Due to the mounting evidence that medication errors are becoming a cost that this country cannot afford, the United States Congress mandated that the Centers for Medicaid and Medicare Services sponsor a study by the Institute of Medicine (IOM) that would address the problem.
In 2000, the IOM caused a national stir when it published To Err is Human: Building a Safer Health System. This was followed by Crossing the Quality Chasm: A New Health System for the 21st Century. These publications documented the need for a safer healthcare system in which errors could be decreased or eliminated.
Prescription for Problems
The latest IOM report, Preventing Medication Errors, concludes that medication errors are common and costly. It also lays out an extensive plan for decreasing the frequency of these errors. This report shows that errors occur in every step of the medication process, however, they are most common when prescribing and administering. Taking into account preventable errors in hospitals, long-term care facilities, and outpatient Medicare patient settings, the IOM committee concluded that there are at least 1.5 million adverse drug events (ADEs) in the United States every year.
The cost of these errors is alarming. In one study, preventable ADEs added $8,750 to the cost of a hospital stay. Another study of Medicare enrollees over 65 years of age found that treating medication errors in this group cost $887 million per year. Clearly, eliminating medication errors could reduce the cost of healthcare or put additional money into underfunded areas.
Taking Action
The IOM committee recommends encouraging patients to take a more active role in their healthcare, thus developing a partnership with healthcare providers. Communication is key and includes listening and talking to patients. As an element of better communication, patients should keep a record of the medications they take and assume more responsibility in monitoring and reporting side effects.
The committee also advises that medication information provided to patients at pharmacies should be standardized, that more drug information be available to patients on the Internet, and that a 24-hour national telephone help line be established.
Advances in information technology have produced methods to help alleviate errors, and the committee recommends that new technologies be put to use. Point-of-care references such as the Internet and personal digital assistants allow prescribers to access information about medications and aid in decision-making. Electronic prescriptions help eliminate errors related to legibility and completeness of the prescription. Electronic-prescription systems can also include information about the patient's history so that mistakes related to allergies, drug-to-drug interactions, and overdoses can be avoided. The IOM committee recommends that all prescribers and pharmacies use electronic prescriptions by 2010.
The report also advises that labeling and packaging of medications needs improvement. As part of this recommendation, the committee states that pharmaceutical companies and federal agencies should work together to prevent drugs from having sound-alike or look-alike names, abbreviations, and acronyms.
Implementing recommendations from this IOM report will necessitate changes on the part of healthcare providers, patients, and in the current system-a huge undertaking. However, the committee believes that the changes will be beneficial in reducing preventable adverse drug events and will lessen the cost to the nation's economy.