TIPS
FOR
SUCCESS
Three Simple Rules to Improve Medication Safety Vincent Barba, MD, FACP, FHM, CPPS
A
medical error is defined as the ‘‘failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aimIincluding problems in practice, products, procedures and systems.’’1 Even after more than 10 years of national effort, medical errors persist at alarming rates. One group of investigators reported there were approximately 18 million adverse events in the United States every year. There are 37,600,000 annual admissions to about 5,000 U.S. hospitals. Using the IHI Global Trigger Tool methodology, they estimated that there were 49 adverse events per 100 admissions. That amounts to 18,424,000 adverse events annually in the United States.2 This astonishing number alone should motivate us to action. However, productive improvements in this area have been slow to arise. In 2000, The Institute of Medicine calculated up to 98,000 U.S. deaths annually because of medical errors.1 The monetary cost of patient safety events has been estimated at 17.1 billion dollars per year. Pressure ulcers are the most common adverse event. Medication related adverse events are reported to occur over 38,000 times annually resulting in approximately 778,000 injuries.3 In 2007, researchers reviewed the literature to assess the incidence of preventable adverse drug events (ADE) in the ambulatory care arena. The incidence rate was reported to be 5.6/1000 person months with an ADE preventability rate of 21%. The incidence of preventable ADE requiring hospitalization was noted to be 4.5/1000 person months. Inadequate therapy monitoring was most frequently responsible for hospital admissions.4 A cohort study of Medicare enrollees cared for by one multispecialty group practice was published in 2003 and reported that the rate of preventable adverse drug events was 1.2/1000 person months.5 Patients are harmed every year because of poor medication safety practices. To improve this situation, many strategies have been deployed in an attempt to avoid errors that lead to harm events. For instance, all hospitals accredited by The Joint Commission (TJC) must have a process for reconciling medications across the continuum of care for all patients. There are other issues such as errors in prescribing, dispensing, and distribution that contribute to patient safety in medication use that will not be discussed here.
THREE SIMPLE RULES With many patients taking more than one medication, a process must be developed whereby all patients benefit from medication safety processes (Table 1).8 Three simple rules are proposed to enhance patient safety in the clinical practice setting when prescribing or evaluating a patient’s medications: 1. Any medication prescribed for a particular condition must be clinically effective as proven by medical evidence. 2. Any medication administered must be safe for the patient to use. 3. The therapeutic plan developed by the clinician with the patient must be followed.
SIMPLE GUIDE TO MEDICATION SAFETY Evaluate each medication as it relates to the patient’s known medical history and follow the 3 simple rules by asking the following 3 simple questions: 1. Is this medication clinically effective for this problem we are attempting to treat? 2. Is it safe for the patient to be taking this medication? 3. Is the patient using this medication properly or at all? In answering these three simple questions, we are getting to the heart of quality care. In 2003, researchers reported that only 55% of patients receive appropriate care.6 By asking these 3 simple questions, each clinician can ensure that their patients are being appropriately managed at each visit. From the Department of Medicine and Preventative Medicine, Rutgers New Jersey Medical School, Newark, New Jersey. Correspondence: Vincent Barba, MD, FACP, FHM, CPPS, Chief Quality Officer, University Hospital and NJ Medical School (e
FOR
SUCCESS
Three Simple Rules to Improve Medication Safety Vincent Barba, MD, FACP, FHM, CPPS
A
medical error is defined as the ‘‘failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aimIincluding problems in practice, products, procedures and systems.’’1 Even after more than 10 years of national effort, medical errors persist at alarming rates. One group of investigators reported there were approximately 18 million adverse events in the United States every year. There are 37,600,000 annual admissions to about 5,000 U.S. hospitals. Using the IHI Global Trigger Tool methodology, they estimated that there were 49 adverse events per 100 admissions. That amounts to 18,424,000 adverse events annually in the United States.2 This astonishing number alone should motivate us to action. However, productive improvements in this area have been slow to arise. In 2000, The Institute of Medicine calculated up to 98,000 U.S. deaths annually because of medical errors.1 The monetary cost of patient safety events has been estimated at 17.1 billion dollars per year. Pressure ulcers are the most common adverse event. Medication related adverse events are reported to occur over 38,000 times annually resulting in approximately 778,000 injuries.3 In 2007, researchers reviewed the literature to assess the incidence of preventable adverse drug events (ADE) in the ambulatory care arena. The incidence rate was reported to be 5.6/1000 person months with an ADE preventability rate of 21%. The incidence of preventable ADE requiring hospitalization was noted to be 4.5/1000 person months. Inadequate therapy monitoring was most frequently responsible for hospital admissions.4 A cohort study of Medicare enrollees cared for by one multispecialty group practice was published in 2003 and reported that the rate of preventable adverse drug events was 1.2/1000 person months.5 Patients are harmed every year because of poor medication safety practices. To improve this situation, many strategies have been deployed in an attempt to avoid errors that lead to harm events. For instance, all hospitals accredited by The Joint Commission (TJC) must have a process for reconciling medications across the continuum of care for all patients. There are other issues such as errors in prescribing, dispensing, and distribution that contribute to patient safety in medication use that will not be discussed here.
THREE SIMPLE RULES With many patients taking more than one medication, a process must be developed whereby all patients benefit from medication safety processes (Table 1).8 Three simple rules are proposed to enhance patient safety in the clinical practice setting when prescribing or evaluating a patient’s medications: 1. Any medication prescribed for a particular condition must be clinically effective as proven by medical evidence. 2. Any medication administered must be safe for the patient to use. 3. The therapeutic plan developed by the clinician with the patient must be followed.
SIMPLE GUIDE TO MEDICATION SAFETY Evaluate each medication as it relates to the patient’s known medical history and follow the 3 simple rules by asking the following 3 simple questions: 1. Is this medication clinically effective for this problem we are attempting to treat? 2. Is it safe for the patient to be taking this medication? 3. Is the patient using this medication properly or at all? In answering these three simple questions, we are getting to the heart of quality care. In 2003, researchers reported that only 55% of patients receive appropriate care.6 By asking these 3 simple questions, each clinician can ensure that their patients are being appropriately managed at each visit. From the Department of Medicine and Preventative Medicine, Rutgers New Jersey Medical School, Newark, New Jersey. Correspondence: Vincent Barba, MD, FACP, FHM, CPPS, Chief Quality Officer, University Hospital and NJ Medical School (e
