August 1st, 2019
After the Institute of Medicine’s landmark study on medical errors, To Err is Human, was published at the turn of the century, health systems have taken great steps to improve quality of care and patient safety. However, there is still much room for improvement, as a recent study in The BMJ finds.
Dr. Maria Panagiati from the Greater Manchester Patient Safety Translational Research Centre at the University of Manchester and colleagues conducted a systematic review of studies measuring rates of preventable patient harm in medical care settings around the world.
Out of 70 studies including more than 300,000 patients, the overall prevalence of preventable patient harm was 6 percent, meaning that more than one in twenty patients experience preventable harm. The rate of severe preventable harm (including harm leading to death), was about 7 out of 1000 patients. Thirty-three of the studies (47%) were conducted in the US, 27 (39%) in Europe, and 10 (14%) in other countries.
Preventable harm from medications was one of the most frequent forms of harm. One quarter of harmful events were medication-related, meaning that about 15 out of 1000 patients suffer preventable harm from medications. This finding corresponds with the Lown Institute’s recent paper, Medication Overload: America’s Other Drug Problem, which documents the growing harm from adverse drug events among older Americans.
In an accompanying editorial, Dr. Irene Papanicolas, associate professor at the London School of Economics and Political Science, and Dr. Jose Figueroa, assistant professor at Harvard Medical School, write that engaging patients and the public is essential for identifying potential causes of preventable harm. “Patients and their families can capture important information from their experience of care, which can be crucial to understanding factors that led to harm, such as lapses in communication, staffing issues, and the care environment,” they write. Additionally, creating a culture where near-misses are seen as learning opportunities, rather than only as a source of punishment or embarrassment, could lead to better reporting of these incidents, and better understanding of preventable harm.
Along with engaging patients and families and encouraging reporting of near-misses, there are steps that institutions could take to reduce preventable harm from medications. The growing number of medications that older Americans are taking makes more difficult for clinicians to know all of the medications their patients are taking, and identify potential drug-drug interactions. Conducting regular medication reviews, to make a complete medication list (with the help of patients and families), and identify potential drugs to deprescribe, can help reduce potential harm.
Patients are especially vulnerable to adverse drug events during transitions from the hospital to nursing home or community. Clinicians should have processes in place to review patients’ medications before discharge to make sure their drug regimen is appropriate and safe. Adding pharmacists to hospital care teams can be extremely helpful in conducting medication reviews and avoiding adverse drug events.
For more recommendations on reducing medication overload and adverse drug events, keep an eye out for our upcoming Action Plan to Eliminate Medication Overload in January 2020!