but do happen.
"They remove the wrong ovary, take off the wrong leg," she said. Many hospitals have stepped up efforts to catch errors in the operating room. But as in this case, she noted, the problem can occur long before the operation begins. "It's wrong in the chart ... and that sets it up for a train wreck."