By Megan Headley
From ordering medications to long-term monitoring, there are countless steps in the medication episode of care that can lead to harm. Data from the World Health Organization indicates that medication-related errors cause at least one death every day and injure approximately 1.3 million people each year in the United States alone.
Part of the challenge is the sheer number of drugs being managed. According to the 2014 National Hospital Ambulatory Medical Care Survey:
- 2% of physician office visits involved drug therapy, and 3.2 billion drugs were ordered or provided
- 5% of hospital outpatient department visits involved drug therapy, and 329.2 million drugs were ordered or provided
- 6% of hospital emergency department visits involved drug therapy, and 317.6 million drugs were ordered or provided
That’s a lot of room for error.
In the recently released report A Dose of Insight: A Data-Driven Review of the State of Medication-Related Errors and Liability in American Healthcare, experts from the medical professional liability insurance and services provider Coverys describe some of the vulnerabilities they’ve identified in their analysis of more than 10,000 closed medical professional liability claims between 2012 and 2016. Per the research, medication-related claims are the fourth most common root cause of claims, with over two-fifths (42%) of medication-related errors occurring in the office or clinic setting.
“We call our malpractice data ‘signal data,’ ” explains Robert Hanscom, JD, vice president of business analytics for Coverys. “It’s a narrow part of the healthcare world … but the signals should tell you what you should be on the alert for in your present environment.”
What the data is signaling
Per the findings, the initial order remains the riskiest step in the medication episode of care. While the report also notes that allegations related to the ordering of medication are on the decline—potentially an indication that newer technologies and processes are making ordering safer—35% of medication-related claims still focus on ordering as the root cause. Medication monitoring and management follow close behind.
Medication reconciliation remains a leading challenge, particularly for patients who see a broad number of specialists. The report presents some suggestions to help patients manage their data—including mobile apps to keep track of medications, or paper “medication cards” that are regularly updated—but Hanscom points out that patients have become more knowledgeable in the last decade about managing their care.
“Patient portals, where patients have a much better view of their test results and the medications they have been prescribed, are playing a role in helping more patients become educated,” he points out. But for physicians, having more information available for medication reconciliation can present its own challenges.
Technology aimed at helping providers manage the prescription process has without a doubt been helpful, but Hanscom wonders if EHRs and other IT-based systems could play a bigger role in solving these problems, noting, “I think we’ve been surprised by the fact that there hasn’t been even more of an impact.”
Hanscom notes that with the introduction of EHRs and CPOE systems, it was widely expected that medication management would be more easily addressed through these systems. “I think we’re seeing certainly a decline in malpractice claims that are related to administration, prescribing, management, etc., but I don’t think we’re seeing the leap forward that we thought we would,” he says.
This could be, in part, due to the new strain that this information puts on already-harried physicians. “They are seeing many more patients than they ever used to in shorter periods of time,” Hanscom says. “This is the tough side to the EHR. It gives them critical information, but the adverse side of that is information overload.”
While the solutions to better medication reconciliation, monitoring, and so on may be there in the data, data is nothing without processes to manage it.
“What they need is the right information to be able to sort through what they need to be able to pay attention to. I think the systems, and what’s been done to create an IT-supportive, safer environment, have been definitely movements in the right direction. But we still have to remember that physicians need the mental bandwidth to be able to pay attention to what’s in front of them, and I don’t think [the industry] has done a good enough job in trying to sort this out,” says Hanscom.
The report points out that 10 years ago, there was a significant push in healthcare to focus on the importance of medication reconciliation. While advances have been made, the industry has changed rapidly in the last decade.
“I think we’re due for a push around medication reconciliation,” Hanscom says. “Particularly with patients that are on complex mediation regimens—including anticoagulants—those patients are generally receiving this as one of several different medications. Once you have a patient who is on a variety of different medications at the same time, you really have this monitoring challenge, which I think can easily get lost in the shuffle of a very busy world of healthcare.”
Tools that work
EHRs may hold unexplored potential to improve medication reconciliation, but the report also highlights a number of advancements that these experts say have led to an improved medication environment:
- By adding scannable barcodes to the traditional patient wristband, many organizations have improved accuracy in accessing medication information. Now new advances are helping healthcare facilities produce more durable and reliable barcodes, with water and heat resistance helping them withstand up to a week of wear.
- The five rights. Not all noteworthy solutions are tech-based. Training healthcare workers who administer medication to double-check on the five rights—right patient, right medication, right dose, right route, and right time—can reduce risks of adverse events.
- Antibiotic stewardship. The Centers for Disease Control and Prevention estimates 20%–50% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate. Effective antibiotic stewardship programs require the coordinated involvement of physicians, pharmacists, infection preventionists, laboratory professionals, nurses, and IT teams.
- Smart pumps for IV opioids. In hospital and inpatient clinic settings where patients are given patient-controlled analgesia to control pain, smart pumps are helping prevent life-threatening overdoses.
- Oxygen monitoring with IV opioids. Continuous respiratory monitoring of patients on IV opioids is helping clinicians prevent opioid-induced sedation and respiratory depression, a sometimes fatal event.
- Self-assessments. For high-alert medications like opioids and anticoagulants, practitioners are benefitting from assessment tools and checklists that gauge their organization’s practices on evaluating patients.
The number one tool leading change
Of course, one of the most valuable tools that has risen in the last decade is the new reliance on data to drive decision-making. Providers willing to use this data to explore areas of vulnerability regarding medication errors can begin finding solutions to slow those errors immediately.
About the Author
Megan Headley is a contributing author to PSQH.