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1. BEWARE OF DRUGS THAT BEGIN WITH THE LETTER "Z"

2. PHYSICIANS TRAINED AT CERTAIN MEDICAL SCHOOLS ARE MORE LIKELY TO BE SUED FOR MALPRACTICE THAN OTHERS

3. VIBRATING SHOES MAY PREVENT FALLS IN UNSTEADY PATIENTS

Patient Safety Monitor Alert, October 8, 2003

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1. BEWARE OF DRUGS THAT BEGIN WITH THE LETTER "Z"

Health care providers are continuing to confuse drugs that begin with the letter "Z." Three of them in particular, Zantac, Zyrtec, and Zyprexa, are leading to dangerous drug mix-ups in pediatric patients, the Food and Drug Administration (FDA) reports.

Some providers are mistakenly dispensing Zyrtec syrup, an antihistamine, when Zantac, acid reducer ,was the drug that had been prescribed. The two drugs don't have overlapping dosage strengths, but are both available as syrup that comes in amber, one-pint bottles.

The Institute for Safe Medication Practices (ISMP) has also reported on mix-ups between Zyrtec and Zyprexa, an antipsychotic. Both drugs are available in 5 mg and 10 mg tablet strengths. One patient who mistakenly took Zyprexa instead of Zyrtec suffered a head injury after losing consciousness, the ISMP reports.

The manufacturer of Zyprexa has redesigned the product's label using tall-man lettering to better highlight the drug's name.

The FDA suggests that providers educate staff medication errors that can result from mix-ups involving look-alike, sound-alike drugs and that hospitals store such drugs separately on pharmacy shelves. Click here for more information.

The Joint Commission on Accreditation for Healthcare Organizations also requires physicians to include the indication for the drug on the prescription and that providers instruct patients to make sure they have received the right medication and the right dosage.

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2. PHYSICIANS TRAINED AT CERTAIN MEDICAL SCHOOLS ARE MORE LIKELY TO BE SUED FOR MALPRACTICE THAN OTHERS

Physicians are significantly more likely to be sued for malpractice if they graduated from a medical school whose graduates are often sued, reveals a study in Quality and Safety in Health Care (Vol. 12, p. 330-6).

Researchers merged data on malpractice claims from three US states with physician data to calculate the proportion of graduates sued for malpractice between 1990 and 1997. Schools were identified as high or low "outliers" according to the number of its graduates who had been sued in the past.

Medical schools that are outliers for malpractice lawsuits against their graduates in one decade are likely to retain their outlier status in the subsequent decade, the researchers found. Public schools and schools that are more recently established have higher incidences of malpractice lawsuits among their graduates than other medical schools.

Some reasons for these findings may include the quality of education offered at the schools, the choice by graduates to enter into specialties that might increase their chances of being sued, and the type of students that the school may attract. Understanding these reasons could help educators develop "best practices" for medical education, the researchers conclude.

The study did not identify which schools with the highest proportion of graduates who have been sued for malpractice.

Click here to view the report.

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3. VIBRATING SHOES MAY PREVENT FALLS IN UNSTEADY PATIENTS

An inch-thick, vibrating insole may one day help wobbly patients keep their balance, according to a study published October 4 in the British journal Lancet (Vol. 362, No. 9390).

Using clear gel insoles, researchers from Boston (MA) University and Harvard Medical School found that small vibrations can neutralize the effects of age- related nerve degradation that can make elderly people unsteady on their feet.

A Rhode Island-based medical device company, Afferent, is already working to turn the insoles into a consumer product, although the technology is years from being ready for public use, say the researchers. For starters, the insoles are not yet small enough to fit into any shoe and are powered by a bulky battery pack.

Every year, about one-third of people over 65 suffer a fall, causing injuries and threatening their independence. The total bill, from fractured hips and other serious ailments, comes to at least $20 billion every year, according to one study.

Click here here for more information.

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Questions, comments, story ideas?

Contact managing editor Wendy Johnson at wjohnson@hcpro.com

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