More than three times as many patients die from medications that are supposed to help them than succumb to AIDS each year.
According to several published estimates, upward of 100,000 hospitalized patients die each year after a drug mix-up or an adverse reaction.
That grim total, even if somewhat inflated as some skeptics believe, would make medication problems the fifth-leading cause of death, ahead of accidents and behind chronic obstructive pulmonary disease on the 1996 top 10 list compiled by the Centers for Disease Control and Prevention, Atlanta.
Though the exact number of illnesses and deaths caused by medication errors is unknown, by all accounts the figure must be huge. Nearly as large is the degree to which hospitals and health systems underestimate the depth of the problem in their institutions.
Underreporting of medication errors is epidemic. Most errors, even lethal ones, are simply never detected, experts say. And of those that are recognized, many are undocumented by healthcare workers who are fearful of punishment. Nonetheless, the human and financial toll is starting to attract serious attention from administrators, clinicians and companies developing solutions.
One such company is Bridge Medical, which features a management roster of former hospital executives who are hell-bent on building a computerized system to help hospitals combat the problem.
With the Bridge system, a nurse or other caregiver must scan into a bedside computer the bar codes on his or her own I.D. badge, the patient's wrist band and the drug package. The bedside system, mounted on an intravenous pole, is electronically linked to computers in a hospital's pharmacy and to the hospital's patient information system. The bedside computer quickly checks whether the dosage, timing and type of drug are right for the patient, and either gives the clinician an OK or nixes the administration.
The Solana Beach, Calif.-based company says its computerized system, which is still being refined, can already prevent 60% to 65% of errors and will soon exceed 80%. The Bridge system, whose price has yet to be set, is expected to go to market late this year, aided by $33 million in financing that the privately held company nailed down this spring.
"We stop an error before it harms the patient and identify the root cause so the hospital can go back and stop it," says John Grotting, president and chief executive officer at Bridge. Grotting, who joined the company in 1997, less than a year after it was founded, is a longtime hospital executive, with stints at Allina Health System, Minneapolis, and Legacy Health System, Portland, Ore. "I saw an opportunity to take 26 years of experience on the delivery side and come over here to develop some tools that would make a meaningful difference for caregivers," Grotting says.
Besides reducing errors, the Bridge system will also provide an electronic medication record, a handy way to fulfill administrative requirements. Eventually, hospitals could tap the information for help in improving cost and quality outcomes.
Last year, 261-bed Northern Michigan Hospital, Petoskey, began field-testing an early model of the Bridge system that brings computerized prescription information to patients' bedsides.
In 1996, hospital management decided to see what could be done to improve medication procedures.
Like most hospitals, Northern Michigan found that its process to get a doctor's order for a drug to a patient was terribly complicated-62 steps in all.
"I don't think we're unusual," says Bob Cook, pharmacy director at Northern Michigan. "If anything, we might have been more streamlined than some. That was a real eye-opener for us."
As part of its assault on medication problems, Northern Michigan started looking for technological help, eventually striking an agreement with Bridge.
Since last December, Northern Michigan has used the Bridge system on about 30 beds.
The system helped reduce common errors in the timing of drug doses, Cook says. For example, the night shift would sometimes give patients drugs at 6 a.m., just before leaving. Then the day shift, eager to get going, would be ready to administer the next dose at, say, 8 a.m. The Bridge system keeps track of who did what when and alerts the day shift when it is too early to administer drugs.
"It does prevent errors; we can prove that," Cook says, although precise figures aren't yet available.
Bridge's approach doesn't catch every problem, such as transcribing errors, Cook says. But the system does a fine job of detecting dispensing errors, identifying wrong drugs sent by the hospital pharmacy and nipping administration errors in the bud.
"Clearly this is a step in the right direction," says Gordon Vanscoy, assistant dean of managed care at the University of Pittsburgh School of Pharmacy. But he points out that the Bridge system and other computerization efforts have some fundamental limitations. "The science changes so quickly," he says. As a result the latest breakthrough may be mistaken for an error by a computer that isn't up-to-date. Doctors frequently prescribe drugs for uses or in doses that aren't covered under the approval of the Food and Drug Administration. To rout out real errors but minimize false alarms, a system has to be smart and timely, he says.