In its landmark 1999 report, To Err is Human, the Institute of Medicine (IOM) found that medication errors contribute to 7,000 deaths a year. In Preventing Medication Errors (2006), the IOM estimated more than 1.5 million preventable adverse drug events in the nation each year.
Medication errors are far too common in all settings of health care, and can be especially problematic as patients move between settings. Efforts are underway in New York, however, to increase drug safety and reduce medication errors.
IPRO, the Medicare Quality Improvement Organization (QIO) for New York State, has been working since August 2008 with physician practices, pharmacists, Medicare drug plans and others to improve prescribing practices and reduce adverse medication events among Medicare beneficiaries. Two projects, Safe Warfarin-Antibiotic Testing (SWAT) and Decreasing Anticholinergenic Drugs in the Elderly (DADE), address issues related to medications that present special issues in the elderly.
While warfarin can improve clinical outcomes in numerous patient groups, it is often responsible for serious adverse events, and is among the top five drugs contributing to emergency department visits. Interaction with antibiotics and other drugs can have devastating consequences. The key to minimizing the risk of warfarin-related toxicity while maintaining efficacy is to keep each patient’s INR value within the target range, which is 2.0-3.0 for most conditions. The SWAT project highlights patient and prescriber awareness of this important interaction, and promotes more vigilant INR monitoring in such cases.
Seniors are also particularly susceptible to dangerous side effects from anticholinergic drugs. These medications can present special challenges in treating dementia, as they may diminish the efficacy of therapy. The DADE project seeks to promote safer prescribing among elderly Medicare Part D beneficiaries.
Electronic health records, with carefully constructed alerts and clinical decision support systems, can assist in managing the use of these medications. Electronic alerts can prompt the ordering of coagulation studies, with corresponding target and actual INR values. E-prescribing helps physicians avoid errors that occur with handwritten prescriptions and embedded clinical decision support tools (both vendor and user designed) can not only provide alerts for drug interactions, dosages, and allergies, but also optimize medication therapy and improve outcomes.
Good news in this regard is that the American Resource and Recovery Act (the “stimulus bill”) included a provision known as the Health Information Technology for Economic and Clinical Health (“HIGHTECH”) Act. HIGHTECH provides $17 billion for incentive payments to physicians and hospitals that participate in Medicare and Medicaid, to help them establish or upgrade EHR systems to meaningful use standards. Money and technical assistance will soon be available in New York.
Technology can play a significant role in reducing errors and ensuring patient safety. IPRO also has a number of evidence-based medication safety tools, available at: https://ipro.org/index/medication-safety-resources
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 9SOW-NY-THM6.2-10-89