The Medication Error Problem
When most people enter a hospital or pick up a prescription, it never occurs to them that they might be given the wrong dose of a medication, or a drug not intended for them. Yet numerous studies show that medical mishaps, including medication errors, run rampant in the U.S. health care system.
Consider the heartbreaking, widely sited story of a Boston Globe health reporter who received a fatal overdose of chemotherapy drugs at the Dana-Farber Cancer Institute - Boston's premier cancer treatment center. In November, 1994, Betsy Lehman, a 39-year-old mother of two, entered Dana-Farber for her third round of chemotherapy for breast cancer.
"She was dealing with horrendous symptoms," her husband, then a scientist at Dana-Farber, told Globe reporters, who wrote an award-winning series on the story. "She was vomiting sheets of tissue. They [Lehman's physicians] said this was the worst they'd ever seen. But the doctors said this was all normal."
On December 3, 1994 - the day Lehman was to be discharged - she left a message on a friend's answering machine sometime after 11:00 in the morning. "She sounded very distraught, tense and agitated," her friend, Hester Hill, told the Globe. "She said, 'I'm calling because I'm feeling very frightened, very upset. I don't know what's wrong, but something's wrong.'"
At 12:15, when a member of Lehman's treatment team came into her room, she was dead. The cause: heart failure due to administration of toxic doses - four times the appropriate amount - of the drug cyclophosphamide for four days in a row. The tragic error wasn't spotted until two months later, when an assistant data manager was doing a routine review of Lehman's hospital stay.
Unfortunately, Lehman's case is just the tip of the iceberg. During the past decade, the Institute of Medicine (IoM), a division of the National Academy of Sciences, has brought together several groups of experts to look at the problem of medication errors. Although the groups have identified numerous strategies for preventing adverse drug events, the rate of medication errors continues to run unacceptably high. In 2007, the Institute of Medicine's Committee on Identifying and Preventing Medication Errors concluded that "large gaps exist in our understanding of medication error incident rates, costs, and prevention strategies. The committee believes the nation should invest about $100 million annually in research on prevention of medication errors."
Estimates show that when all types of errors are taken into account, hospital patients are subjected to at least one medication error daily. Some studies project that some 380,000 to 450,000 injuries due to medication errors occur in hospitals each year -- all of which are preventable. Other research suggests that some 800,000 preventable adverse reactions due to medication errors occur in long-term care facilities. In addition, researchers have conservatively projected that 530,000 preventable injuries due to medication errors occur among outpatient Medicare patients annually. Overall, the 2007 IoM report concluded that at least 1.5 million preventable adverse drug events occur in the United States each year.
Medication errors alone kill more than 7,000 people each year, according to a 2000 report from the Institute of Medicine – more than the 6,000 people lost to workplace injuries annually. One study found that each preventable adverse reaction due to a medication error added about $8750 to the cost of a hospital stay. Conservative estimates suggest that 400,000 of these events occur each year, costing some $3.5 billion among hospitalized patients alone. In a separate study, preventable errors occurring in Medicare enrollees aged 65 and older cost an estimated $887 million. And, these estimates do not account for lost earnings, pain, and suffering.
What is most striking, according to the 2007 report, is that most of the harm due to medication errors is preventable. A variety of strategies and techniques have been developed and shown to help reduce medication errors. One of the first steps is to develop a model of healthcare that is a partnership between patients and their health care providers. Historically, the US health care system has been paternalistic and provider-centric. In the future, patients need to be encouraged and allowed to take a more active role in their own medical care.
