Medication Safety: Legislation to the Rescue?
September / October 2006
Medication Safety
Legislation to the Rescue?
I was amused by a headline in a recent edition of a Chicago newspaper that read, “City Council considers ban on frying food in trans fat oils…” Can you imagine? Could this be another government regulation stating the obvious and trying to protect us from what we already know?
Despite the emphasis on diabetes and childhood obesity, among other health issues, and published reports detailing the dangers of trans fats in our diets, our society continues to exercise its right to use a trans-fat laden oil of its choice. And we, as fast food junkies with limited time to do what we do, patronize enterprises that continue to fry their food in trans fats. That is, of course, until the City Council has its way… Frankly, I felt reassured the politicians were truly health conscious and looking out for our welfare.
On the next page was a headline that read, “Governor signs bill mandating electronic prescribing by 2011…” Can you imagine? Here it is again, another government regulation stating the obvious and trying to protect us. And on the same day the City Council considered the ban on trans fats!
This second headline really caught my eye. Not only is this a topic that is near to me, it is another attempt to mandate the obvious. Our politicians can now say in their re-election campaigns they have the public’s health in mind.
How sad… do we actually need a law to mandate e-prescribing?
I reflected for a few minutes on the many articles I have read, presentations I have heard, and the companies, patients, and hospitals I have visited who all talked about the benefits of “being able to clearly read that scribble!” How many times have patients asked me, “You can decipher that? Do you understand what my doctor wants? If you can’t read it, how do you know it’s good for me?” More important, how many times have I called a prescriber and said, “Excuse me, but I can’t make out your writing on the order for Mrs. X,” or, “Does the order say ABC, and are you aware Mrs. X is currently taking XYZ for her DEF?” And how many times was I met with a response akin to “Why are you wasting my time?”
Do we need a law to mandate a solution for poor handwriting and drug verification? Do prescribers think so little of their knowledge and ability that they must scribble something that can’t be read? With many patients seeing multiple prescribers, how can I reasonably check all possible drug and disease state interactions, especially if I can’t read the order in the first place?
A Crisis
Apparently the crisis in malpractice insurance wasn’t enough to change thinking. Neither was the emphasis on quality healthcare and patient safety enough. The IOM study To Err Is Human (2000) raised awareness, but didn’t do it, nor were recent court cases about medication errors caused by undecipherable handwriting enough to change practice. Didn’t we all learn to write in grammar school? Wasn’t communications one of our college courses? Does something as obvious as writing words legibly require legislation?
In July, the IOM released another report, Preventing Medication Errors, to further raise the industry’s awareness of the unacceptable personal anguish and societal cost of medication errors. In spite of the industry’s efforts during most of the last decade, the report concludes there are still at least 1.5 million preventable adverse drug events (ADEs) in the United States each year. The report calls on all healthcare providers to create plans for e-prescribing within the next 2 years and implement them by 2010. If this call-to-action doesn’t inspire the entire industry to adopt this change in behavior, then our legislators seem poised to mandate it.
What Is the Problem?
Perhaps the problem is the many suppliers who sell e-prescribing systems. These systems cover the full range of capabilities from electronic dosing calculations and basic prescription writing to connectivity with pharmacies and full integration with electronic health records (EHRs). According to the Department of Health and Human Services, the definition is clear: e-prescribing is the electronic transmission of prescription data between a prescriber, dispenser, pharmacy benefits manager (PBM), or health plan. Handwriting is only a small part of the problem; coordinating care with disease states, diagnostics, treatments, and multiple health professionals is also problematic and has become cumbersome despite the many advances in technology. Or is it because of the advances of technology that these are problems, especially if a member of the healthcare team refuses to use it because of expense or difficulty? Maybe legibility isn’t the issue at all?
Excuse me? You say you aren’t using one of these systems? You don’t think this is your problem?
Documenting one’s thoughts so others can follow and contribute to a patient’s well-being is certainly a goal of all clinicians involved in the delivery of care. Many still fear computers. Hasn’t writing on paper worked well for many years? But did it really work that well? Relying on our manual process, did we catch all drug interactions and poor treatment choices? Do we know all of our patient’s allergies and disease states? Is lack of time the excuse for not admitting that we aren’t perfect? The IOM is looking for change, and now our legislators are, too. But there continues to be a segment of our clinical society that ignores (or doesn’t agree with) the obvious, preferring to scribble notes and prescriptions, accepting the risk of an error, and refusing to commit the time required to adopt the use of technology in our industry.
What is holding us back? With recent changes in insurance and compliance regulations, even cost is rapidly becoming a non-issue. Some would say standards are still problematic, but the various accrediting and trade associations are making substantial progress in standardizing e-prescribing transactions so that one system may be used in a variety of situations. This will go a long way to accommodating prescribers who practice with different providers and face the need to communicate with a number of different systems.
You still don’t want to use e-prescribing?
Perhaps motivating patients to contact their legislators and demand legislative mandates is necessary to jump-start e-prescribing and make it a standard of practice rather than a “nice-to-have” suggestion. Perhaps pressure from insurance companies (in the form of payment modifications), pharmacies, and hospitals will spur prescribers to more rapidly adopt this capability. One would hope the emphasis on quality and realization that medication safety really matters would be enough, but to date, it hasn’t been. Regardless of the impetus, I believe e-prescribing will become a clinical best practice and reduce the incidence of medication errors in the next few years.
It’s about time.
Larry Pawola is associate professor on the faculty in the College of Applied Health Sciences at the University of Illinois at Chicago. He has more than 35 years of experience in technology, clinical practice, and executive management. He is president of his own healthcare information technology and clinical services consulting firm, Lincolnshire Consulting Associates LLC. As a respected industry consultant for more than 25 years, Dr. Pawola has worked with a variety of ambulatory clinics, community hospitals, and academic medical centers. His work has focused on assessing clinical systems needs, operational improvements, strategic planning, and education. He has also consulted with healthcare companies for the strategic positioning of their technology products. Pawola is a member of PSQH’s Editorial Advisory Board and may be contacted at lpawola@uic.edu.
References
References Institute of Medicine (IOM). (2007). Preventing medication errors: Quality chasm series. P. Aspden, J. Wolcott, J. L. Bootman, & L. R. Cronenwett (Eds.). Washington, DC: National Academy Press. Prepublication copy available at www.nap.edu/catalog/11623.html#toc
Institute of Medicine (IOM). (2000). To err is human: Building a safer health system. L. T. Kohn, J. M. Corrigan, & M. S. Donaldson (Eds.). Washington, DC: National Academy Press.