Risk Watch e-column
August 2006
An update of risk management news, issues and items of interest
A Preventable Epidemic: Drug Errors
A serious drug error cannot only add time to a hospital stay, but thousands of dollars to a patient’s bill as well. According to a July report from the Institute of Medicine (IOM), Preventing Medication Errors, there are about 400,000 preventable medication errors yearly in U.S. hospitals alone—costing patients $3.5 billion.
The IOM found that, on average, patients can expect to be subjected to one medication error per day. However, not all of these errors are serious enough to warrant further time in the hospital.
A 1999 estimate put deaths from medication errors at a conservative 7,000 per year. The 400,000 total number of injuries is also a conservative estimate. The report only tabulates the probable number of mistakes made in hospitals and nursing homes and not mix ups in doctors’ offices or by patients themselves.
There have already been efforts to minimize errors—among them bar-coding medications. To further reduce the potential for errors, the IOM is advocating that by 2010 all prescriptions be written electronically.
Among the IOM’s other recommendations:
- Patients and their families should be aggressive in obtaining from their physician a list, rationale and dosage for all of their prescribed drugs and have it on hand during every healthcare interaction.
- The United States should invest $100 million annually in research about how to avoid medication errors.
- The Food and Drug Administration should improve drug information leaflets, eliminating confusing jargon.
- The federal government should establish telephone hotlines to assist those who speak foreign languages, the illiterate, or those who have other problems.
One of the biggest challenges facing physicians is that there are about 10,000 approved prescription and 300,000 over-the-counter drugs, which makes it impossible to memorize important patient factors that need to be assessed when prescribing a medication.
It is estimated that four out of five American adults take at least one medication or dietary supplement every day. And about a third of these patients take at least five.
(Source: Institute of Medicine)
Cursive Writing Banned from Washington State
The state of Washington has banned cursive writing from the prescription pad. Under the provisions of a law that took effect on June 7, physicians will be required to hand print, type or electronically generate their prescriptions. If they don’t, the prescription will not be filled.
One of the advocates of the law, William Robertson MD of the Washington Poison Center, told the Seattle Post-Intelligencer that of 6,000 randomly sampled prescriptions collected throughout the state, 24% to 32% were found to be illegible.
According the article, the new law is forcing physicians to slow down while writing prescriptions—carefully printing and reviewing them before giving the order to patients.
(Source: Seattle Post-Intelligencer)
Modern Humans Evolving
The way humans live has evolved in the last 100 years as have humans themselves.
Humans in industrialized countries are smarter, heavier, taller and living longer than ever. They are also healthier, staving off chronic diseases like heart disease, lung disease and arthritis until later in life.
That’s what University of Chicago researcher Robert W. Fogel has discovered, according to The Indianapolis Star.
Researchers believe that improved medical care is only part of the reason for the transformation. Childhood vaccinations and good nutrition seem to play an important role, as well. Indeed, the researchers point to key events in a person’s life before the age of 2 that will determine a long life free from chronic ailments. Conversely, having a serious health problem earlier in life makes a person prone to developing a chronic condition sooner.
However, researchers worry that obesity could blunt the strides industrialized humanity has taken toward the next evolutionary leap. Civil War-era males had a body mass index of 23 (normal) while today’s men have one of 28.2 (overweight and edging to obesity).
(Source: The Indianapolis Star)
Breast Cancer History Has Two Sides
When they give their family history about breast cancer, female patients may only have half the story—their mother’s. The lack of information about breast cancer in their father’s family may make patients and physicians discount the patient’s risk for the disease. This is the conclusion reached by researchers at Virginia Commonwealth University.
In a study of 899 women age 40 and under, the researchers found that 16% of women reported a history of breast cancer in their mother’s family, and 10% reported that the disease was present in their father’s family.
For the researchers, this discrepancy was higher than expected. Statistically speaking, the numbers should have been nearly identical. It has been established that the genetic risk of breast cancer is passed on equally from the father and mother.
The findings have particular impact on physicians who rely on family history to gauge breast cancer risk, so it is important for these physicians to inquire about the history of the disease in the patient’s father’s family. The results of the study will be published in the September 2006 issue of the American Journal of Preventative Medicine.
(Source: American Journal of Preventative Medicine)
Medi-Spas Must Be Operated by a Qualified Physician
In its quarterly newsletter, Action Report, the Medical Board of California recently reiterated that a non-physician cannot provide the services offered at a medi-spa. These specifically include laser and cosmetic medical treatments.
According to the Medical Board, a physician cannot legally act as a “medical director” for a medi-spa operated by a layperson. A physician acting as an employee of a lay-owned business would be aiding and abetting the unlicensed practice of medicine per Business and Professions Code sections 2264, 2286 and 2400.
A medi-spa can provide laser or cosmetic medical services if it is either part of a physician-owned practice or a professional medical corporation with a physician as the majority shareholder.
(Source: Action Report)
