Viewpoint: Many drug errors can be prevented

November 6, 2006

Medication safety has always been an important issue, but the Institute of Medicine's (IOM) recent report showing that preventable medication errors injure at least 1.5 million Americans annually illustrates the seriousness of this predicament. The authors of the IOM report, Preventing Medication Errors: The Quality Chasm Series, even acknowledge that this is likely a conservative assessment of drug safety gaps. The report noted that each year 530,000 preventable adverse drug events-injuries due to medication-affect outpatient Medicare patients, 380,000 to 450,000 occur in hospitals, and another 800,000 in long-term care facilities.

The problem of medication errors stems from our fragmented healthcare system. Drugs are becoming increasingly complex, placing a premium on whether patients are getting the right drug, at the right dose, and at the right time. And with prescription medication utilization on the rise, and as patients see multiple doctors for a variety of conditions, the likelihood of adverse drug reactions will continue to grow.

While the adoption of e-prescribing has been slow to take hold, there are encouraging signs. In February 2005, three of the nation's largest automakers along with Blue Cross Blue Shield of Michigan, Health Alliance Plan/ Henry Ford Medical Group, and Medco Health Solutions launched the Southeast Michigan e-Prescribing Initiative, an e-prescribing pilot program that recently hit a milestone of one million Rxs submitted using e-prescribing technology. Approximately 98,000 of those were changed or canceled due to drug interaction alerts received through e-prescribing, thus demonstrating the important impact this technology can have on preventing errors.

In addition, integrated data networks that link medical records with lab and pharmacy data can alert clinicians to potential risks, including drug and disease interactions that often occur because of a lack of shared information among different physicians treating the same patient. In 2005, Medco's RationalMed Patient Safety System sent 1.5 million alerts to physicians and R.Ph.s about possible drug errors, demonstrating the importance of systems that use electronic medical records to bring potential conflicts in care to the attention of doctors. This becomes even more critical when patients are seeing more than one doctor or receiving drugs from multiple pharmacies.

While some of its recommendations are directed at clinicians, IOM encourages patients to take more responsibility for their care by monitoring what they are taking and understanding their medical condition. This places the onus on patients to keep accurate records of their medicines, but technology can also help here. Health plans and PBMs can ease this burden by providing easily accessible on-line tools. For example, Medco's on-line pharmacy-at http://www.medco.com/-provides patients with their own printable prescription drug history that can be shared with their doctors.

These alarming new statistics about patient injuries could have a profound response within the medical community. IOM's 1999 report on medical errors spurred investments in computerized physician order entry to remedy those problems. The new IOM report could be the catalyst that takes us that last mile in eliminating the preventable problem of medication errors. Solutions are available. The call for e-prescribing by 2010 will require some investment, but the price of this technology is a lot less than the costs associated with medication errors.