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Patient safety

Study finds high rate of medication errors

A new study has found that nearly 25% of patients admitted to the internal medicine department of the Vancouver General Hospital arrived because of adverse drug events, physicians prescribing the wrong medications, or other drug errors.

What’s more, the lead researcher says he anticipates similar results from a follow-up look at emergency cases that has just been finished.

“The healthcare system is bursting at the seams,” Dr. Peter Zed told the National Post newspaper. Dr. Zed, who spearheaded the study, said, “I’m sure the hospital doesn’t need 25% of their medicine patients being there because of drug misadventure... Just looking at the preventable group, that’s a big population: one in five, one in six patients whose admissions maybe could be avoided.”

The authors have recommended that better monitoring of patients is required – systems must be improved to ensure that patients are taking the right medications, in the right combinations and doses, and at the proper time.

It has long been known that medication errors lead to a significant number of patient injuries and adverse events; the study at Vancouver General Hospital is the first in Canada to quantify it, said Dr. Zed, a clinical pharmacist.

There is no reason the findings, published recently in the journal Pharmacotherapy, could not be extended to hospitals across Canada, he said.

“It’s a difficult story to read, because these things are avoidable,” said Sharon Sholzberg-Gray of the Canadian Healthcare Association, which represents most of Canada’s hospitals.

The healthcare system is aware of the problem and is working on it, but the process is complicated, she said.

Ms. Sholzberg-Gray said drug use could be made much safer with an electronic medical record system, which would provide easy access to all of a patient’s medicines and ailments in one place, and a beefed-up home-care network whose workers would monitor patient drug use.

The researchers at Vancouver General followed 565 patients admitted to the hospital over a 12-week period in 2005. All were internal-medicine patients, chosen because they suffered a range of conditions, from heart disease and diabetes to psychiatric illness.

Unlike similar studies conducted in the United States, patients were reviewed as they entered the hospital, not retrospectively after they had left.

The researchers found 24% of hospitalizations were drug-related and 72% of those were preventable.

The most common problems were adverse reactions to a drug, improperly prescribed medication and “non-compliance,” where a patient forgets to take their medication or uses it improperly. Most drug problems were rated mild or moderate, but more than 10 cases were severe and one person died. All were sick enough to be admitted to hospital.

Dr. Zed, now at Queen Elizabeth II Hospital in Halifax, recalled one case in which a woman stopped taking her diuretic and blood-pressure medications to get better sleep before her granddaughter’s graduation.

She ended up in emergency on graduation day with heart-failure problems. Other patients might have adverse reactions because their physician did not prescribe the correct dose for them, he said.

The patients admitted for drug-related problems were predominantly elderly, had multiple medical problems and took an average of 7.5 prescription and non-prescription medicines.

Dr. Zed said tackling the problem is complex, as it involves the hospitals that discharge people with a regimen of drug treatment to follow, pharmacists, family physicians who oversee their care and prescribe medicine, and home-care services and nursing homes that are also supposed to monitor patients.

The paper recommends doctors and other healthcare professionals avoid duplicating drugs, discontinue those that are unnecessary, monitor kidney function and anticipate drug interactions.

Patients should also be encouraged to use just one pharmacy and report non-prescription drugs and alternative-health products they take to their doctors, the study says.