Focus on medication safety

Those 55 and older at highest risk

By Donna Lenz Wright / The Week

(Published on 12/21/06 at 9:54 a.m.)

People experiencing adverse drug reactions account for 1 million hospital admissions every year, with another 500,000 not serious enough to require hospital admission, officials say.

In people ages 55 and older, 80 percent have one or more chronic conditions with 90 percent of those 65 and older taking two or more medications - and half of those taking five or more medications.

Because of statistics like these, Kathryn Leonhardt, MD, Aurora care management medical director, applied for and received a $492,000 two - year grant through the Wisconsin Department of Health and Human Services.

The grant was received in June 2005 and the new program was implemented beginning in November, said Patti Pagel, RN, senior care program coordinator.

The Walworth County Patient Safety Council was formed to study the problem and come up with a plan of improvement.

"(The council) consists of 22 individuals, half of these people are patients - older adults - and half are health-care providers," Pagel said.

In a presentation created by Leonhardt and Britton Kolar, MD, the major contributing factors in medication errors in people 55 and older are:
-Having more than one doctor
-Having more than one pharmacy
-High medication costs
-Living alone
-Failure to understand physician instructions
-Vision difficulties
-Depression
-Taking multiple medications
-Taking three or more doses a day

With input from over 300 emergency medical service workers (EMS), medical workers, family members and citizens, the group concluded that keeping closer tabs on patient medications was paramount in combating sometimes lethal medication errors in those 55 and older and those taking multiple medications.

Universal medication lists and blue medication bags were chosen as a starting point.

"Our goal is to educate people about the importance of utilizing a medicine list and bringing their medicine in to the physician whenever they have appointments so their list will match the physician's," Pagel said.

A list available to patients, doctors and pharmacies, and bags where all medications are kept so patients can take them to doctor appointments or EMS workers and family members can quickly find them, will alert potential errors before they can occur.

Over 6,000 medication bags have been distributed through the hospital, nursing homes and community groups (Rotary, Kiwanis and bridge clubs, etc.) so far.

"And the hospital has changed its discharge policies incorporating the list and bag," Pagel said. "The feedback is that people are using them and they're very helpful."

The group concluded that the elderly and those taking multiple medications are at high risk and interventions can help, are doable and can be done inexpensively.

Although funding from this grant ceases in June 2007, the group has already decided to continue the effort targeting medication safety, Pagel said.

"This is the only group working with this population regarding prescriptions, and has been showcased internationally through the Council Advancing Patient Safety (CAPS) and Midwest Airlines."

Other areas of identified improvement are:
-Patient wait times
-Transitioning from hospitals to nursing homes, assisted care facilities or home
-Medication packaging
-Use of pill boxes
-Family support
-Medication lists with online accessibility
-Fewer medications
-Physician enforcement
-Pharmacy involvement

For more information, call Pagel at 249-4618 or visit www.myaurora.org

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