1 in 10 patients gets drug errors in Mass. community hospitals

(Community hospitals are usually charitable institutions)

One in every 10 patients admitted to six Massachusetts community hospitals suffered serious and avoidable medication mistakes, according to a report being released today by two nonprofit groups that are urging all hospitals in the state to install a computerized prescription ordering system. The report is the first large-scale study of preventable prescription errors in community hospitals, and its author, Dr. David Bates of Brigham and Women's Hospital in Boston, said he was surprised that these mistakes were so frequent in these community hospitals. Previous studies in large academic hospitals that also lacked computerized systems found such medication errors occurred less than half as often, he said.

Researchers declined to release the names of the six Massachusetts hospitals, which participated in the $5 million study voluntarily on condition that they would remain unnamed. Of 73 hospitals in the state, only 10, almost all of them large teaching hospitals in Boston, have adopted the computerized physician order entry system, which requires doctors to type into a central database every medical order, including prescriptions, diagnostic tests, and blood work. The doctors' orders are matched against the patient's medical history, triggering red flags to prevent problems related to drug allergies, overdoses, and dangerous interactions with other drugs. Bates said that after this system was put in place at Brigham and Women's Hospital in 1995, preventable medication errors declined by 55 percent over the next two years.

The researchers could not explain the higher rate of preventable errors in the community hospitals but cautioned against patients assuming that these hospitals overall are less safe than academic teaching hospitals. They said this is one of only a small number of studies nationwide that have analyzed prescription error rates at hospitals, and comparisons are difficult because each study varied slightly in its scope and definitions.

Donald Thieme, head of the Massachusetts Council of Community Hospitals, said studies show that many community hospitals offer the same, if not better, care for patients with some serious illnesses. He said community hospitals struggle to adopt the computerized prescription systems because of cost, but they are committed to improvements because they want "errors down to zero." Thieme said he could not comment on the specifics of today's study because he had not seen it.

Community hospitals in Massachusetts may not have a choice but to implement such computerized systems, based on increasing pressure from insurers who see the systems enhancing patient safety and saving money. Gerald Greeley, director of information services at Winchester Hospital, said Blue Cross Blue Shield of Massachusetts and Harvard Pilgrim Health Care, over the last year, have demanded the gradual introduction of the computerized physician order entry system as a condition of reimbursement contracts with Winchester Hospital.....

The researchers reviewed a total of 4,200 randomly selected patient medical charts at the six community hospitals, covering stays from January 2005 to August 2006. An average of 10.4 percent of patients suffered a preventable "adverse drug event" - defined as a case in which the patient was given a drug even though the medical records noted that the medication could trigger a drug allergy or that the dose given would exacerbate a medical condition. Medication errors were counted only when patients suffered serious reactions, including going into shock or suffering kidney failure. In nearly every instance, the patients remained in the hospital longer to recover from the mistake. Nobody died from any of the mistakes, researchers said.

Everett said the study's findings can be "generalized to all hospitals" without such computerized systems, and indicate that prescription errors are often made in the rushed hospital atmosphere. She recommended that patients inquire about a hospital's patient-safety systems, and ask medical staff to double-check dosages and names of all medications given. "I'd demand it," she said.

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Australia: Another disastrous public hospital

New hospital worse than the old one

THE new $98 million Bathurst hospital is so dysfunctional it is dangerous, doctors say, forcing the Health Department to halt demolition of the old one and raising serious concerns about the future of all hospital redevelopments. Surgeons have indefinitely suspended routine elective surgery at the new Bathurst Base Hospital, warning that serious design and construction flaws - such as an inadequate emergency alarm system and a pipe that leaked raw sewage into the maternity ward - are putting patients at risk.

It is the latest in countless public hospital blunders that have forced the Health Minister, Reba Meagher, to call a Special Commission of Inquiry into acute care services in NSW, which began last week. "The minister has sought urgent advice from the area health service about the issues from the redevelopment. This number of issues with a brand new hospital is unacceptable and we are getting to the bottom of that," a spokeswoman for Ms Meagher said yesterday. She said medical staff had been extensively consulted during the planning stage. But the Opposition and doctors say the debacle raises wider concern about the consultation process on all of the state's hospital redevelopments, including the $702 million Royal North Shore facility.

Significant problems with the new Bathurst hospital include possible hanging points and access to sheer drops outside the mental health unit - which has remained empty - and major communication failures with pagers and mobile phones. Medical Staff Council chairman Chris Halloway said areas in intensive care, operating theatres and accident and emergency were also too small. Dr Halloway said the hospital, which opened three weeks ago, was unsafe. "It's mainly accident and emergency and the surgical features that are the problem. The reason that we had to cut off elective surgery is simply . so we could cope with the dysfunction," he said. "We can't deliver a proper standard of patient care . the community in Bathurst don't have the health care facility that they had a couple of months ago."

The inadequate alarm system was "a pivotal safety issue" but also only half of the intensive care beds could be seen from the nurses station due to poor design, he said. "[It] seems to us to be clinically crazy."

Dozens of patients have had their surgery postponed. One Bathurst hospital doctor, who did not want to be named, said developers had decided to "shrink-fit the facility". "They didn't consult us and what consultation there was they didn't pay attention to," he said.

A spokeswoman for the Greater Western Area Health Service did not dispute the safety concerns. A team of technical experts had been at the hospital all weekend attempting to rectify the problems, she said. A fire and safety audit had been ordered as well as an audit on room sizes. "This is a really serious issue for us and we're working extremely hard to try and assess the issues," she said. She said area health service agreed to doctors' demands not to demolish the old hospital yet. "It was down to start tomorrow. It has been deferred until Wednesday," she said.

"It's just another case of the Iemma Government and Reba Meagher failing to listen to frontline health workers," the Opposition Leader, Barry O'Farrell, said. The GWAHS spokeswoman said clinicians were engaged in "extensive consultation".

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