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We often note here that quality improvement in hospitals seems excruciatingly slow to happen, and engaged patients and families need to keep their eyes wide open, because sometimes a fix doesn’t require being a genius. We’re in our 13th year after To Err, yet this morning SPM member Paul Bearman spotted this article by Maura Lerner in the Minneapolis Star Tribune and posted a note on our member listserv.
What I love about the story is how intelligent change can be so wonderfully effective.   A small tweak reversed critical failures in discharge prescribing. He and his colleagues decided to do a spot-check of 37 patients who were discharged from the hospital to nursing homes over three months in 2008 and 2009. The most common problems: Hospital physicians had prescribed the wrong doses, duplicate medications or omitted medications. The project worked so well, Thompson said, that some doctors now call the pharmacist before they write the discharge orders.
Share the Star Tribune article with your hospital (and nursing home’s) pharmacy staff. I personally know of two cases in my own family, in the past year, where medications were overlooked or wrong at discharge. Kudos to Bruce Thompson and team at Hennepin County Medical Center – and to all the people there who gladly adopted the change. The doctor’s original thought is still, in a way, being inspected by the pharmacist before the order is being written. I hope that the pharmacists aren’t continually finding and fixing the same problems, whether before or after order writing. That pharmacist inspection step is going to be prone to failure, before or after order writing, since 100% human inspection is never 100% effective.
I appreciate the efforts being made in hospitals, but what about the walking wounded in the clinics.
Participatory Medicine is a model of cooperative health care that seeks to achieve active involvement by patients, professionals, caregivers, and others across the continuum of care on all issues related to an individual's health. An example of a medication error caused by misread prescription written by physician caring for diabetes patient.
One research study revealed that the amount of medication errors and medicine mistakes involving doctor’s bad handwriting was a shocking 37 errors for 100 prescriptions (37%). Medication errors are so commonplace among medical professionals that these medicine mistakes have a nickname: they’re called an “ADE” (for “Adverse Drug Event”). Consider a case out of Texas this week, where the poor penmanship of a doctor was so impossible to read by anyone else that a patient was killed by a fatal medication error, as a kidney dialysis patient hospitalized for amputation of a toe was given 120 millimoles of potassium instead of the prescribed 20 millamoles. At trial, the doctor explained that he had decided to up the dosage from 10 to 20, and used his pen to change the “1” to a “2.” Seems like an easy enough thing to do, right?

Except it was read not as “10” or as “20” but as “120” — and as a result, the 72 year old woman died from an overdose of potassium.
The jury found for the family and against the doctor this week in a jury trial; the hospital has already settled with the patient’s family.
Long ago, whether or not a doctor had bad handwriting was not such a big deal, because they were always around to answer questions and oversee things.
These preventable ADEs are shameful, and rarely are they going to be freely acknowledged by the health care providers to the patient or their family.
A good piece of advice if you or a loved one has been harmed because of a medical provider’s error, is to at least speak with an experienced personal injury lawyer before you file a claim to learn about some of the issues that can arise with these claims, including the type of evidence needed to prove a claim and the type and amount of damages you can recover. If you found this information helpful, please share this article and bookmark it for your future reference. To learn about the 5 things you get when you hire Alan Sackrin, click on the "About" link above. How Do You Know If A Business Acted Reasonably In Trying To Prevent an Office Slip and Fall Accident? How Do You Know If A Business Acted Reasonably In Trying To Prevent a Restroom Slip and Fall Accident? The hiring of a lawyer is an important decision that should not be based solely upon advertisements.
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Visit our tri-district website featuring Changing our Picture of Health a series of videos and tools to help you understand (or facilitate) the social determinants of health. Reduction of medication errors requires constant attention as inaccuracies can lead to serious and life threatening effects on patients. The Institute for Safe Medication Practices (ISMP) in Canada has compiled a list of abbreviations, symbols, etc.
Provide education for health care professionals about abbreviations that should be avoided in practice.

Review and revise all preprinted orders and clinical pathways to ensure that no dangerous abbreviations are present.
Provide examples of errors that have resulted from the use of dangerous abbreviations during orientation for all new staff. It’s a great example of the positive impact pharmacists can make when positioned properly in the healthcare system. From my own experiences in a large HMO, I finding about 50% errors, and thanks to the pharmacist that caught the last one. Participatory medicine is an ethical approach to care that also holds promise to improve outcomes, reduce medical errors, increase patient satisfaction and improve the cost of care.
Science Daily reports that this number may be much higher, with as much as 61% of the medication errors taking place in hospitals being the result of a physician’s handwriting that is simply too hard to read correctly, or from a transcription error when someone tried to decipher what the doctor had written. When these ADEs cause serious injury or death all because someone’s handwriting isn’t legible, then it’s a real injustice since these are obviously preventable events.
The doctor argued that this was not all his fault, because 120 millimoles of potassium is so over the range of acceptable dosages for a human that anyone on the hospital staff — any nurse, any lab tech, any doctor or nurse practitioner – would know (or should have known) that 120 was the wrong number. In today’s modern medical environment, doctors aren’t always hands-on with their patients, especially during their hospital stay. If you or a loved one suspect that they have been a victim of an ADE or medication error, then you may need professional investigation and legal assistance to discover the truth and get justice.
Most personal injury lawyers, like Alan Sackrin, will offer a free initial consultation (over the phone or in person) to answer your questions.
In many cases the use of abbreviations, symbols, and unclear dose designations as well as illegible handwriting, results in serious consequences. Much of the health care given to patients today is by non-physicians, who have been delegated the task of one-on-one care of the patient. Medicine mistakes and drug errors are seriously harming people and medication errors are killing patients all over the country, but the health care industry isn’t going to help victims voluntarily. The ISMP recommends that these be eliminated from all documentation in the medication use process. More importantly, without adequate dissemination it can be difficult for other institutions to benefit from the practices reported here and ultimately to generate improvements for patients.

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