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A drug by any other name...


Dermatologists and other physicians can expect increased pressure to provide prescriptions electronically as one method of reducing medication errors, which the Institute of Medicine (IOM) of the National Academies says harm at least 1.5 million people every year.

In a report issued in July, the IOM says the extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year. The IOM says at least 400,000 preventable drug-related injuries occur each year in hospitals, while another 800,000 occur in long-term care settings and roughly 530,000 occur just among Medicare recipients in outpatient clinics.

The cyber-move

It recommends that by 2008, all healthcare providers should have plans in place to write prescriptions electronically, and by 2010, all providers should be using e-prescribing systems.

By then, it says, all pharmacies should be able to receive prescriptions electronically.

The Food and Drug Administration (FDA) immediately issued a statement saying the FDA is already working on many of the committee's recommendations.

According to the IOM, all healthcare provider groups should be actively monitoring their progress in improving medication safety, suggesting that such efforts might include computer systems that detect medication-related problems and periodic audits of prescriptions filled in community pharmacies.

The study committee was headed by J. Lyle Bootman, Ph.D., Sc.D., dean and professor at the University of Arizona College of Pharmacy, and Linda R. Cronenwett, R.N., Ph.D., professor and dean, School of Nursing, University of North Carolina.

Scope of errors

Medication errors encompass all mistakes involving prescription drugs, over-the-counter products, vitamins, minerals or herbal supplements.

The study says errors are common at every stage in the process. It estimates that on average, there is at least one medication error per hospital patient per day.

Establishing and maintaining strong partnerships between healthcare providers and patients is crucial to reducing medication errors, the committee says, calling on consumers to be active partners in their medication care and on physicians, nurses and pharmacists to know and act on patients' medical care rights.

The report provides consumers a list of specific questions to ask providers, such as how to take their medications properly and what to do if side effects occur. Patients should ask providers for a printed record of the drugs they have been prescribed and should maintain an up-to-date list of all medications they use - including over-the-counter products and dietary supplements. That should be shared with all their healthcare providers, the committee advises.

The IOM report says the FDA should work with other groups to standardize the text and design of medication leaflets so they are comprehensible and useful to all consumers. The FDA says that in January, it announced a "major revision" to the format of prescription drug information on the package insert to give providers "clear and concise" prescribing information.

Navigating the name game

Confusion caused by similar drug names accounts for up to 25 percent of all errors reported to the Medication Error Reporting Program operated cooperatively by United States Pharmacopeia (USP) and the Institute for Safe Medication Practices (ISMP), the study says.

In addition, labeling and packaging issues were cited as the cause of 33 percent of errors, including 30 percent of fatalities.

The IOM report says drug-naming terms should be standardized as much as possible, and all companies should be required to use the standardized terms. The FDA, the Agency for Healthcare Research and Quality (AHRQ) and the pharmaceutical industry should collaborate with USP, ISMP and other appropriate organizations to develop a plan - by the end of 2007 - to address the problems associated with drug naming, labeling and packaging.

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