The use of pharmaceuticals is an essential element of the American health care system, helping to treat acute illnesses and maintain control of chronic conditions in many people.
This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on medication- or drug-related adverse outcomes that were seen in hospitals in 2008, updating previously published information on inpatient stays in 2004.5 In addition, we provide information on these occurrences in treat-and-release emergency department (ED) visits. Among inpatient stays with drug-related adverse outcomes, the mean patient age was 62.8 years. Over the five years between 2004 and 2008, there was a 52 percent increase in drug-related adverse outcomes in the inpatient setting—more than half of this increase was due to corticosteroids, anticoagulants, and sedatives and hypnotics. In the inpatient setting, corticosteroids, such as prednisone, caused 13.2 percent of all drug-related adverse outcomes. Over 53 percent of all inpatient stays with a drug-related adverse outcome were for patients 65 or older. Among treat-and-release ED visits involving drug-related adverse outcomes, analgesics and antibiotics were common causes of events for all age groups. A similar pattern was observed in treat-and-release ED cases, although the mean age of 39.4 years was significantly lower than the mean age for inpatient cases. For each hospital stay or ED visit, multiple drug-related adverse outcomes can be reported. As shown in table 2, in the inpatient setting, hormones and synthetic substitutes were the most common cause of general drug-related adverse outcomes, responsible for 16.1 percent of all drug-related adverse outcomes (345,300 events). From 2004 to 2008, the proportion of drug-related adverse outcomes caused by agents that affect blood constituents also increased.
In the inpatient setting, hormones, analgesics, and systemic agents were among the top five most common causes of drug-related adverse outcomes for all age groups (figure 4).
Among treat-and-release ED visits, analgesics and antibiotics were among the most common causes of drug-related adverse outcomes for all age groups (figure 5).
The estimates in this Statistical Brief are based upon data from the HCUP 2008 Nationwide Inpatient Sample (NIS) and 2008 Nationwide Emergency Department Sample (NEDS). The principal diagnosis is that condition established after study to be chiefly responsible for the patient's admission to the hospital or visit to the ED.
ICD-9-CM is the International Classification of Diseases, Ninth Revision, Clinical Modification, which assigns numeric codes to diagnoses. Total hospital charges were converted to costs using HCUP Cost-to-Charge Ratios based on hospital accounting reports from the Centers for Medicare and Medicaid Services (CMS).8 Costs will tend to reflect the actual costs of production, while charges represent what the hospital billed for the case.
HCUP is a family of powerful health care databases, software tools, and products for advancing research.
The HCUP Nationwide Inpatient Sample (NIS) is a nationwide database of hospital inpatient stays. The HCUP Nationwide Emergency Department Database (NEDS) is a unique and powerful database that yields national estimates of emergency department (ED) visits. AHRQ welcomes questions and comments from readers of this publication who are interested in obtaining more information about access, cost, use, financing, and quality of health care in the United States. 6 Specific ICD-9-CM codes used in this study are listed in the Definitions section of this report. To help make sense of all of this and put it into perspective, the UK’s National Health Service put together the Atlas of Risk. The charts above are averaged among the population but on the NHS site you can tailor these charts to your sex and group. Paddy Kevane talks about how lack of government support can impact families during an emotional period. Poet Connie Roberts talks about her experiences growing up an abusive alcoholic father and attending an industrial school.
ABSTRACTControlling blood sugars with insulin is essential in the management of hyperglycemia in both diabetic and nondiabetic patients. Studies have shown that large babies have a higher rate of complications that can lead certain to, fetal, neonatal, infant, and long-term injuries and disabilities. The risks of high birth weight can be reduced and even eliminated with appropriate medical treatment. A baby whose weight is in the 90th percentile for his or her gestational age is generally considered to be a “large baby.” There are number of factors that can lead to higher-than-normal birth weights, including maternal age, weight and diabetes.
Larger babies are at greater risk for certain complications that can lead to brain injuries during birth. These can result in decreased oxygen supply (hypoxia) and decreased blood flow (ischemia) to the baby’s brain, which can lead to brain damage. In addition, complications such as placental abruption are more common for older mothers – especially after age 40 – and therefore may be more common among larger babies as well. Due to the increased risks associated with higher birth weights, induction and augmentation of labor can in appropriate circumstances be the safest options for large babies. If your baby suffered a brain injury during delivery or is experiencing developmental delays or other signs of brain damage, it is important to speak with someone right away. Brief description of your question or issue*PhoneThis field is for validation purposes and should be left unchanged. Latest Bollywood News: After successfully hosting four consecutive seasons of reality show "Bigg Boss", Bollywood superstar Salman Khan is on the small screen next year as host of a new show based on social causes, and says that it's from a "Satyamev jayate ".
In 2012, his contemporary Aamir Khan launched the 14-episode talk show "Satyamev Jayate", highlighted in the issues such as female feticide, dowry ills and medical errors. Dosthana is the trusted source and it's aim is to get the Listings, Movies, Mobiles etc information at one place for global audience. Extreme environments present significant challenges to industrial, military and public safety operations, demanding strenuous activity in dangerous conditions, including high heat and exposure to harmful chemical, biological and radiological agents. In mild cases, heat stress can cause dehydration, pulmonary and cardiovascular stress, and fatiguea€”reducing work capacity, stamina and efficiency, and increasing operator errors.
The patented Cap-Vest cools the head and body simultaneously, and integrates easily with standard clothing and protective gear.NO SWEAT! Decades of NASA research have concluded that the best method for maintaining core temperatures (originally, for astronauts in non-permeable space suits) at safe levels over long periods of time is through active, constant cooling. The combination Cap-Vest cools the torso and head simultaneously, increasing total surface area for cooling and providing enhanced intervention against neurocognitive degradation compared to conventional, torso-only cooling garments.
Care was taken to exclude stays and visits associated with illicit drug use or with evidence of intentional harm, self-inflicted or otherwise.
Only 18.5 percent of treat-and-release ED visits with a drug-related adverse outcome were for elderly patients.
Psychotropics were another common drug-related adverse outcome for all age groups younger than 65. For 8,400 inpatient cases and 14,600 ED cases with neuropathy or dermatitis drug-related adverse outcome codes, the ICD-9-CM codes do not identify whether the origin of the adverse outcome was poisoning or adverse effects due to drugs administered properly. Leading this category were corticosteroids, such as prednisone, the cause of 13.2 percent of all inpatient drug-related adverse outcomes (283,700 events). This is based on a total of 2,147,700 drug-related adverse outcome events in 1,874,800 inpatient stays, and 997,100 events in 838,000 ED visits with at least one drug-related adverse outcome recorded. This category includes drugs for relieving pain and reducing fever, such as acetaminophen (an aromatic analgesic, such as Tylenol), non-steroidal anti-inflammatory drugs (including salicylates, such as aspirin), opiates including methadone, and antirheumatics such as indomethacin. HCUP data include OB-GYN, ENT, orthopedic, cancer, pediatric, public, and academic medical hospitals.
For each hospital, a hospital-wide cost-to-charge ratio is used because detailed charges are not available across all HCUP States. Sponsored by the Agency for Healthcare Research and Quality (AHRQ), HCUP includes the largest all-payer encounter-level collection of longitudinal health care data (inpatient, ambulatory surgery, and emergency department) in the United States, beginning in 1988. The NEDS was constructed using records from both the HCUP State Emergency Department Databases (SEDD) and the State Inpatient Databases (SID). We also invite you to tell us how you are using this Statistical Brief and other HCUP data and tools, and to share suggestions on how HCUP products might be enhanced to further meet your needs. Clarifying adverse drug events: A clinician's guide to terminology, documentation, and reporting.
It’s why someone might light up a cigarette while talking about how worried they are about a terrorist attack. The main idea is to visually show that our fears are often misplaced and that most of us should worry more about quitting smoking and eating vegetables than dying in a murder freak accident.


However, studies have shown that the use of insulin has been associated with more medication errors than any other type or class of drug. One of the greatest concerns associated with high birth weight is the increased risk of brain damage due to complications during delivery. However, when doctors, nurses, and hospitals commit errors during labor or delivery, the results can be severe. In addition, under normal circumstances, babies continue to grow as long as they are in the womb, so overdue babies are more likely to be larger – even if their weight is not otherwise outside of the typical range.
In addition to the conditions mentioned above, these can include problems with the mothers’ blood pressure, neonatal anemia, infections, preeclampsia and eclampsia, and trauma during delivery.
However, induction and augmentation – facilitated by the drug, Pitocin – carry their own risks as well. On the other hand, medical errors during induction can have drastic consequences, including brain injuries. Your baby’s condition may be the result of a medical error, and you may be entitled to significant compensation to cover your medical expenses and other losses. Unlike many sites Dosthana uses the latest technology to full fill the reader ease and usability. Heavy protective equipment is a musta€”although it exacerbates already-elevated heat risk factors, degrading performance and posing significant health risks.
In severe cases, heat stress can cause loss of consciousness, heat stroke, cardiovascular collapse and death. Work Enhancement System consists of a portable, pack-based chiller (the Conditioning Unit) and a lightweight microclimate cooling garment (the Cap-Vest). A drop-in one gallon phase change cartridge serves as the heat sink, providing up to 4 hours of cooling; if conditions or duration demand, the cartridge can be replaced in under 30 seconds for continuous cooling. Air Force study, the Cap-Vest reduced all heat stress factors, including sweat rate (70% less body and 90% less facial), heart rate rise (8%), and core temperature rise (82%) for airmen performing strenuous activity in heavy chemical defense protective gear, as compared to peers performing the same work in standard (cloth) uniform and gas mask (30 lbs. Army) at the Kansas State University Institute of Environmental Research, WElkins cooling technology was pitted against a competing active cooling system for a 180-minute performance test in high heat (110 degrees Fahrenheit) and humidity (45 percent). Excluded are long-term care, rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals. Hospital charges reflect the amount the hospital charged for the entire hospital stay and does not include professional (physician) fees. The NIS is a sample of hospitals and includes all patients from each hospital, regardless of payer. From January 2008 to June 6, 2009, Pennsylvania healthcare facilities submitted 2,685 event reports to the Authority that mentioned medication errors involving the use of insulin products.
Cerebral palsy, developmental delays, speech impediments, learning disabilities, paralysis, and even death have all been linked to brain injuries suffered by large babies during birth.
When a doctor fails to diagnose a condition that creates an increased risk for brain injuries, this is a mistake that can give rise to a claim for medical malpractice. Many of these errors are associated with improper administration of Pitocin during the delivery process. To learn more about what an experienced medical malpractice attorney can do to help, please contact us today. Space Foundationa€™s Technology Hall of Fame for his landmark work on astronaut cooling, WElkinsa€™ NO SWEAT! Packaged in a rugged, high-performance thermoplastic pack, the Conditioning Unit pumps liquid coolant to the Cap-Vest via an insulated umbilical. Please note, a discharge of this nature will be included in the NIS if it occurred in a community hospital. It is drawn from a sampling frame that contains hospitals comprising about 95 percent of all discharges in the United States. The NEDS was created to enable analyses of ED utilization patterns and support public health professionals, administrators, policymakers, and clinicians in their decision-making regarding this critical source of care.
Before being induced, it is important to have your doctor explain all of the potential risks involved.
We would be proud to implement any suggestions you have of your choice, you can have your ideas sent through contact us form.
In other words, WElkinsa€™ technology improved safety and dramatically increased productive time on the job site. The vast size of the NIS allows the study of topics at both the national and regional levels for specific subgroups of patients. This cannot be possible with the support, sharing and regular feedback of the users coming to the site and engaging the activity. Strategies to address these problems include limiting the variety of insulin products on the organization’s formularies, developing standardized protocols and a standard format for prescribing insulin, avoiding the use of abbreviations or other shortcuts when communicating orders for insulin, and requiring an independent double check of all doses before dispensing and administering intravenous insulin. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Costs and Utilization Project, Nationwide Inpatient Sample and Nationwide Emergency Department Sample, 2008. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. For example, it is used to manage hyperglycemia in intensive care unit (ICU) patients, a common finding caused by insulin resistance in the liver and muscle tissue. Some have considered insulin resistance to be an adaptive response, providing glucose for the brain, red blood cells, and wound healing.3 Due to a number of conflicting published studies, there has been an increased effort to determine the benefit of tightly controlled blood glucose levels, both in diabetic and nondiabetic patients.
For example, in a large, single-center study of postoperative surgical patients, an initial investigation by van den Berghe et al.
Patients receiving intensive insulin therapy were found to be less likely to require prolonged mechanical ventilation and intensive care. The NICE-SUGAR study also demonstrated that there was no significant difference between the two treatment groups in the median number of days in the ICU or hospital or in the median number of days of mechanical ventilation or renal-replacement therapy. In a meta-analysis of randomized controlled trials of tight glucose control versus usual care in critically ill adults, the authors found no significant difference in hospital mortality or new need for dialysis. Although tight glucose control was associated with a significant reduction in septicemia overall, subgroup analysis suggested this benefit was limited to surgical ICU patients. Conversely, they found clear evidence that hypoglycemia increased roughly fivefold, regardless of the ICU setting, and was more common with patients receiving very, rather than moderately, tight glucose control.6For many years, literature has shown that the use of insulin has been associated with more medication errors than any other type or class of drug. This imprecise data collection limits individual facilities and the Authority from accurately determining the most common pairs of insulin products involved in wrong-drug errors.
In addition, many of these reports did not specifically state why the error occurred or what went wrong that led to the patient receiving the wrong insulin product. Analysts were able to determine the following:Seventy-five (20%) reports of wrong-drug insulin errors specifically mention that the breakdown occurred when retrieving the medication, for example, from stock or an automated dispensing cabinet (ADC). Specifically, 28 reports (37.3% of stock errors) mentioned the use of overrides to obtain the insulin product from an ADC. Sixty-five (17.4%) reports of the wrong-drug events specifically identified that the error occurred during the prescribing node.
When the physician came in the following day, the order was clarified, and he ordered Novolin N insulin. Unless this infusion is distinguished with highlighting or a prominent sticker, an insulin infusion will resemble other pharmacy-prepared infusions.
Of the wrong-drug errors involving insulin reported to the Authority, infusion bags containing insulin were mentioned in 9.4% (n = 35) of the cases. Examples are as follows:An IV insulin bag was hung when replacing the patient’s Versed® (midazolam) bag. Two bags of insulin were then hanging, one at rate of 8 (Versed rate) and one at 5 (insulin rate). The wrong-bag error was found at [the next] change of shift.A patient was ordered IV Lasix® (furosemide), as well as IV insulin. The nurse meant to hang the IV Lasix but [before midnight] hung a bag of IV insulin instead. Both IV drips were turned off at that time, and the patient was given 50 ml of 50% dextrose. Four hours later, the oncoming RN was checking and verifying the patient’s IV drips and discovered the error. For example, correction doses, sometimes referred to as “coverage” or erroneously as “sliding scales,” are used to adjust glucose levels around mealtimes.


Organizations often have multiple algorithms for corrections doses, such that a facility may have “low dose,” “medium dose,” and “high dose” algorithms that require the nursing staff to obtain and document each patient’s blood glucose reading, determine the patient’s ordered algorithm, and then select the proper dose based on the blood glucose reading.The predominant theme mentioned in reports of wrong-dose events involves the dosing of insulin based on a range of blood glucose values with a corresponding coverage dose, determined by a patient’s blood glucose reading. Of the wrong-dose errors submitted to the Authority (n = 712), 26% (n = 185) mention coverage or sliding scales. While this term may be used in place of “correction dose” or “coverage,” it should be noted that sliding-scale insulin regimens used alone are ineffective and potentially harmful. When using subcutaneous insulin injection therapy, scheduled or standing insulin regimens should be the standard of care.18-21) As mentioned previously, this recommended method of maintaining tight control of a patient’s blood sugar, regardless if the patient is diabetic or not, adds complexity to the medication-use process for all healthcare practitioners.
Adding to the complexity of these orders are the multiple values often used for multiple ranges of blood sugars. Problems have also occurred when shortcuts are taken when writing these types of orders for insulin. For example, orders have been written stating doses of insulin as “6+1” or “6+2” instead of writing out “7” or “8” (see Figure 1).   Figure 1. Errors also have occurred when selecting the blood glucose range, dose, or algorithm from a pharmacy label, a handwritten MAR, or a computer-generated MAR (see Figure 2). Pennsylvania facilities are experiencing these types of errors as evidenced by these events reported to the Authority:A patient was ordered insulin on sliding scale level 2, but the order was transcribed incorrectly on the MAR as sliding scale level 1. Order was transcribed onto medication sheet as bedtime coverage, but original order was for no bedtime coverage. The chart was reviewed due to the very high dose of Novolog to be given, and it was found that the 5 was crossed off. Although writing out the complete word “units” is the recommended alternative to using the abbreviation “U,” be aware that tenfold overdoses may still occur when writing the word “unit(s),” particularly when there is inadequate white space between the dose number and the word (see Figure 3).
Examples reported to the Authority include the following:A patient was admitted to the ED [emergency department] after [the patient’s] morning insulin had been administered. The patient was transferred, and the nurse administered the evening dose of Lantus 70 units as ordered, with appropriate double check. The nurse increased tube feedings, and subsequent accuchecks were read as “error.”The physician transcribed an incorrect insulin dose from the transfer orders. The physician misinterpreted the order due to the fact that the u (for units) was very close to the 7 on the transfer orders.   Figure 3. Order Written for 8 Units of Lantus Insulin Misread as 80 UnitsTranscribing and Order-Entry ErrorsAmong the wrong-dose insulin errors, 13.8% (n = 98) of the events involved breakdowns that occurred when transcribing orders, such as when entering orders into an MAR or a computerized order-entry system.
Examples reported to the Authority include the following:A patient was ordered “human regular insulin 150 units subcutaneously qam prn,” with the reason stating that the patient was on the medication at home. The first blood sugar parameter was incorrectly entered by the [physician] as the insulin dose.A physician wrote an order for a patient to receive four units of regular insulin if the patient’s early morning blood sugar was equal to or greater than 250. Specific problems reported to the Authority included reporting an incorrect value, confusing the patient’s weight for his or her blood glucose level, and communicating the wrong patient’s value, as well as simply documenting the wrong result.
Both licensed professionals and support staff have been involved in these breakdowns.The patient’s blood sugar was written on the board as 148. When the nursing assistant wrote the Accuchecks on the bulletin board, the blood glucose of 97 was written for that patient. The nurse used the wrong number for the coverage, using the patient’s weight of 341 pounds, when the BG was 81.
The nurse’s aide gave her the wrong number.A nurse extern came out of patient’s room at the time accuchecks are performed.
The nurse covered the patient with four units of regular insulin when five minutes later nurse extern informed the RN that the patient’s blood glucose level was 130.
In a similar example reported by the Institute for Safe Medication Practices (ISMP), a nurse picked up a piece of scrap paper that listed several patients with a number next to each name.23 All of the numbers were well above 200. Assuming the numbers were blood glucose results, she administered insulin to each patient using a sliding scale protocol. Similarly, pharmacy-provided, computer-generated MARs and other forms of drug information display dosage strength or concentration information the same way as the label. Although this issue was only apparent in 14 events reported to the Authority, it is of great concern because of the potentially large difference between the intended dose and the administered dose.Patient was on Lantus insulin at the nursing home. The patient’s blood sugar was 85 [that evening], so this dose was not given, and it was subsequently decreased to 80 units.
The patient did receive the 80 units the next day, and the blood sugar dropped to 52 two days later.
The Lantus dose was decreased again to 40 units on the following day and was administered at bedtime.
When I saw these medications ordered for [the evening dose], I questioned the patient on the amount of Lantus he takes at home.
I asked how much he had last night, and he said the nurse brought in a large syringe full of insulin.
The insulin is then administered using an insulin syringe specially designed for use with this concentration of insulin. When a patient needs a dose of 40 units, a caregiver draws the insulin to the designated 40-unit marking on the insulin syringe. For example, a patient using U-500 insulin with a U-100 syringe might state his dose as “40 units” because he is reading 40 units on the U-100 syringe he used to administer the insulin.
However, he is actually administering 200 units of insulin because of the higher concentration.
This increases the risk that a fivefold dosing error will occur when the patient communicates his dose to a healthcare practitioner.
The Authority’s database includes the following examples:A patient was admitted on routine regular insulin, and sliding scale was ordered at admission.
The pharmacist modified the insulin orders with additional signature of the patient’s own medications. The regimen ordered was Humulin R 85 units before lunch, 70 units before breakfast, 95 units before supper, and 35 units [at bedtime]. Wednesday after D50W administration and eating breakfast.U-500 insulin was prescribed as units (from a U-100 syringe) instead of volume. A call was made to the physician to ask about changing to U-100 insulin for more accurate measurement. He simply thought it would be easier for the nurses if he prescribed 25 units knowing that the “25 units” marking on a U-100 insulin syringe scale would actually measure 125 units when U-500 insulin was used. In another case, a physician changed a patient’s insulin to U-500 and prescribed 5 units at noon and 8 units at dinnertime. As in the first case, the doctor meant for the nurses to use a U-100 syringe when preparing and administering the U-500 insulin.
Thus, he intended the patient to receive 25 units at noon and 40 units at supper.25 Problems also arise with the vials on nursing units.
One case involved a vial of U-500 insulin that was left in a nursing unit refrigerator after the patient for whom it was prescribed went home.26 While looking for regular insulin in the refrigerator, a nurse saw the familiar brand name, Humulin R (regular insulin) but did not notice the U-500 concentration. Luckily, another nurse saw the vial that was used and noticed that the U-500 insulin was given in error—a fivefold overdose.Risk Reduction StrategiesOrganizations should strive to identify system-based causes of errors with the use of both insulin vials and insulin pen devices and implement effective types of error reduction strategies. Error reduction strategies such as constraints and standardization, which are more powerful because they focus on systems, will be more effective than education alone, which relies on individual performance and will likely be ineffective when used alone.Constraints Organizations should use strategies that lessen the chance of harm with the use of insulin. If a nonstandard insulin concentration is needed, list the concentration and the patient’s dose in units and volume.29 Establish a plan for treating hypoglycemia for each patient. Apply bold labels on atypical insulin concentrations.27RedundanciesFor example, require an independent double check of all doses before dispensing and administering IV insulin. Sample strategies include the following:Nurses need to know patient’s blood glucose level before administering insulin. Prevalence of Diagnosed and Undiagnosed Diabetes in the United States, All Ages, 2007 [online].



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