Medical
Errors May Cause Significant Number of Heart Attacks
By
Adam Marcus
HealthScoutNews Reporter
(HealthScoutNews) -- As many as one in seven
heart attacks in heart patients may be the result
of medical errors, accidents that could be prevented
by more vigilant physicians. That's the message
from the American Heart Association, which today
issued a new statement calling for changes to improve
safety for heart attack and stroke victims. The
statement recommends implementing computer systems
to track prescriptions and drug doses, and more
doctor education on ways to avoid drug mix-ups involving
like-sounding compounds.
The guidelines also stress the problem of "errors
of omission" -- when doctors fail to offer
eligible patients potentially life-saving therapies.
Certain heart drugs, such as heparin, beta blockers
and angiotensin-converting enzyme (ACE) inhibitors
are widely under-prescribed, experts say.
Avoidable medical errors are blamed for between
44,000 and almost 100,000 deaths a year in this
country, according to a recent report from the Institute
of Medicine. Data for how many of these involve
heart and stroke patients are scarce.
One study of 203 heart attacks found that 14 percent,
or one in seven, resulted from a doctor's action.
Medication errors were to blame 44 percent of the
time, and half were preventable.
"It is clear," the statement says, "that
with increasing patient age and the frequent prescribing
of multiple medications, concerted efforts for prevention,
reporting and management must be undertaken nationwide."
The statement appears in tomorrow's issue of Circulation.
Medical errors are about twice as common in people
over 65 as in younger patients -- occurring in 5.3
percent versus 2.8 percent of hospital patients,
respectively. That difference reflects the fact
that older patients often have more than one health
problem, requiring them to take multiple treatments.
One potential pitfall in treating stroke patients
is overdoses or mistimed administration of clot-busting
drugs. The statement suggests hospitals take steps
to streamline the use of these treatments, including
reducing the number of these drugs available in
the hospital, standardizing order forms and protocols
for using the drugs, and being sure to record a
patient's weight to calibrate the proper dose.
Bill Hendee, vice president of the Medical College
of Wisconsin and secretary of the National Patient
Safety Foundation, says heart and stroke patients
are especially vulnerable to medical errors because
their condition is so dicey from the start.
However, Hendee adds, the measures the statement
outlines, while needed, aren't so easy to implement.
Improved reporting, for example, runs into the reluctance
of doctors and hospitals to accept blame that might
lead to liability. "Denial is ingrained in
the system," Hendee says.
Similarly, computerized drug order systems are hamstrung
by the fact that it's usually easier for a physician
to write a prescription than type it on a keyboard.
"After that, it's probably more efficient and
less error-prone, but for physicians it is just
a burden," Hendee says.
Dr. Christopher Granger, a Duke University cardiologist
who has studied medical errors in heart patients,
says doctors should strive to be more careful. However,
Granger adds the impact of the steps laid out in
the new statement might not be as great as they
appear on paper.
"One needs to be careful in ascribing bad outcomes
to a medication error, because medication errors
are more likely to occur in patients who are more
likely to have bad outcomes," Granger says.
"We should be doing all we can to avoid them.
But the relationship of the errors and the bad outcome
may not be quite as close as it appears on the surface."
In one study, for example, Granger and his colleagues
found the risk of serious bleeding in heart attack
patients was the same when doctors mistakenly prescribed
clot-busters or sugar pills, between three- and
four-fold in each case. The reason: People who get
the wrong dose of a drug frequently have other high-risk
characteristics that make poor results likely, he
says.. |
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