To err may be human, but Canadian
hospital staff may be wearing their human fallibility
on their sleeves when it comes to dealing with heavily
medicated patients. According to a Toronto-based study,
more than half of patients taking over four prescription
medications end up with medication errors on their charts
when they're admitted via the emergency ward.
Speaking on the telephone from
his University of Toronto office, study co-author Dr
Steven Shadowitz, an internal medicine specialist, said,
"We look for medical errors not to assign blame, but
to find weaknesses in the system and fix them. Doctors
and nurses are human and humans make mistakes."
Writing in the February 28 issue
of the Archives of Internal Medicine, the researchers
looked at the charts of 523 patients admitted to hospital
over a three-month period. The study included 151 patients
with an average age of 77 years, all of whom had at
least four prescriptions on file before admission.
DISCONCERTING
NUMBERS
Comparing the information entered at admission with
detailed interviews conducted later with patients and
families, the authors found discrepancies in 53.6% of
the cases. The most common error was the omission of
a medication that was regularly used by the patient.
Other types of errors included noting a wrong dosage,
a mistaken frequency of dosage, or an incorrect drug
prescription. The authors concluded that nearly 40%
of the errors could have led to moderate to severe discomfort
or clinical deterioration.
Dr Shadowitz said he was not surprised
by the results. The ER "is a challenging environment,"
he explained. "There are a lot of decisions to make,
multiple demands on the physician. And it is time-consuming
to take a good medication history." He added, "[It can
also be] hard to confirm the accuracy of a drug history.
The physician has to make phone calls and sometimes
the pharmacists cite patient confidentiality [and won't
release the information.]" But he feels that "the main
reason these errors occur is because patients are not
always aware of all the pills they are taking."
According to Dr Shadowitz, the
best way to prevent such errors is to advise patients
to always carry a list of their medications and make
sure their loved ones have a copy as well. He'd also
like to see more provinces adopt a central electronic
prescription database like the one in use in BC. What's
more, he calls for a greater role for pharmacists in
working with the admitting staff: "They are professionals
specially trained to recognize prescribing errors."
Arch Intern Med Feb 28, 2005;165:424-9
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