Physicians, and the healthcare systems in which they work, could use something like a "watch list" to more efficiently identify medication errors that are likely to lead to injury to elderly patients. This list of drug and laboratory signals could be used to help design better and safer systems for prescribing and monitoring drug therapy, according to Jerry Gurwitz, MD, executive director of Meyers Primary Care Institute of Worcester, Massachusetts, a joint initiative of the Fallon Healthcare System and the University of Massachusetts Medical School.
These errors can lead to serious harm, known as adverse drug events (ADEs). Elderly patients are of particular concern, Gurwitz noted, pointing to a January 16, 2002 report in JAMA, which found that approximately 20 percent of community-dwelling elderly persons are taking five or more different medications on a regular basis.
Under a grant from the National Institute on Aging, Gurwitz and his colleagues found that a large number of preventable ADEs could be uncovered by examining emergency room notes, hospital discharge summaries and automated signals from lab tests.
About one third (between 35 percent and 37 percent) of each of these sources yielded information about preventable ADEs. Analyzing such information can provide "a list of drugs for which errors are more likely to occur in managing patients," he says. "It takes a more pro-active and non-passive approach to identify events that are genuinely preventable," says Gurwitz.
He notes that the least efficient and fruitful sources for getting information on preventable ADES were "voluntary reports by health care providers." This intensive research project entailed a study of 27,500 patients over 65 years of age. The study detected 1202 adverse drug events. "Physicians, pharmacists, nurses, and other healthcare professionals work in a world that is inherently dangerous to patients. We require new systems to reduce the likelihood of error in delivering patient care," says Gurwitz. "As the Institute of Medicine has said," he notes "We need to make it easier for healthcare providers to do the right things."
Founded in 1900, the ASCPT consists of over 2,200 professionals whose primary interest is to promote and advance the science of human pharmacology and therapeutics. The Society is the largest scientific and professional organization serving the discipline of Clinical Pharmacology.