Health and Disability

The first study to measure the incidence of medication errors and adverse drug events during the perioperative period - immediately before, during and right after a surgical procedure - has found that some sort of mistake or adverse event occurred in every second operation and in 5 percent of observed drug administrations. The study of more than 275 operations at Massachusetts General Hospital (MGH), which will appear inAnesthesiology, the official medical journal of the American Society of Anesthesiologists, also found that a third of the errors resulted in adverse drug events or harm to patients. The report is being published online to coincide with a presentation at the ANESTHESIOLOGY® 2015 annual meeting in San Diego.

"We found that just over 1 in 20 perioperative medication administrations resulted in a medication error or an adverse drug event," says Karen C. Nanji, MD, MPH, of the MGH Department of Anesthesia, Critical Care & Pain Medicine, lead author of the report. "Given that Mass. General is a national leader in patient safety and had already implemented approaches to improve safety in the operating room, perioperative medication error rates are probably at least as high at many other hospitals. Prior to our study, the literature on perioperative medication error rates was sparse and consisted largely of self-reported data, which we know under-represents true error rates. Now that we have a better idea of the actual rate and causes of the most common errors, we can focus in developing solutions to address the problems."

A leading neuroscientist at Florida Atlantic University has developed the "Lewy Body Composite Risk Score" (LBCRS) to quickly and effectively diagnose LBD and Parkinson's disease dementia (PDD) in about three minutes. The LBCRS is a brief rating scale that can be completed by a clinician to assess clinical signs and symptoms highly associated with the pathology of this disease. With this important tool, a clinician can assess whether the patient has bradykinesia, rigidity, postural instability, or rest tremor without having to grade each extremity. This simple, one-page survey provides structured yes/no questions for six non-motor features that are present in patients with LBD, but are much less commonly found in other forms of dementia.

"Within five years, all of America's medical records are computerized," he announced in January 2009, when visiting Virginia's George Mason University to unveil his stimulus plan. "This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests."

Unfortunately, in some ways, our medical records aren't in any better shape today than they were before. 

THIS IS A personal issue for me—I'm one of those Americans with a dizzyingly complex medical history. In April 1997, two months shy of my 11th birthday, I was diagnosed with acute lymphoblastic leukemia. Over three years of chemotherapy—and the seizures, spinal compression fractures, sepsis infections, and debilitating nerve pain that came with it—I amassed a thick file of prescriptions filled, body parts scanned, and blood sampled.

Dementia places a much larger financial burden on families in the last 5 years of life than cancer, heart disease, and other conditions, especially among the social groups least prepared to cope, according to a study published in Annals of Internal Medicine.

Not enough is known about the cost of end-of-life care for persons with different medical conditions. Researchers used data from the Health and Retirement Study (HRS) to examine the social costs and financial risks faced by Medicare beneficiaries 5 years before death. They considered various social costs associated with disease, such as government spending (Medicare), private insurance, out-of-pocket expenditures, and informal care. They also examined how these spending components varied across four disease groups: dementia, cancer, heart disease, and other conditions.

The researchers found that total social costs for Medicare patients with dementia was $250,000 per person in the last 5 years of life, which is 57 percent greater than social costs associated with death from other conditions.

"We're targeting the high utilizers of the emergency department," says Mark Huber, the hospital's senior vice president of social responsibility.

Huber says the hospital placed social workers in the ER full time. It then identified 313 so-called frequent fliers who visited Aurora Sinai's ER at least five times in four months. Those patients alone accounted for 1,827 emergency room visits in that time.

The social workers chose 39 people out of the 313 and spent the next eight months trying to change their habits so that when they get sick, they go to a primary care doctor or clinic rather than the ER.

"These are people who are in crisis all the time," Huber says. "They don't know where they're going to sleep or whether they can get groceries. They can't think about making appointments and planning ahead."

The social workers developed a plan for each patient that included finding transportation to a doctor and securing child care for the appointment. Then they helped the patient make a first appointment. They even sometimes accompanied them to the visit.

Editor’s note: This spring, Health Affairs held its first ever poetry contest. Three winning poems were published in the journal. We’re also featuring some of our other favorites on the Blog throughout the month of October.

Despite known risks of serious side effects, especially in older adults, the fraction of seniors treated with antipsychotic medications increases with age, researchers have found. Such medications may be appropriate for treating certain mental disorders, yet more than three-quarters of seniors receiving an antipsychotic prescription in 2010 had no documented clinical psychiatric diagnosis during the year. Further, among those who did have a diagnosed mental disorder and/or dementia, nearly half of the oldest patients had dementia, regardless of FDA warnings that antipsychotics increase mortality in people with dementia.

Known side effects of antipsychotic medications include metabolic problems and weight gain. For older adults receiving antipsychotics, the risks of dangerous side effects such as strokes, fractures, kidney injury, and mortality are increased. Despite concerns, researchers found that the percentage of people receiving an antipsychotic prescription in 2010 increased with age after age 65. The percentage with an antipsychotic prescription was approximately twice as high among people 80 to 84 as among those age 65 to 69.