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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2002;162:1804.
Medication Errors Observed in 36 Health Care Facilities
How often are doses of medication ordered in hospitals and skilled nursing
facilities given in error? Trained observers accompanied nurses as they prepared
and administered medications and witnessed the administration to the patient,
and then they compared what they saw with the physicians' original orders
to identify discrepancies. The 3216 doses studied were those given (or omitted)
during at least 1 medical pass on a high medication–volume nursing unit
in a stratified random sample of 36 institutions (18 in Georgia and 18 in
Colorado). The results showed that medication errors are more common than
suggested by previous studies, which were conducted mostly in teaching hospitals.
Those rated potentially harmful by a physician panel occurred at the rate
of 40 per day in the typical 300-bed facility, confirming that defective medication
administration systems are widespread.
(SEE ARTICLE)
A Survey of Oral Vitamin K Use by Anticoagulation Clinics
Patients taking warfarin occasionally present with asymptomatic but
dramatic elevation of their international normalized ratio (a measure of the
intensity of anticoagulation). This survey uses mock patient scenarios to
assess the current practice of anticoagulation clinics facing this dilemma.
The data presented suggest that there is substantial variability with respect
to the use of oral vitamin K (phytonadione), an intervention recommended (for
certain patients) by the American College of Chest Physicians, the American
College of Cardiology, and the Anticoagulation Forum.
(SEE ARTICLE)
A Utilization Management Intervention to Reduce Unnecessary Testing
in the Coronary Care Unit
Patients in intensive care units are likely to receive large panels
of "routine" diagnostic tests. However, the literature suggests that many
of these tests are unnecessary. An intervention to reduce unnecessary testing
was performed in a coronary care unit at a large teaching hospital. This intervention
consisted of guideline development, computerized order template design, and
educational efforts. There were no significant changes in length of stay,
readmission to the intensive care unit, or hospital mortality.
(SEE ARTICLE)
Depression-Related Costs in Heart Failure Care
Costs of care for heart failure are high, but it is unclear what factors
contribute to these costs. In this study, 1098 health maintenance organization
patients were evaluated following a first hospitalization with a primary diagnosis
of heart failure. Depression and heart failure status were determined through
diagnostic, laboratory, and pharmacy records. Actual utilization and cost
values were derived from administrative data. After adjusting for age, sex,
medical comorbidity, and length of stay at index hospitalization (as proxy
for heart failure severity), costs were 26% higher in the antidepressant group
and 29% higher in the depression diagnosis group compared with the no depression
group (both P<.001). Increased inpatient and outpatient
utilization both contributed to the increased costs. Depression may make a
significant contribution to the high costs of care for heart failure.
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Depression group costs by 6-month intervals. 1, No depression group;
2, antidepressant prescription only group; and 3, antidepressant prescription
and depression diagnosis recorded group.
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(SEE ARTICLE)
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