Therapeutic Misadventure

Therapeutic Misadventure
by Harold Stearley

It's all in how you word your disasters
In 1991, the Harvard Medical Practice Study determined that errors in treatment accounted for the deaths of an estimated 180,000 people each year -- the equivalent of three jumbo jets crashing and burning every other day.
All told, the 1.3 million Americans injured annually by medical treatments become just another statistic. The individual identities are lost, the pain and suffering hidden, the curtain is drawn, and the industry somehow remains untarnished -- it's all in how you word your disasters.

Nurses intercepted 86 percent of all medication errors
As early as 1964, studies published in the Annals of Internal Medicine by Dr. E. M. Schimmel, indicated that 20 percent of all patients admitted to university hospital settings had some form of medically inflicted injury. Of these injuries, one-fifth suffered serious disability or death.
That was just the beginning. Here are some more recent figures:

According to studies published in the 1981 New England Journal of Medicine, 36 percent of all inpatients suffered physician-inflicted injury, with 25 percent being serious or life-threatening.
Patients in intensive care had 1.7 medication errors per patient, per day, as reported in a 1989 study. Twenty-nine percent of these errors had the potential for death.
64 percent of all cardiac arrests in the hospital setting were not only totally preventable, but were caused by the inappropriate use of prescription medication, said a 1991 JAMA report.
Almost 11 percent of all hospitalizations in this country are caused by complications produced by physicians misprescribing drugs -- either the wrong medication, the wrong dosage, or in combination with incompatible drugs, according to a 1994 Hospital Practice editorial.
The July 5, 1995 issue of the Journal of the American Medical Association (JAMA) reported that 19.4 percent of all medical injuries were caused by adverse drug events (ADEs). Errors in physician's ordering accounted for 39 percent of these ADEs, with an additional 12 percent associated with the way they transcribed the orders. Incidents associated with nurses administering medications accounted for 38 percent of the ADEs, and the remaining 11 percent of the errors occurred when pharmacists dispensed the medications. Not surprisingly, the physician authors offered a "systems analysis" of these errors and determined it was not any one individual or group of practitioners who were responsible, but rather the systems under which medical practitioners work which produce the errors.
Complex health care systems inherently impede the communication of vital patient and treatment information. Lack of knowledge regarding the medications was the most common proximal cause of errors producing 22 percent of the patient injuries, followed by lack of information about the patient's status or underlying conditions at 14 percent. The remaining errors were caused by violating prescribing rules on dosage and administration, by "memory lapses," or by inadequate monitoring. The errors specifically committed by the nursing staff were attributed to excessive workloads, and lack of experienced nurses.
The JAMA study also revealed that it was the nurses who intercepted 86 percent of all medication errors and prevented their occurrence. The pharmacy staff intercepted an additional 12 percent of the errors, so the massive number of drug related injuries were caused by the 2 percent of errors which slipped through the system.
There seems to be no question that errors will occur in medical practice. If the physician researchers are correct in their assessments about health care delivery systems accounting for increases in the numbers of these adverse events, then we all, as consumers of health care, had better take note of how present and future systems are implemented. Managed health care has attempted to apply the same assembly-line techniques used in the production of wood pulp to the delivery of patient care. As the statistics of therapeutic misadventure rise under these new "drive-through" medical plans, let's not forget these casualties have names, faces, and families. We might even know some of these statistics personally.

It's all in how you word your disasters	In 1991, the Harvard Medical Practice Study determined that errors in treatment accounted for the deaths of an estimated 180,000 people each year -- the equivalent of three jumbo jets crashing and burning every other day. All told, the 1.3 million Americans injured annually by medical treatments become just another statistic. The individual identities are lost, the pain and suffering hidden, the curtain is drawn, and the industry somehow remains untarnished -- it's all in how you word your disasters.
Nurses intercepted 86 percent of all medication errors	As early as 1964, studies published in the Annals of Internal Medicine by Dr. E. M. Schimmel, indicated that 20 percent of all patients admitted to university hospital settings had some form of medically inflicted injury. Of these injuries, one-fifth suffered serious disability or death. That was just the beginning. Here are some more recent figures: According to studies published in the 1981 New England Journal of Medicine, 36 percent of all inpatients suffered physician-inflicted injury, with 25 percent being serious or life-threatening. Patients in intensive care had 1.7 medication errors per patient, per day, as reported in a 1989 study. Twenty-nine percent of these errors had the potential for death. 64 percent of all cardiac arrests in the hospital setting were not only totally preventable, but were caused by the inappropriate use of prescription medication, said a 1991 JAMA report. Almost 11 percent of all hospitalizations in this country are caused by complications produced by physicians misprescribing drugs -- either the wrong medication, the wrong dosage, or in combination with incompatible drugs, according to a 1994 Hospital Practice editorial. The July 5, 1995 issue of the Journal of the American Medical Association (JAMA) reported that 19.4 percent of all medical injuries were caused by adverse drug events (ADEs). Errors in physician's ordering accounted for 39 percent of these ADEs, with an additional 12 percent associated with the way they transcribed the orders. Incidents associated with nurses administering medications accounted for 38 percent of the ADEs, and the remaining 11 percent of the errors occurred when pharmacists dispensed the medications. Not surprisingly, the physician authors offered a "systems analysis" of these errors and determined it was not any one individual or group of practitioners who were responsible, but rather the systems under which medical practitioners work which produce the errors. Complex health care systems inherently impede the communication of vital patient and treatment information. Lack of knowledge regarding the medications was the most common proximal cause of errors producing 22 percent of the patient injuries, followed by lack of information about the patient's status or underlying conditions at 14 percent. The remaining errors were caused by violating prescribing rules on dosage and administration, by "memory lapses," or by inadequate monitoring. The errors specifically committed by the nursing staff were attributed to excessive workloads, and lack of experienced nurses. The JAMA study also revealed that it was the nurses who intercepted 86 percent of all medication errors and prevented their occurrence. The pharmacy staff intercepted an additional 12 percent of the errors, so the massive number of drug related injuries were caused by the 2 percent of errors which slipped through the system. There seems to be no question that errors will occur in medical practice. If the physician researchers are correct in their assessments about health care delivery systems accounting for increases in the numbers of these adverse events, then we all, as consumers of health care, had better take note of how present and future systems are implemented. Managed health care has attempted to apply the same assembly-line techniques used in the production of wood pulp to the delivery of patient care. As the statistics of therapeutic misadventure rise under these new "drive-through" medical plans, let's not forget these casualties have names, faces, and families. We might even know some of these statistics personally.

Albion Monitor January 12, 1996 (http://www.monitor.net/monitor)

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Therapeutic Misadventure

by Harold Stearley

It's all in how you word your disasters

Nurses intercepted 86 percent of all medication errors

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