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Many
injuries in LTC facilities are preventable, June 2005- Drug-related injuries continue to be a major problem in long-term care, both in Canada and the United States, and they are more common than previously thought, according to a study published in the American Journal of Medicine in early 2005. The study involved two large, long-term care facilities—one in Ontario and one in Connecticut—with a total of 1,247 long-term stay residents. Over a period of nine months (2000-2001), 815 adverse drug events were recorded. Of these, 225 were serious, life-threatening or fatal. The most common adverse events were over-sedation, confusion, hallucinations, delirium, and gastrointestinal problems (abdominal pain, diarrhea, constipation and bleeding). Out of a total of 815 adverse events, 338 were judged preventable. Errors occurred most commonly at the ordering and monitoring stages (as opposed to the dispensing and administration stages). Most commonly, the problem was the wrong dose or the wrong drug choice. Interestingly, both of the long-term care facilities in the study are classified as “academic” facilities (ie, they are connected to medical schools with on-site research and training programs). One of the study authors said this does not bode well for facilities that are not connected to medical schools. “The academic centres in our current study are exceptional facilities, strongly committed to improving patient care and safety, and with many more resources than community nursing homes. So if we’re seeing these rates at these facilities, we believe they must occur at similar or higher rates at most nursing homes in the country,” said Dr. Terry Field, University of Massachusetts Medical School. Following this study, enhanced surveillance and reporting systems were recommended, as well as intensified educational efforts. Computerized order entry with clinical decision support may hold the greatest promise for reducing medication errors, the report states, noting that this would require scarce financial resources. Lead author Dr. Jerry Gurwitz says families can play a big role. “In many of our studies, we’ve seen that it is often a family member who brings attention to a problem with a medication. So engagement of family members in the care of their older relatives is very important. People should be aware of the drugs that are being prescribed, the reasons for their use, and potential drug side effects, and they should report any changes they notice in their relative’s condition,” Dr. Gurwitz said. Reference |