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Study: Many adverse drug events among elderly outpatients are preventable
Colorado anesthesiologists sue governor in the name of patient safety
Residents offer tips for reducing errors in teaching hospitals

Patient Safety Monitor Alert, March 5, 2003

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STUDY: MANY ADVERSE DRUG EVENTS AMONG ELDERLY OUTPATIENTS ARE PREVENTABLE

Most hospital professionals worry about adverse drug events among inpatients, but outpatients—especially the elderly—also suffer from harmful reactions to drugs. Adverse drug events among population are not uncommon-and many of them are preventable, according to a study recently published in the Journal of the American Medical Association (JAMA).

Researchers found 1,523 adverse drug events among the 27,617 Medicare enrollees (all age 65 years or older) they studied. They considered 421 (or 27.6 percent) of those events preventable.

Most of the errors occurred at the prescribing and monitoring stages, though some were also caused by patients not taking their medications as instructed, according to a press release from JAMA. Cardiovascular agents, diuretics, antibiotics, nonopioid analgesics, and anticoagulants were the medications most commonly associated with the preventable events.

Jerry H. Gurwitz, MD, from the University of Massachusetts Medical School in Worcester, MA was the lead researcher on the study. His colleagues included David W. Bates, MD, MS, a consultant who serves on the advisory board for McKesson MedManagment, which helps hospitals prevent adverse drug events.

COLORADO ANESTHESIOLOGISTS SUE GOVERNOR IN THE NAME OF PATIENT SAFETY

Anesthesiologists in Colorado are suing the state's governor to keep him from exempting the sate from federal Medicare rules that require a physician to supervise nurses that administer anesthesia.

Medicare allows the governor to bypass the supervision requirement if, among other things, it is "consistent with state law and in the best interest of the citizens of Colorado," according to a press release from the Colorado Society of Anesthesiologists (CSA) The lawsuit seeks a "declaratory judgment" that the exemption is contrary to current state law that requires a physician to supervise anesthesia nurses.

"Patients expect and deserve their anesthesia care to be supervised by a physician," said Randall M. Clark, MD, spokesperson for the CSA, in the press release. "This has been a state law in Colorado longer than anyone can remember and it has been a federal law since 1965."

Supporters of the exemption argue that the requirement could cause rural facilities to have to transfer their patients to urban centers or even close down, says Clark.

RESIDENTS OFFER TIPS FOR REDUCING ERRORS IN TEACHING HOSPITALS

Residents may be new to the discipline, but they have suggestions for reducing errors, too-especially when it comes to mistakes in the teaching hospitals where they work. In a recent New England Journal of Medicine article, Kevin G. M. Volpp, MD, PhD, and David Grande, MD, offer suggestions for improving patient safety in teaching hospitals, based on their experience as residents. Their suggestions cover use of technology, improvement of the work environment, and changing the "academic culture." Here are some of their recommendations:

- Designating messages on alphanumeric pagers as emergency, urgent, or routine, to reduce residents' distractions during patient care

- Developing a single system for chart storage, vital-sign flow sheets, equipment type and location, storage and contents of procedure kits, and examination-room layout, so that residents don't lose time trying to find or figure out how to use equipment

- Providing formal training in leadership and management for residents to better equip them for facilitating good communication and coordination among the care team

According to the authors, some people have expressed concern that residents may not learn from their errors if mistakes are attributed to system problems. In that case, "a balance must be achieved that allows residents to take personal responsibility for their errors and to discuss them constructively as a means of facilitating collective learning and improving clinical practice," they wrote in the article.

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