EMBARGOED FOR RELEASE: 3 p.m. (CT) TUESDAY, JANUARY 21, 1997
Media Advisory:
To contact David W. Bates, M.D., M.Sc., or Jerry Avorn, M.D.,
call Terri Hornbach-Torres at 617/732-5008.
To contact David C. Classen, M.D., M.S.,
call Jeff Gomez at 801/321-2182.
To contact Timothy S. Lesar, Pharm.D.,
call Richard Puff at 518/262-3421.
DRUG ERRORS COSTLY TO HEALTH CARE SYSTEM Errors can be measured, are often preventable
The substantial expense of drug errors, as well as the increased risk of morbidity and mortality, justifies investing in efforts to prevent them from happening, according to a series of articles and an editorial in this week's issue of The Journal of the American Medical Association (JAMA).
In one article, David W. Bates, M.D., M.Sc., from the Division of General Medicine, Brigham and Women's Hospital, Boston, Mass., and colleagues assessed the costs associated with adverse drug events (ADEs). In a previous JAMA study, the authors found an overall ADE rate of 6.5 per 100 admissions, and of these, 28 percent were judged preventable.
The authors write: "We estimated that the annual additional costs associated with preventable ADEs occurring in a large tertiary care hospital were $2.8 million and that the costs associated with all ADEs were $5.6 million. Moreover, these estimates do not include costs of injuries to patients, malpractice costs, or the costs of less serious medication errors or admissions related to ADEs. These results suggest that hospitals can justify devoting additional resources to develop systems that reduce the number of preventable ADEs not only to improve patient care but also to reduce ADE-related expenses."
The study included 4,108 admissions to two tertiary-care hospitals over a six-month period. A self-report by nurses and pharmacists and by daily chart review shows 190 ADEs, of which 60 were preventable. The additional length of stay associated with an ADE was 2.2 days, and the increase in cost associated with an ADE was $3,244. For preventable ADEs, the increases were 4.6 days in length of stay and $5,857 in total cost.
ADEs Almost Double Risk of Death
In a second article in this week's JAMA, David C. Classen, M.D., M.S., from the Department of Clinical Epidemiology, LDS Hospital, Salt Lake City, Utah, and colleagues determined the excess mortality attributable to ADEs in patients hospitalized at LDS from January 1990 to December 1993.
The researchers found that the occurrence of an ADE was associated with nearly double the risk of death at 1.88. The researchers also determined that among their study group an ADE was associated with an increased length of hospital stay of 1.91 days and an increased cost of $2,262.
The researchers write that ADEs may account for up to 140,000 deaths annually in the U.S. and that fatal ADEs are expected in approximately 0.31 percent of hospitalized patients.
The authors write: "We conclude that the occurrence of ADEs significantly prolongs hospital length of stay and increases costs as well as mortality. The potential costs of ADEs both institutionally and nation-wide are enormous. Improvements in this area will come from a system-wide approach to improve the process of drug use that includes a monitoring program for the occurrence of ADEs as an important outcome of drug therapy."
Adverse Drug Events Can Be Reduced by Improving Training
In a third article in this week's JAMA, Timothy S. Lesar, Pharm.D., from the Department of Pharmacy, Albany Medical Center, N.Y., and colleagues quantified the type and frequency of identifiable factors associated with medication prescribing errors. The overall error rate during this study was 3.99 per 1,000 medication orders, with the rate varying among medication classes and prescribing services.
The authors found: "Factors commonly associated with errors in prescribing medications were inadequate knowledge or use of knowledge regarding drug therapy; presence of important patient factors related to drug therapy such as age, impaired renal function, and drug allergy; the need for calculation of drug doses; and specialized dosage formulation characteristics and medication prescribing nomenclature."
They continue: "By focusing efforts on the factors identified in this study, the risk to patients from prescribing errors should be reduced. Efforts to reduce medication prescribing errors should include standardization of processes, reduction of system complexity, computerization of the drug prescribing process, improved and refocused prescriber education, and expanded use of the expertise of pharmacists through better integration with the health care team."
Editorial: Studies on ADEs Present Important Information
In an accompanying editorial in this week's JAMA, Jerry Avorn, M.D., from the Program for the Analysis of Clinical Strategies, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass., writes on what can be learned from the ADE studies: "First, that ADEs in hospitalized patients are countable, dangerous, and evaluable events, not just a collection of unhappy accidents that strike, like cosmic rays, in ways that we cannot predict or understand. Second, that a systems approach to studying what happens in hospitals can make it possible to measure how frequently bad (as well as good) events occur, as well as why they occur, under what circumstances, and how they can be prevented. Third, the articles [in this week's JAMA] illustrate the enormous power that hospital computing systems can bring to bear on the detection and definition of clinical events, both wanted and unwanted.
"In an era of constrained resources, it is vital to remember that ADEs in hospitals are common, costly, and preventable in many cases. Even if techniques are not yet available to perform case-mix and severity adjustment with the precision needed to quantify the economic costs and consequences of ADEs perfectly, these articles make a good case for the need to pay far more attention to these important causes of morbidity, mortality, and resource use. Whatever the precise measure of their impact, their toll in human and fiscal terms is clearly large enough to justify commitment of hospital resources to programs designed to reduce preventable ADEs to the lowest possible incidence."
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For more information: c
ontact the AMA's Jim Michalski at 312/464-5785.
email: [email protected]
AMA web site: http://www.ama-assn.org
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