A recent study published in the Journal of Patient Safety concluded that more than 400,000 hospital patients die each year as a result of preventable adverse events. That estimate is stunningly higher than the landmark Institute of Medicine (IOM) study, To Err is Human: Building a Safer Health System, which estimated that the annual number of hospital deaths due to adverse events is between 44,000 and 98,000. This article explores the weighty problem of adverse events in long-term care and suggests strategies to mitigate medication-related adverse events in long-term care settings.
In 2011, more than 1.4 million residents received care in the 15,671 facilities that participate in the Medicare and Medicaid programs, according to the U.S. Department of Health and Human Services. Of those residents, almost half received nine or more medications per day. Polypharmacy and multiple chronic medical conditions combine to make frail and elderly residents especially susceptible to medication errors. Decreased renal function, impaired hearing and vision, and cognitive or functional limitations place older residents at an even greater risk for medication errors and adverse drug events. Faulty or sparse documentation of medication administration by the skilled nursing staff can add additional medical and legal risks.
Adverse drug events (ADE) are defined by the IOM as, “injuries resulting from a medical intervention related to a drug.” Multiple studies reveal that ADEs are common in the nursing home setting, with an estimated 135 ADEs per year for the average size nursing facility. As one of the most daunting problems facing nursing facilities, ADEs are credited for an estimated 93,000 deaths annually and additional healthcare costs of almost $4 billion.
ADEs occur most often at the ordering and monitoring stages. Some categories of drugs pose greater risks than others. Residents who receive antipsychotic agents, anticoagulants, diuretics and anti-epileptics are more likely to suffer from an ADE. Thus, emphasis should be placed on categories of drugs which pose a greater likelihood of serious harm as well as on the ordering and monitoring stages.
Much of the risk associated with medication errors and adverse drug events in long-term care environments can be mitigated through diligent attention to several high-risk situations that create fertile ground for such errors. Creating solid protocols surrounding prescription documentation, drug/treatment verification and proper monitoring after medication administration can help reduce health risks for residents and business risks for the facility.
TRANSITIONS OF CARE AND MEDICATION RECONCILIATION