Medicine Errors in Nursing Homes -- Part 1

Background

- 900, 000 preventable adverse pill reactions (ADEs) each year*

- they are serious, life threatening nicely fatal

- half are preventable

*Gurwitz et far. Incidence and preventability regarding adverse drug events during Nursing Homes. Am J Therapeutic 2000; 109(2): 87-94

Why a multitude of? America is living longer and medicines are the mainstay for treating chronically ill residents. Most medication orders cost a lot by phone and often among multiple providers with limited expertise in the resident (cross-cover docs, Extenders, etc). Adjustments are often made without the present day medication list and dependant on incomplete or inaccurate information. Miscommunication results in abnormal medications, duplicative treatment in areas inappropriate dosing.

ADE Prevention Safe medicines oversight is coordinated regarding the physicians (prescribing), pharmacies (dispensing), consultant pharmacists and convalescent homes (administration and monitoring). Most ADEs occur effectively as monitoring stage. Revised increase profits with F-Tag 329 (Unnecessary Medications) the majority of F-Tag 428 (Medication Schedule Review) emphasize multidisciplinary burden. While they make a good impact on dispensing and also administration, the physician role in monitoring nonetheless underutilized and facilities might possibly not have the systems to consistent basis change this. EMR (electronic medical record) software could certainly play a pivotal role in lowering medication errors.

In spite of the guidelines most intentions of all, one of the following scenario is all very familiar:

- Day 1 Your (PCP) visit diagnosis separation anxiety and prescribes antidepressant PRODUCING.

- Day 2 Store weekend staff notes easily annoyed, calls on-call physician. Medicine list is unavailable to antidepressant B is another good.

- Day 30 Likely going to pharmacist reviews duplicate prescription medication. Recommendation left for staff to telephone PCP.

- Day 37 Recommendation provided to PCP staff. PCP understands but will not modify the medications without reviewing anybody.

- Day 50 PCP holiday escapes discontinues antidepressant B.

The scenario above was preventable if the medication list had been viable for the on-call physician.

New Opportunities Greater physician use of CPOE (e-prescribing) and electronic permanent medical record technology in Nursing Homes makes certain new opportunities for interventions error reduction.

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