Medicine
When physicians and health care administrators talk about about "improving patient safety," they're usually referring to preventable events that occur in hospitals: blood transfusion mismatches, or infections in intensive care units, to give examples. But the vast majority of health care takes place in communities, in outpatient or ambulatory care settings ("ambulatory" being something of a misnomer, since wheelchair-bound patients can and do seek treatment in offices). In this setting, errors in dosing prescription and over-the-counter medications are an important safety issue.
Taking doses that are too large, or taking correct doses too frequently, can cause serious and even fatal side effects. An advisory committee to the Food and Drug Administration recently voted to lower the maximum daily dose of Tylenol due to evidence that many adults sustain liver damage by inadvertently taking too much. On the other hand, inadequate dosing of medications can result in conditions such as epilepsy, diabetes, and high blood pressure being poorly controlled.
Patients may take medicines improperly because their doctor gives inadequate oral or written instructions. More prescription medications also may make errors more likely. In a 2006 study published in the Annals of Internal Medicine, Dr. Terry Davis and colleagues examined the relationship between literacy levels and a patient's understanding of common prescription drug labels.
In this study, 395 English-speaking adults were recruited from 3 primary care clinics' waiting rooms. They were shown 5 labeled prescription medicine bottles and asked to describe how they would take each medication, including the number of pills to be taken in a day. The interview concluded with a health literacy assessment to determine the patient's literacy level: low (sixth grade and lower), marginal (seventh to eighth grade), or adequate (ninth grade and higher).
Out of 1,975 responses, 374 were incorrect. Most incorrect responses were dosage errors (51.8 percent) and dose frequency errors (28.2 percent). A few patients were unable to find the instructions on the label (5.8 percent) or admitted to being unable to read (3.2 percent). Incorrect responses were strongly associated with low and marginal literacy levels, and the risk of an incorrect response increased with more medications used. Surprisingly, many patients who read the instructions correctly still counted out an incorrect number of pills.
This study reinforced my longstanding (but unfortunately time-consuming) practice of asking all of my patients who take regular medications to bring in their pill bottles at every visit so we can go over how to take each one properly. Quite often, I'd find that another doctor had added or changed a prescription without telling me about it, often leading the patient to take two different medicines for the same condition. Without a single physician coordinating care, medication errors become almost inevitable. So how might health reform address this problem? Stay tuned.
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Medicine
Medication errors and patient safety
When physicians and health care administrators talk about about "improving patient safety," they're usually referring to preventable events that occur in hospitals: blood transfusion mismatches, or infections in intensive care units, to give examples. But the vast majority of health care takes place in communities, in outpatient or ambulatory care settings ("ambulatory" being something of a misnomer, since wheelchair-bound patients can and do seek treatment in offices). In this setting, errors in dosing prescription and over-the-counter medications are an important safety issue.
Taking doses that are too large, or taking correct doses too frequently, can cause serious and even fatal side effects. An advisory committee to the Food and Drug Administration recently voted to lower the maximum daily dose of Tylenol due to evidence that many adults sustain liver damage by inadvertently taking too much. On the other hand, inadequate dosing of medications can result in conditions such as epilepsy, diabetes, and high blood pressure being poorly controlled.
Patients may take medicines improperly because their doctor gives inadequate oral or written instructions. More prescription medications also may make errors more likely. In a 2006 study published in the Annals of Internal Medicine, Dr. Terry Davis and colleagues examined the relationship between literacy levels and a patient's understanding of common prescription drug labels.
In this study, 395 English-speaking adults were recruited from 3 primary care clinics' waiting rooms. They were shown 5 labeled prescription medicine bottles and asked to describe how they would take each medication, including the number of pills to be taken in a day. The interview concluded with a health literacy assessment to determine the patient's literacy level: low (sixth grade and lower), marginal (seventh to eighth grade), or adequate (ninth grade and higher).
Out of 1,975 responses, 374 were incorrect. Most incorrect responses were dosage errors (51.8 percent) and dose frequency errors (28.2 percent). A few patients were unable to find the instructions on the label (5.8 percent) or admitted to being unable to read (3.2 percent). Incorrect responses were strongly associated with low and marginal literacy levels, and the risk of an incorrect response increased with more medications used. Surprisingly, many patients who read the instructions correctly still counted out an incorrect number of pills.
This study reinforced my longstanding (but unfortunately time-consuming) practice of asking all of my patients who take regular medications to bring in their pill bottles at every visit so we can go over how to take each one properly. Quite often, I'd find that another doctor had added or changed a prescription without telling me about it, often leading the patient to take two different medicines for the same condition. Without a single physician coordinating care, medication errors become almost inevitable. So how might health reform address this problem? Stay tuned.
- Pharma Industry Free Speech Is Anything But Free
Last month, the American Medical Association (AMA) called for a ban on direct-to-consumer (DTC) advertising of prescription drugs and medical devices, arguing that this type of advertising drives the nation's escalating drug bill by creating demand...
- How To Make Sure Patients Understand Health Information
In the current issue of American Family Physician, Dr. Barry Weiss shares an anecdote about a hospitalized patient's confusion about a conversation between himself and a consultant who said that it was okay to move her from the intensive...
- Preventing Electronic Medical Errors
Even though it happened several years ago, I still experience a visceral feeling of guilt and embarrassment when I recall the time I almost prescribed the wrong type of antibiotics for a patient's inner ear infection. As medical errors go, this would...
- Money-saving Medication Tips
When you purchase a new item of clothing, television set, or a car, as a general rule you can assume that the higher-quality items are the newest and/or those with the highest price tags, even if you know little about the products themselves. But this...
- Why I'm A Doctor And Not A Pharmacist
One of my favorite patients in residency was a lady in her seventies who had longstanding high blood pressure, high cholesterol, and diabetes. Each time she visited the office, I would recommend that we start multiple medications to control these conditions,...