Archive: May, 2011
Handwritten prescriptions combined with look-alike drug names are among the most risky conditions associated with medication use. Running closely behind is the combination of sound-alike drug names and the thousands of orally communicated prescriptions heard every day in hospitals, doctor offices and pharmacies. Even computerized prescribing and pharmacy prescription processing don't prevent all name mix-ups as many look-alike names appear near one another on drug inventory selection screens and it’s too easy to choose the wrong item.
In Pennsylvania, one in ten medication errors submitted to the state's reporting program is associated with providing the wrong drug to a patient and of those, one in three is due to confusion between medications with similar names. The same findings are seen with errors submitted to our national error reporting program, the ISMP Medication Errors Reporting Program.
Last week a pharmacist sent us a report that’s typical of those involving medication errors due to name mix-ups. A woman who had surgery for breast cancer was given a prescription for Femara tablets. The drug blocks formation of estrogens that may increase the chance of the cancer returning and spreading. It is only effective in post-menopausal women. Unfortunately, her pharmacy misread the prescription and dispensed a hormone replacement therapy called FemHRT. The ingredients in the drug are similar to birth control pills although it’s used for symptoms of menopause such as hot flashes/night sweats and the prevention of osteoporosis. Giving FemHRT to a woman who’s had surgery for breast cancer is almost exactly the worst type of error to make in a patient for whom Femara is prescribed because the hormones in FemHRT could stimulate cancer cells to grow. The error was discovered when this woman began menstruating and suffered breast pain and swelling. It’s too early to tell if there will be any long term effects.
Pity poor Mitt Romney. His signature accomplishment as governor of Massachusetts is now his albatross. Try as he might, he just can’t seem to shake it.
As governor, Romney guided passage of a revolutionary health reform plan. The effort was bipartisan and collaborative. The plan, which was enacted in 2006, has extended coverage to thousands of previously uninsured residents and brought Massachusetts the lowest rate of uninsurance in the country, a mere 2%.
The plan’s basic elements may sound familiar. Everyone is mandated to have health insurance. Individuals can purchase it through an exchange. There are subsidies for those with low incomes and an expansion of Medicaid for the very poor. These should sound familiar because they are also the core elements Obamacare.
Postings in the blogosphere during recent weeks have discussed changing the organization of Big Pharma companies to increase drug development productivity. For example, the author of one posting considers it mandatory for various companies to become active competitors in biosimilars. Even as Pfizer's CEO, Ian Read, says he is considering divesting up to 40% of that company's operations, the pharma reporter at Forbes wrote that discussion of what the company may sell or how it will reorganize itself are beside the point because the important issue is what Read will do to fix the research operation there.
Clearly the industry finds itself in its current trough because it has been failing at its historic mission of developing new drugs to advance curative medicine. So improving this principal function would seem to represent management's most important challenge. But Big Pharma companies cannot rectify the way they do research without first changing their business model and the way they are organized.
During the 1990s CEO Bill Steere basically created Pfizer in the form it exists today. This structure and function represent the prototype of pharma's reigning megacompany-blockbuster model that impedes more productive research. Steere's plan, later adopted by the rest of Big Pharma, was able to capitalize on a fruitful research paradigm of medicinal chemistry by building an industrial economy of scale around it. It called for creating a big company led by an overwhelming marketing organization and the resources to throw a larger number of compounds into the pipeline than its competitors. Statistical probability meant that a small proportion of these compounds would win approval and, even if most of them were second or third-to-market, me-too entries, the industry's cartel powers over its customers would make those products enormously profitable.
By Michael R. Cohen, President Institute for Safe Medication Practices
Although it’s not within our purview as a federally certified patient safety organization (PSO), healthcare consumers sometimes send us complaints about their pharmacy shorting them on the number of tablets or capsules they’re supposed to get when a prescription is dispensed. It seems like we’ve gotten a lot of these recently so I thought I’d share some thoughts. Of particular concern is that reported episodes often involve federally listed controlled drugs such as prescription opioid narcotics like Oxy-Contin, Vicoden and Lortabs or sedatives like Xanax or Ambien.
Consumers tell us that when they identify missing pills they call the pharmacy to inform or complain about being short and the pharmacy insists it dispensed the proper quantity. Neither party believes the other. The pharmacy thinks the patient or someone in their home removed some tablets (either for themselves or for the black market) and the patient thinks the same about the pharmacist and/or their staff. So it basically winds up being a “he said, she said” situation. So where are these drugs going? What are can be done to provide better control?
Do you know anyone who died because they drank a cup of water?
If you live in America, probably not. But hundreds around the globe die every day because they did just that.
Do you know of any children who died from measles, whooping cough, or polio?
In a 2007 survey, the public rated the pharmaceutical industry less favorably than IT, electronic goods, food & beverages, waste collection/recycling, medical devices, telecom, automotives, and personal/beauty products. The only industries that the survey's 1,200 respondents viewed more unfavorably than pharma were those involving oil & gas, chemicals and tobacco.
That was an ominous result because pharma's profitability rests on a base of patent protection and regulation that impede competitive entry and provide insulation from the market. Stated another way, if a substantial part of an industry's profit depends upon an ongoing monopoly/oligopoly bestowed by popularly elected governments, then that industry should regularly try to enhance its image in the public eye.
Pharma appears in the process of ignoring an opportunity to do just that. Shortly before and after last fall's Congressional elections, the industry's lobbying group made it clear that they intend to terminate their short-lived cooperation with the Obama administration's health care efforts and return to their historical support for Republicans. That's unfortunate because if pharma opposes the Republican budget proposals, especially the one from Congressman Paul Ryan, the industry can help mitigate its tattered public image.
One of the benefits of consumers seeking to become more informed about their health care is that many of them have also stepped up efforts to become more directly involved in error prevention. I’m convinced that patient involvement is an absolutely critical component of patient safety. As health care providers, my colleagues and I need to engage patients not just as a disease or injury in need of our expertise and care, but also as equal partners in gaining positive treatment outcomes.
This concept really hit home last week when a close friend of mine, a cancer patient, related an experience that happened to him when he went to a health care facility for chemotherapy. He told me about it because he thought it could become an important learning experience for patients and consumers alike. What happened might have been life-threatening had it not been for simple steps that his doctor and nurse took just before he was to receive his IV chemotherapy: they made sure they mentioned the name of the cancer drug he was supposed to get and also involved him during the drug administration process.
After he settled into the infusion room, his nurse came by and said that he would be getting cisplatin. However, during the visit with his doctor just an hour before, he heard him say he’d be starting a cycle of three treatments with an IV drug called paclitaxel. The thought of getting cisplatin was a big surprise since, in the past, he’d had a serious allergic reaction to it. He remembered it well because it was the first time he had any sort of serious reaction to any of the cancer treatments. He described it as “a little scary,” as the allergy symptoms came on rapidly and strong and the nurses had to jump into action with Benadryl, nasal oxygen, taking vital signs, etc. Fortunately, he recovered fairly quickly, but it wasn’t a pleasant experience.