Preventing Drug Mistakes In The Hospital

Hospitals are dangerous places. Our ancestors intuitively knew that and generally tried to stay out of the hospital if at all possible.
These days we like to think of hospitals as sterile, safe and high tech. They are unquestionably high tech, but there is still a long way to go before hospitals are truly safe and infection free.
Hospital-acquired infections are a huge problem. People who are relatively healthy when they enter a hospital may leave with persistent, even life-threatening, diarrhea caused by a bacterium called C. difficile.
But the biggest concern may be medication mistakes. In one study, one dose out of every five administered was in error (Archives of Internal Medicine, Sept. 9, 2002). The wrong drug, the wrong dose, the wrong time or omitting a drug completely are common problems.
You might think that patients would be able to keep watch on the drugs they are taking to help avoid some of these lapses. They should be motivated, since inaccurate drug administration can have life-threatening consequences.
Before patients can serve as the final safety checkers before a medication is given, however, they must know what they should be taking, when and at what dose. A new study shows that most people do not (Journal of Hospital Medicine, online Dec. 10, 2009).
The investigators questioned 50 alert patients within the first day of hospitalization. They spoke English, had no cognitive impairment and knew what medications they were taking at home. In the hospital, they had been prescribed an average of 11 medicines. When asked to complete a list of these in-hospital drugs, only 2 of the 50 could name every one. On average, patients did not know at least half of the drugs they were taking.
Older patients were even more vulnerable. When queried, they left out 88 percent of their hospital medications.
These results should not be attributed to indifference or stupidity on the part of the patients. The investigators discovered that “the majority desired a more active role in learning about their hospital medications and believed that their involvement might prevent hospital medication errors from occurring.”
Hospital procedures are designed to maximize efficiency for staff. Taking time to educate patients about what pills they are expected to swallow or which medicines are being injected may be seen as unproductive.
If a patient or family member questions a medication, it may seem to nurses or physicians as a challenge to their authority. And some people may fear being labeled a “bad patient” and punished if they ask too many questions.
As important as it is to know about benefits and risks of drugs when you are an outpatient, it is even more critical to know about your medications when you are hospitalized. To assist in gathering this important information, we offer our free Drug Safety Questionnaire.
For patients to participate as partners in making the hospital a safer place, they must be well informed. The staff may find that improving patient safety through education is worth every extra minute spent.