Hospital safety project aims to save thousands of lives

A new project in mid-Atlantic region hospitals puts the spotlight on reconciling medications for intensive care unit (ICU) and operating room patients. As part of a nationwide "100,000 Lives and Beyond" Collaborative, pharmacists who care for patients in Delaware, Maryland, Northern Virginia, and Washington, D.C., hospitals beginning in January 2006 will have the opportunity to formalize processes for getting a complete and accurate list of each patient's current home medications, including name, dosage, frequency, and route and comparing them to the physician's admission, transfer, and/or discharge orders.

Hospital staff will bring discrepancies to prescribers' attention and, if appropriate, change orders and document them, according to the Delmarva Foundation, the Medicare quality improvement organization for Maryland and Washington, D.C. It is running the project with a $450,000 grant from CareFirst BlueCross BlueShield. Debbie Christian, Delmarva's director, said the project is still in the planning stages.

The Institute for Healthcare Improvement (IHI) is leading the collaborative in response to a landmark 1999 Institute of Medicine report that estimated that close to 100,0000 preventable deaths occur in American hospitals each year due to medical mistakes, mostly drug errors. The collaborative aims to prevent 100,000 such deaths nationwide by June 14 of next year. So far, 2,800 hospitals nationwide are involved.

Christian said that medication reconciliation may involve determining which drugs to be given in the hospital might interact dangerously with a patient's preexisting medication regimen or making sure that the patient doesn't get the same drug twice because it's marketed under two different names.

Having no one in charge of medication reconciliation is a common challenge in hospitals, the project guide notes. Nurses use different reconciliation processes; clinicians writing medication orders lack relevant information. To link medication history to admission orders, the project guide suggests placing patients' medication lists prominently in charts.

"Medication reconciliation procedures ensure that patients receive all intended medication and no unintended medication following transitions in care locations," said IHI president and CEO Don Berwick, M.D, at an American Health Quality Association meeting earlier this year.

Hospitals can solve medication reconciliation problems with electronic drug dose systems or other, low-tech interventions, Christian said. "Not having a bar-coding system is no excuse for not knowing where something is likely to go wrong and not having a system to prevent an error."

The "100,000 Lives and Beyond" Collaborative also aims to empower hospital staff at all levels to deploy rapid-response teams at the first sign of a patient in distress and to prevent:

Christian noted that the mid-Atlantic region's participation in the collaborative grew out of a Delmarva ICU safety project involving 38 Maryland hospitals. The project spurred many to include pharmacists in daily multidisciplinary rounds. Pharmacists were quick to notice if patients were at risk for overdose from the same drug marketed under two different names and made sure those on blood thinners got needed lab work, she said.

Including pharmacists in rounds helps especially in hospitals that rely heavily on house staff and nurses without much ICU experience, Christian added.

Colby Thomas, Pharm.D., BCPS, a critical care R.Ph. at Sinai Hospital of Baltimore, said she hopes her participation in the collaborative will not only improve medication reconciliation but also help her build on advances made through the Delmarva ICU project. She was part of a team that developed a deep vein thrombosis (DVT) prophylaxis assessment procedure in preparation for a Joint Commission on Accreditation of Healthcare Organizations core measure that takes effect in January.

Thomas, who is part of the multidisciplinary team that goes on ICU rounds, now presents data, at a quarterly quality meeting, on how many patients she has assessed for DVT risk and how often they got approved drugs and interventions.

THE AUTHOR Is a writer based in Maryland.