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The Eighth Leading Cause of Death in the U.S. is...

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by Anxious Patient Anxious Patient (Member) Member

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You are reading page 6 of The Eighth Leading Cause of Death in the U.S. is.... If you want to start from the beginning Go to First Page.

lamazeteacher specializes in OB, HH, ADMIN, IC, ED, QI.

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Well, if you start counting omission as a med error, my nurses added at least 20 to the tally while I was hospitalized for 3 days, last week. None of them comprehended that the reason for patients listing medications they normally take daily by patients, should be ordered.

If the doctor doesn't do it, we're supposed to list them legibly, on the doctors' order sheet along with other admission orders, for his/her signature. That's called continuity of care....... Do I sound angry? You bet I am! When patients are deprived of their meds, certain untoward effects occur as a result!

For example, when maxcide isn't given daily, as it was for 20 years, BP goes up as does LLEs swelling. If the pharmacy doesn't supply the same anti-hypertensive and diuretic, get doc to substitute another...... When the antidepressant taken for the past 20 years isn't otherwise available, get doc to allow patient to take her own! Otherwise severe withdrawal symptoms will occur, and possibly suicide. My nurse told me, after wrangling about it for 2 hours from 2 am to 4 am, that since it was the next day, that would mean a double dose had been taken for the next day (I usually take it from 1 - 3am...).

Then she said, as I became frantic, "I'll lose my license if you take your own med.") I looked at her as kindly as I could, and said, "Do you really think that would happen?") Then I popped the pill!

When the hospital's pharmacy formula excluded Prevacid from their supply of proton pump inhibitors, they did have Protonix IV. Protonix PO wasn't effective for me previously, and I told them that. Someone said Prevacid was too expensive.....don't I know it, having paid $10/capsule for it, the past 3-4 years, since samples became unavailable due to the possibility of it "going generic". Well, how much more expensive is the IV version of Protonix, including the IV paraphenalia and need for a new line? I was having an upper GI bleed.......

At least here in the east side of the USA, giving Benadryl isn't insisted upon before transfusing patients. On the west coast, I was told that transfusion reactions would be noticed as the symptoms of that are different than allergic ones. Huh? Nurses there have accepted the necessity of giving Benadryl without question. I refused it.

When tylenol with codeine is usually effective when taken occasionally for a patient's chronic arthritic pain, why couldn't it be crushed and given with honey if the tablet is thought to possibly exacerbate the bleeding? I said, "That's like taking a sledge hammer to a tack!" when injected morphine was offered. Finally the pain drove me to take it, partially to mollify the nurse, and I slept the clock 'round afterward, hardly able to describe any symptoms when asked.

Nursing theory taught in educational settings, seems to have exited minds with graduation from those institutions. How tragic!

Edited by lamazeteacher
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lamazeteacher specializes in OB, HH, ADMIN, IC, ED, QI.

2,170 Posts; 16,349 Profile Views

Maybe medication administration in institutions should be taken over by pharmacists or pharm techs. There have been many other duties of the nurse which have been permanently relegated to others: respiratory, physical, occupational therapists, cna's etc...

If the nurse doesn't know what med the patient has been given, or when and how, how would she think to recognize an untoward or allergic reaction? :specs:

Edited by lamazeteacher
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references(for the previous post):

for the first batch of data:

http://www.cardinalhealth.com/clinicalcenter/education/statistics/#1

original sources:

1. kohn, lt, jm corrigan and ms donaldson, ed. to err is human: building a safer health system. washington, dc: national academy press; 1999.

2. food and drug administration (fda) website: http://www.fda.org

3. barker kn, flynn ea, pepper ga, phd, bates dw, mikeal rl. medication errors observed in 36 health care facilities. arch intern med 2002;162:1897-1903.

for the second batch of data:

http://www.ahrq.gov/qual/aderia/aderia.htm

original sources:

5. bates dw, cullen dj, laird n, et al. incidence of adverse drug events and potential adverse drug events. jama 1995;274(1):29-34.

19. leape ll, bates dw, cullen dj, et al. systems analysis of adverse drug events. jama 1995;274(1):35-43.

immrbill3, hope you can find the original sources,they are a bit dated.

i take all studies with a grain of salt. like you said, many aspect can be neglected. the purpose was not not disseminate faulty information, but to give at least some insight into the numbers. given that i cant find the original studies i cant give the specifics. i am not trying write a research paper here.

nursing administration, most likely means all errors on the nursing end. like you said, the rn would be responsible in most real world instances and that is whats important. if its important for you to know if its rns or med aids you can do the extra research.

self-administration is most likely a neglected aspect of analysis, however it could still fall under one of the phases. someone did not prescribe the right drug, or dispense the right dose, or teach and monitor the patient, etc. as long as the patient is at a facility, there should be some level of responsibility. this is a very vague area.

as far as the nurse catching errors; i would assume it is still a med error by the physician, pharmacy, or transcriber. therefore it should be reflected in one of the categories accordingly. the nurse is key in preventing errors, no question.

i must mention that most studies out there reflect ades (adverse drug effects), which are only a part of medication errors. the actual number of med errors out there would difficult to calculate since many go unreported or unnoticed. you can read more on the relationship between ades and med errors here : http://www.rcpe.ac.uk/journal/issue/journal_37_4/williams.pdf

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ImMrBill3, RN has 2 years experience and specializes in ICU, Home Health Care, End of Life, LTC.

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The statistic misquoted in this thread is erroneous. The post below :typing identifies its original source and the error, as well as discussing some of the list of statistics provided by Phil from http://www.cardinalhealth.com/clinicalcenter/education/statistics/#3

I realize this post will bore :yawn: :crying2: many but it is a good look at how the numbers we often see bandied about are derived and then contrived. I continue to assert the position that RNs must be directly involved in medication administration.

Thanks Phil!

The info you gave me led me back to the source for the "eighth leading cause of death" statistic original source. It contains a significant error. It cites two studies (1984 and 1992 data BTW) that state MEDICAL ERROR rates at 2.9 and 3.7% with 58 and 53% of those preventable. It then extrapolates that to the 33.6 million hospital admissions in 1997 and (here's the BIG error) states that means 44,000 to 98,000 Americans DIE from hospital errors. The two studies stated medical errors were :pntrghi:INJURIES the report takes the rate of preventable INJURIES and multiplies by all admissions and gives a statistic for :pntrghi:DEATHS (Kohn, LT, JM Corrigan and MS Donaldson, ed., 1999, p. 26).

:deadhorse

Several of the statistics in the first list are secondary cites of this same source. The FDA website listed on your source is in error it is http://www.fda.gov not .org. The FDA website lists a variety of conflicting figures :uhoh21: from 95,000 reports of medication errors received since 2000, to 1,400 reports a month, to 1.3 million medication errors causing injury per year. It should be noted that the FDA considers pt error in self administration at home among medication errors.

The 7,000 deaths a year from medication errors on your source is unreferenced the FDA says at least one person dies per day. :uhoh3:

The statistic of errors occurring in 1 of 5 doses of meds in a typical hospital is somewhat misleading. The error rate for accredited hospitals :up: was 16%, for non-accredited hospitals 20% and for skilled nursing facilities 22%. Which of these facilities uses RNs for med admin and which uses med aides? Another factor to consider is that wrong time was the most frequent error accounting for 6%, 11% and 10% at the facilities respectively. If wrong time is excluded the overall rate of errors is 11% (10, 9 and 12% respectively by facility type [still alarmingly high]). The units selected were those identified as high volume by officials at the facility. The authors were looking to collect data on 50 med admins per unit in the shortest time possible. :twocents: MOST important (IMO) is that only 7% of the errors were considered potential ADEs (Barker, Flynn, Pepper, Bates, & Mikeal, 2002).

For the figure of 26-38% of medication errors from administration it was based on a study published in 1995 that involved TWO hospitals and six months worth of admissions (N=4031). Data was collected by stimulated self report and the information reported was ADVERSE DRUG EVENTS (n=247) of which 28% were judged avoidable. The ADEs judged avoidable were then analyzed for cause resulting in a statistic of 34% for administration. This statistic represents about 23 preventable ADEs and as stated reflects two hospitals before 1995 (Bates, Cullen, Laird, Petersen, Small, Servi, Laffel, Sweitzer, Shea, Hallisey et al, 1995).

:idea: How well can that be generalized to other hospitals? Can it be generalized to other types of facilities at all? I don't think so. Have conditions changed since pre 1995? How reliable was the "stimulated self report" has the technique been validated?

It is interesting to note that the second study cited appeared to use the same data (or at least the same cohort) but to detect errors, results and causes. It reports 264 ADEs resulting from 334 errors. That doesn't seem to jibe with the previously discussed study (247 ADEs, 28% preventable or 69 preventable ADEs [bates, 1995]) to my thinking an ADE resulting from an error would be preventable thus giving this cohort 264 preventable ADEs. This second study's intent was to identify the system errors that resulted in medication errors and ADEs. It found that, "The most common systems failure was in the dissemination of drug knowledge, particularly to physicians, accounting for 29% of the 334 errors." (Leape, Bates, Cullen, Cooper, Demonaco, Gallivan, Hallisey, Ives, Laird, Laffel, et al., 1995).

:twocents: IMO this absolutely supports having RN's administer medications as they are responsible for having a much more complete knowledge of drugs they dispense than are LPN/LVN's or medication aides. RNs also have the authority, responsibility and stature to question medication orders from physicians, NPs or PAs

:tinkbll:

Barker, K., Flynn, E., Pepper, G., Bates, D., & Mikeal, R. (2002). Medication errors observed in 36 health care facilities. Archives of Internal Medicine, 162, 1897-1903. Retrieved May 3, 2009, from Academic Search Complete database.

Bates, D. W., Cullen, D. J., Laird, N., Petersen, L. A., Small, S. D., Servi, D., Laffel, G., Sweitzer, B. J., Shea, B. F., Hallisey, R., et al. (1995).Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. The Journal of the American Medical Association, 274, 29-34. Abstract retrieved May 3, 2009, from, http://jama.ama-assn.org/cgi/content/abstract/274/1/29

Leape, L. L., Bates, D. W., Cullen, D. J., Cooper, J., Demonaco, H. J., Gallivan, T., et al. (1995). Systems analysis of adverse drug events. ADE prevention study group. JAMA: The Journal of the American Medical Association, 274, 35-43. doi:10.1001/jama.274.1.35

Kohn, LT, JM Corrigan and MS Donaldson, ed. (1999). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press. Retrieved May 3, 2009 from, http://www.nap.edu/catalog.php?record_id=9728#toc

:tbsk:

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diane227 has 32 years experience as a LPN, RN and specializes in Management, Emergency, Psych, Med Surg.

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I don't know all about the stats, but just from general observation what I have seen is that some nurses just don't think about what they are doing and how dangerous it is. I work with one nurse who will absolutely not look anything up. NOTHING. She also does not know how to add and subtract and do basic algebra. And apparently she has never considered buying a calculator. We always suspected that she was bad at math, but the other day she had to give a PCA bolus which was to be double the 1.5 dose. She could not figure how how much 1.5 and 1.5 was!!!!!. The charge nurse worked with her but she could never understand how to get the answer. One time the doctor wrote an order for 5 ml guiafenisen Q4h prn cough. The pharmacy transcribed this order as 50 ml. No one apparently though nothing of taking 10 doses out to give the pt until one of the nurses I work with on 3-11 said, "what is this!!!. Of course, the patient had been getting the wrong dose for at least 24 hours.

We have two great ways that we can look medications up. We can use our pyxis or we can use our new pharmacy system. There is absolutely no excuse for people to be making med errors. You know, I can't get these nurses to even count a pulse before they give dig anymore. It is just not like it used to be.

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nerdtonurse? is a BSN, RN and specializes in ICU, Telemetry.

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I can tell you one reason why...in the RN program I'm in right now, they took out the pharmacology class and replaced it with nutrition. WHY.....ON....EARTH.....

Okay, now I know I've only been a nurse a couple of years, but I have never seen a handful of nurses standing around a bed at 0300 trying to figure out a diet order. I have, however, seen a nurse keep giving a pt their heparin drip at 1.5x the amount specified by our own policies, disregarding that the pt's APTT was greater than 250....which is our lab's version of "OMG, stop the infusion!"

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