Americans spend billions of dollars every year on prescription drugs, over-the-counter medications, weight-loss products, vitamins, and herbal supplements. Many products are beneficial when used as directed — they cure illness and maintain and improve our health.
But the explosive use of these products means there is plenty of room for error. Medication errors have become far too common and costly in today’s health care system.
In July, the nation’s Institute of Medicine (IOM) issued a landmark report, Preventing Medication Errors. The report jolted the health care industry, stating that medication errors injure an estimated 1.5 million people each year in the United States. IOM also calculated that the expense of treating drug-related injuries in hospital costs alone is some $3.5 billion annually. Both numbers, IOM said, were likely underestimates.
But the disturbing part of the report was that IOM considered these 1.5 million errors to be preventable. Such preventable errors can occur at any point along the way — from prescribing to dispensing to administering to monitoring the drug for side effects. Patients, too, can be confused about instructions for taking the medication.
To reduce such errors, IOM listed action steps for everyone involved in health care: patients, nurses, pharmacists, physicians, hospitals and health care organizations, pharmacies, government agencies, and pharmaceutical companies. Among the recommendations were improved drug container labeling, more information for consumers, better communication of medication information to consumers and providers, and the use of electronic prescribing and other information technology applications.
All are good steps, of course, but what IOM said is crucial to reducing medication errors is “establishing and maintaining strong partnerships between health care providers and patients” — in essence, improving the patient-provider relationship.
Through a new initiative called Med List, Massachusetts patients, providers, and pharmacists now have tools to help them do just that.
Launched by the Massachusetts Coalition for the Prevention of Medical Errors and the Massachusetts Medical Society, with support from the Betsy Lehman Center for Patient Safety and Medical Error Reduction, Med List promotes patient safety in three ways.
First, it helps patients track their use of medications, when they should be taken, the purpose for taking them, if monitoring is required, and possible danger signs. Second, it helps patients discuss their medication history and use with their physicians. And third, it gives physicians more complete and accurate information about a patient’s medications, thus providing a safer level of care.
Med List promotes a process called “medication reconciliation.” This is done during medical visits when a physician compares the patient’s current medication list with the list in the medical record, discusses the list with the patient, makes necessary adjustments, and ensures the updated list is shared with the patient and the physician coordinating care. The purpose of reconciling medications is to avoid medication errors associated with omission, duplication of therapy, drug-to-drug interactions or drug-to-disease interactions.
The process addresses a significant contributor to medication errors: poor communication between patients and physicians. The physician or nurse practitioner may not be aware of all the medications or supplements the patient is taking, or may not know that the patient stopped taking a medication. The patient may not know the purpose of the medication or possible side effects that might indicate trouble. Med List provides a reminder to the patient and physician to discuss these topics and have a permanent record for the patient to keep.
IOM also urged physicians to educate their patients about the medications they are taking, why they are taking them, what the medications look like, what time they should take them, potential side effects, what to do if they experience side effects, and what regular testing is necessary. Physicians should also remind patients about appropriate physician-ordered monitoring.
A great advantage of Med List is that it addresses all the players: patient, prescriber, and pharmacist. Med List includes Actions for Prescribers, a checklist for inpatient and outpatient providers, nursing homes, and assisted living facilities; and Actions for Pharmacists, a similar checklist for pharmacists. Both contain recommendations from IOM to improve medication safety.
Remember, though, that Med List is just a tool. The initiative for using it must come from the patient, health care provider, and pharmacist. But used often and carefully, Med List can be a great step forward in patient safety and reducing medication errors.
Dr. Ronald Goodspeed is president of the Massachusetts Coalition for the Prevention of Medical Errors, and president and CEO of the Southcoast Hospitals Group in Fall River, New Bedford, and Wareham.