Hospitals are supposed to be places of recovery and healing. But they can also be dangerous. A 1999 landmark study sponsored by the Institute of Medicine (IOM) estimated that medical errors in hospitals kill between 44,000 and 98,000 Americans each year. Approximately 7,000 of these deaths are due to errors in medications. The message is clear: Whether you’re being treated for a heart attack or a heel spur, you should know how to protect yourself before you set foot in a hospital.
In hospitals, the biggest threat often comes in little pills. In 2006, the IOM issued a follow-up to its 1999 study, estimating between 380,000 and 450,000 hospital drug errors occur each year. This figure climbed dramatically in long-term care facilities where nearly 800,000 people suffered due to drug mistakes. The report concluded that there were at least 1.5 million preventable medication errors overall each year and stressed that the true number may actually be much higher.
Sometimes these errors occur when patients are the sickest and least able to catch a problem. The Agency for Healthcare Research and Quality studied patients admitted to two intensive care units and found that almost 10 percent of them suffered a preventable adverse event — and most of these events involved medication errors.
With so many medications flowing through the average hospital ward, mistakes are inevitable, says Mark Graber, chief of medicine at the Veteran’s Administration (VA) Hospital in Northport, New York. “Medical care is extremely complex, and giving medications is the most complex thing we do,” he says. The average patient at the VA hospital takes nine different medications, he says, and the doses and schedules are constantly changing.
Since the IOM report was released, hospitals have been working hard to take the errors out of prescriptions. Patients at Veterans Administration hospitals now wear bracelets with bar codes that match up with bar codes on their medications. Other hospitals use computer programs to eliminate the potential for mix-ups in the pharmacy. A 2008 review of 12 studies evaluating the effectiveness of the computerized physician order entry system found that 80 percent of the studies reported a significant reduction in prescribing orders. A computerized prescription system was installed at Boston’s Brigham and Women’s Hospital in 1993, and five years later serious medication errors had fallen by 83 percent.
Despite the obvious advantages of bar codes and computers, most hospitals still take the old fashioned approach: The doctor writes the prescription, the pharmacist reads the handwriting (or tries to), and the patient takes the medicine. Each prescription requires perfect communication between the doctors, pharmacists, and nurses. Every patient is just one misunderstanding — one illegible prescription, one misheard word — away from a medication error.
During the past few years, the U.S. Food and Drug Administration (FDA) has taken significant steps to help ensure the safety and accuracy of in-hospital medication regimens. In 2004, the FDA issued a regulation that requires bar codes on most prescription drugs and on over-the-counter drugs commonly used in hospitals.
Vigilance: The best defense
For patients in any hospital, vigilance continues to be the only defense. “Every patient should know exactly what medications they are on,” Graber says. If a new medication shows up, if one disappears, or if there’s a sudden change in dosages, the patient needs to ask questions. “You just have to be as alert as you can,” he says. “Unfortunately, a lot of people in the hospital aren’t in the best position to be alert.”
Strength in numbers
That’s the basic problem with hospitals: The people with the most to lose may be dazed with medications or fighting for survival. For this reason, friends and family members can be invaluable allies. In addition to checking and rechecking medications, they can ask and answer questions, serve as go-betweens for nurses and doctors, and provide much-needed moral support.
Here are some other tips for preventing medical errors in the hospital:
- Make sure doctors and nurses know about all of the other drugs you currently take — both prescription and over-the-counter medications, including dietary supplements. Ideally, you should bring the medicine bottles to give the healthcare workers a firsthand look. A written list can also be very helpful.
- Look at every medicine before you pop it in your mouth. If it doesn’t look familiar, double-check with a nurse.
- Make sure nurses check your ID bracelet before giving you medicine.
- Remind your doctor and nurses about any allergies or sensitivities before you start a new drug.
- If you have to undergo a test or procedure, ask if it will require another drug.
- Before you go home, have a doctor, nurse, or pharmacist describe how to take any new prescriptions. Ask if they should be refrigerated or if you need to take them with a meal or on an empty stomach.
- If English isn’t your first language, ask that a bilingual family member or translator be present when a doctor or nurse has to describe how to take new prescriptions.
- Never be afraid to ask questions.
Remember, the nurses and doctors in the hospital are on your side. They want you to take the right medications, and they want to help you get better. They just might need a hand.
Institute of Medicine. Preventing Medication Errors. July 2006.
Interview with Mark Graber, MD, chief of medicine at the Veteran’s Administration Hospital in Northport, New York.
Barker, KN, et al. Medication errors observed in 36 health care facilities. Archives of Internal Medicine. September 9, 2002. 162: 1897-1903.
Institute for Safe Medication Practices. Be an informed consumer. 2003.
Institute of Medicine. Preventing death and injury from medical errors requires dramatic, system-wide changes. November 29, 1999.
Strategies to Reduce Medication Errors. Michelle Meadows. FDA consumer Magazine. May-June 2003.
ICU Patients at Significant Risk for Adverse Events and Serious Errors. Press Release, August 8, 2005. Agency for Healthcare Research and Quality, Rockville, MD.
Food and Drug Administration. FDA Issues Bar Code Regulation. February 2004.
Shamliyan, TA, et al. Just what the Dr. ordered. Review of the evidence of the impact of computerized physician order entry system on medication errors. Health Services Research. February 2008; 43(1 pt 1): 32-53.