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Many Malpractice Cases on Drug Reactions Preventable

Study finds 73% of drug errors could be avoided

MONDAY, Nov. 25, 2002 (HealthDayNews) -- Nearly three-quarters of physician malpractice claims involving bad reactions to drugs could be avoided with safety measures like computerized prescribing systems and greater pharmacist involvement in patient care, a new study has found.

The study of more than 2,000 New England malpractice claims in the 1990s found 6 percent were a result of adverse drug reactions. Of those, 73 percent were a result of overdoses, botched orders and other preventable mix-ups. Most of the incidents, some of which were deadly, involved antibiotics, blood thinners and other cardiovascular drugs, mood medication, and anti-psychotics.

"One of the main problems was communication" between doctors, said Dr. Jeffrey Rothschild, a Harvard University physician and lead author of the study. Errors also occurred when hospitals had nurses doing tasks better left to residents, Rothschild said. And many resulted from inadequate training.

A controversial 1999 report from the Institute of Medicine found that 44,000 and 98,000 people die each year from medical errors. The 7,000-plus medication errors annually eclipses the number of workplace deaths in this country.

Harvard University doctors conducted the new study, which appears in today's Archives of Internal Medicine.

Rothschild and his colleagues evaluated 2,040 medical malpractice claims filed in New England between 1990 and 1999. Of those, 129 (or 6.3 percent) were the result of adverse reactions to drugs. Nearly half of these cases were serious or fatal. Two doctors who reviewed the cases deemed that 94 of them (73 percent) to be preventable blunders.

Costs to insurers of defending the adverse drug reaction claims ran about $65,000 for non-preventable outcomes -- for instance, a bad reaction that couldn't be foreseen -- that occurred in a hospital. However, the price tag for the blunders that were deemed to be preventable rose to $376,000.

Using computers to process prescriptions and catch potential mistakes could prevent about 40 percent of drug errors, Rothschild said. Having clinical pharmacists go on rounds with physicians could avoid 50 percent of such mistakes. Also effective are "smart" infusion pumps that help nurses at the bedside administer appropriate doses of medications.

In 1999, the Institute of Medicine panel called for a 50 percent reduction in errors by 2004.

Panelist Mary Wakefield, a nurse who directs the Center for Rural Health at the University of North Dakota in Grand Forks, said the last three years have seen "substantive" progress. "That report's not a sleeper," she said.

Wakefield said the document has catalyzed debate and changes at all levels of health care, from hospitals and medical school campuses to providers and patient groups.

Dr. Joseph Scherger, dean of the college of medicine at Florida State University in Tallahassee, who was also on the errors committee, said he's optimistic that the 2004 goal is achievable, if not even beatable.

However, Scherger said lack of adequate funding for safety initiatives and "inertia" on the part of doctors has blocked more rapid progress.

What To Do

The Institute of Medicine and the U.S. Food and Drug Administration have information on medical errors. For more on patient safety, visit the National Patient Safety Foundation.

SOURCES: Jeffrey M. Rothschild, M.D., M.P.H., Brigham and Women's Hospital, instructor, Harvard Medical School, Boston; Joseph Scherger, M.D., M.P.H., dean, College of Medicine, Florida State University, Tallahassee; Mary Wakefield, R.N., Ph.D., director, Center for Rural Health, University of North Dakota, Grand Forks; To Err Is Human, Institute of Medicine, 1999; Nov. 25, 2002, Archives of Internal Medicine
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