MONDAY, Nov. 11, 2002 (HealthDayNews) -- As many as one in seven heart attacks in heart patients may be the result of medical errors, accidents that could be prevented by more vigilant physicians.
That's the message from the American Heart Association, which today issued a new statement calling for changes to improve safety for heart attack and stroke victims. The statement recommends implementing computer systems to track prescriptions and drug doses, and more doctor education on ways to avoid drug mix-ups involving like-sounding compounds.
The guidelines also stress the problem of "errors of omission" -- when doctors fail to offer eligible patients potentially life-saving therapies. Certain heart drugs, such as heparin, beta blockers and angiotensin-converting enzyme (ACE) inhibitors are widely under-prescribed, experts say.
Avoidable medical errors are blamed for between 44,000 and almost 100,000 deaths a year in this country, according to a recent report from the Institute of Medicine. Data for how many of these involve heart and stroke patients are scarce.
One study of 203 heart attacks found that 14 percent, or one in seven, resulted from a doctor's action. Medication errors were to blame 44 percent of the time, and half were preventable.
"It is clear," the statement says, "that with increasing patient age and the frequent prescribing of multiple medications, concerted efforts for prevention, reporting and management must be undertaken nationwide."
The statement appears in tomorrow's issue of Circulation.
Medical errors are about twice as common in people over 65 as in younger patients -- occurring in 5.3 percent versus 2.8 percent of hospital patients, respectively. That difference reflects the fact that older patients often have more than one health problem, requiring them to take multiple treatments.
One potential pitfall in treating stroke patients is overdoses or mistimed administration of clot-busting drugs. The statement suggests hospitals take steps to streamline the use of these treatments, including reducing the number of these drugs available in the hospital, standardizing order forms and protocols for using the drugs, and being sure to record a patient's weight to calibrate the proper dose.
Bill Hendee, vice president of the Medical College of Wisconsin and secretary of the National Patient Safety Foundation, says heart and stroke patients are especially vulnerable to medical errors because their condition is so dicey from the start.
However, Hendee adds, the measures the statement outlines, while needed, aren't so easy to implement.
Improved reporting, for example, runs into the reluctance of doctors and hospitals to accept blame that might lead to liability. "Denial is ingrained in the system," Hendee says.
Similarly, computerized drug order systems are hamstrung by the fact that it's usually easier for a physician to write a prescription than type it on a keyboard. "After that, it's probably more efficient and less error-prone, but for physicians it is just a burden," Hendee says.
Dr. Christopher Granger, a Duke University cardiologist who has studied medical errors in heart patients, says doctors should strive to be more careful. However, Granger adds the impact of the steps laid out in the new statement might not be as great as they appear on paper.
"One needs to be careful in ascribing bad outcomes to a medication error, because medication errors are more likely to occur in patients who are more likely to have bad outcomes," Granger says. "We should be doing all we can to avoid them. But the relationship of the errors and the bad outcome may not be quite as close as it appears on the surface."
In one study, for example, Granger and his colleagues found the risk of serious bleeding in heart attack patients was the same when doctors mistakenly prescribed clot-busters or sugar pills, between three- and four-fold in each case. The reason: People who get the wrong dose of a drug frequently have other high-risk characteristics that make poor results likely, he says.
What To Do
For more on patient safety, try the National Patient Safety Foundation or the National Coordinating Council for Medication Error Reporting and Prevention. You can also check the Institute for Safe Medication Practices.
