Deaths caused by mixing prescription medications with alcohol or street drugs-especially in patients' homes-have increased dramatically over the past 22 years, according to findings from the first large-scale U.S. study of out-of-hospital medication use.
Researchers at the University of California, San Diego, examined nearly 50 million death certificates filed between 1983 and 2004, focusing on those citing medication error as the cause of death. Fatal medication errors overall rose 361% from 1983 to 2004 and were classified into four categories:
* type 1: at home, involving alcohol or street drugs or both (rose a staggering 3,196%)
* type 2: at home, not involving alcohol or street drugs (rose 564%)
* type 3: not at home, involving alcohol or street drugs or both (rose 555%)
* type 4: not at home, not involving alcohol or street drugs (rose only 5%)
By way of comparison, in the same period deaths from alcohol or street drug use alone-not combined with medication error-rose 41%, deaths from medication adverse effects rose 33%, and deaths from surgical error rose 43%. Increases in fatal medication errors were found in all age groups except children ages nine and younger. Adults 40 to 59 years old showed the greatest increase, whereas those older than 60 showed the smallest. Before this study, most research on medication errors focused on elderly patients in clinical settings. These results suggest that "more research should be devoted to middle-aged patients and domestic settings," write the authors.
Over the 22 years of the study, services have shifted from inpatient to outpatient care, many drugs once administered in hospitals are taken at home, and more drugs once given only by prescription are available over the counter. All of these factors can make it easier for people to mix medications with alcohol or street drugs-which many people don't know "can be a serious mistake," says epidemiologist Gwendolyn E. C. Barker, a study coauthor. She notes that antidepressants or painkillers like codeine can cause major problems when taken with alcohol.
These results show that nurses must more closely evaluate patients' ability to manage medications, screen them more often for alcohol and drug abuse, and educate them more thoroughly. Nurses "are in a good position to give patients clear directions about drug use," Barker says, "and point out the dangers of combining drugs or drinking alcohol with drugs."
Carol Potera
World Health Roundup
[black right pointing small triangle][black right pointing small triangle] Arab countries formed a nurses' union at a July nursing conference in Amman, Jordan, reported the Kuwait News Agency. Ten Arab countries were represented at the conference. Mohammed Hatamlah, the dean of the Jordanian nurses' union, noted that Arab nurses of both sexes think nursing has enjoyed less progress in Arab countries than other disciplines have. The new Arab Union of Nurses will confront the profession's problems in order to advance and regulate nursing in their countries.
[black right pointing small triangle][black right pointing small triangle] New HIV and AIDS recommendations are available from the World Health Organization, which launched a guide, Priority Interventions: HIV/AIDS Prevention, Treatment, and Care in the Health Sector, at the 15th International AIDS Conference in Mexico City in August. Continual updates to the guide will reflect the latest recommendations. The authors intend the guide to help countries provide universal access to HIV prevention and services by 2010. To print out a copy of the guide, go to http://www.who.int%2fhiv%2fpub%2fguidelines%2f2008priorityinterventions%2fen%2fi.
[black right pointing small triangle][black right pointing small triangle] Nurses' bill of rights endorsed at AIDS conference. Recognizing that many nurses, especially those in developing countries, are at high risk for HIV, the Association of Nurses in AIDS Care and Physicians for Human Rights issued a joint call to action at the 15th International AIDS Conference in August. Calling upon world leaders to provide for the health needs of nurses and other health care workers and to enact policies and programs to ensure the health and safety of nurses in the workplace, the statement is available at http://actnow-phr.org%2fcampaign%2fnurses%26%2395%3bhealth%26%2395%3brights.