Medication errors present a global challenge that threatens the quality of care and patient safety and contributes to continually escalating healthcare spending.
Medication errors result in 2% to 5% of all hospital admissions worldwide—the majority of which experts believe are preventable, according to the Agency for Healthcare Research and Quality.1 As many as 30% of patients who are hospitalized encounter some degree of medication-related harm, and 7% of these incidents are severe. At least 7 million patients fall victim to preventable medication errors, costing the U.S. healthcare system $21 billion annually. Moreover, not only is the problem associated with increased lengths of stay in the inpatient setting, but it increases morbidity, mortality, and additional costs to the healthcare system.2 Despite these statistics, more than 25% of these error incidents are entirely preventable. This presents pharmacists with prime opportunities to prevent these mistakes and ameliorate the problem.2
“The pharmacy profession is well-positioned to manage high-risk medication errors, but we have to be willing to convince the leadership of value in this area and step into this role,” says Vincent Vidaurri, PharmD, BCOP, clinical oncology pharmacist at the University of Colorado Health in Fort Collins, CO.
What Contributes to Errors?
Taking on such responsibility can be arduous because any factors increase the risk for medication-related harm. Among these are advanced age, renal impairment, presence of chronic disease and comorbidities, the complexity of the patient’s medication regimen, and the administration of high-risk medications.2,3 Each medication added to a regimen increases the risk for medication-related harm exponentially. In the inpatient setting, for example, administering two medications carries a 13% risk for harm, but the risk jumps to 82% for patients receiving seven or more medications.2
Additionally, medications that are classified as “high-risk” can vary depending on the practice setting, and may include antineoplastics, anticholinergics, insulin and other hypoglycemics, antimicrobials, opioids, potassium and other electrolytes, anticoagulants, and heparin.2,4 While medication safety is problematic across the board, pharmacists and other healthcare providers can expect to encounter different and/or additional challenges depending on the environment in which they work.
“Because all medications work together to optimize treatment, I would say each medication can be considered high-risk,” observes Brenda Doughty, MBA, RN-BC, CVRN-BC, cardiac rehabilitation manager at Texas Health Arlington Memorial Hospital.
Home Health Care Challenges
Where a patient receives care plays a critical role in medication-related challenges and the risk for medication errors.
While the total number of homebound U.S. residents remains unclear, 3.4 million Medicare patients received home care in 2017.5 About one-third of older patients who received home health services either take medications inappropriate for older patients or have a potential medication-related problem. Environment and other patient circumstances often create a backdrop conducive to medication-related errors in patients who are homebound—a problem that again becomes exponentially more complicated in the elderly.
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