Older patients at risk for prescription medication injuries

Estimates from a study of more than 30,000 Medicare patients conducted in 1999 and 2000 show that older adult patients treated in outpatients settings may suffer from as many as 1.9 million medication-related injuries per year, according to a March 4, 2003, news release from the Agency for Healthcare Research and Quality. Injuries consist of medication errors and adverse medication reactions not caused by errors. Approximately 180,000 of these injuries are life threatening or fatal, and more than half of them can be prevented.

In the study, researchers identified 1,523 medication-related injuries, including falls that caused fractures, bleeding requiring transfusion, hypoglycemia, and kidney function deterioration. Nearly 38% of injuries were characterized as serious, life threatening, or fatal. Twenty-eight percent of all injuries and 42% of serious, life threatening, or fatal injuries were considered preventable by a panel of physician reviewers. Common medications associated with preventable adverse events include cardiovascular medications, diuretics, analgesics, hypoglycemic agents, and anticoagulants.

Analysis of preventable injuries indicated that 58% of errors occurred because of prescription error (eg, wrong medication, wrong dose), inadequate patient education, or prescription of medication for which there was a known interaction with a medication a patient already was taking. Sixty-one percent of preventable injuries involved mistakes in monitoring medication, such as inadequate laboratory monitoring or delayed response to symptoms of toxicity. Patients' failure to adhere to instructions about medication use comprised more than 20% of preventable injuries.

According to researchers, computerized systems may help prevent prescription of medications with known interactions or warn health care workers to monitor patients more closely. Thorough patient education regarding medication use also can reduce the risk of medication-related injuries.

Outpatient Prescription Drug-related Injuries are Common in Older Patients, but Many can be Prevented (news release, Rockville, Md: Agency for Healthcare Research end Quality, March 4, 2003).

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