September 1, 2000 - Efforts Launched to Address Medical Errors
According to the November 1999 report released by the Institute of Medicine (IOM), medical errors (medications, surgery, diagnosis, equipment, and lab reports) are the eighth leading cause of death in the U.S. It is higher than car accidents (43,458), breast cancer (42,297), or AIDS (16,516).
The IOM estimated that as many as 44,000 to 89,000 people die in our hospitals each year because of medical errors and that as many as 7,000 deaths result from medication errors. These medical errors cost approximately $37.6 billion each year; $17 billion of these costs, however, could have been prevented.
The majority of the medical errors are "systems related" and are not due to individual negligence or misconduct. Research indicates that system improvements can reduce the error rates and improve quality of medicine. For instance, anesthesia services have reduced their error rates by using standardized guidelines and protocols as well as standardizing equipment. One hospital in the Veteran's Administration system uses hand-held, wireless computer technology and bar coding which cut overall hospital medication error rates by 70%. Eventually, this system will be implemented in all VA hospitals. A 1999 study found that including a pharmacist on medical rounds reduced medication ordering errors by 66%,
from 10.4 per 1,000 patient days, to 3.5 per 1,000 patient days.
Much of the recent controversy over the IOM report and legislation addressing medical errors have focused on whether the reporting of medical errors should be mandatory or voluntary. In addition, according to hospital nurses, there was a link between the nursing shortage, mandatory overtime, and the number and type of medical errors.
There are four pieces of Congressional legislation that specifically address medical errors. Senator Charles Grassley (R-IA) introduced S.2378 the "Stop All Frequent Errors (SAFE) in Medicare and Medicaid Act of 2000." Senator Arlen Specter (R-PA) introduced S. 2038 the "Medical Error Reduction Act of 2000." Senator James Jeffords (R-VT) introduced S. 2738 the "Patient Safety and Errors Reduction Act." Congresswoman Connie Morella (R-MD) introduced H.R. 3672, the "Medication Error
Prevention Act of 2000."
"The Medical Error Reduction Act of 2000," S. 2038 by Senator Specter, authorized grants to states to establish medical error reporting systems and would fund at least 15 demonstration projects to test ways of reducing medical errors through technology, staff training, etc. The "SAFE" legislation, or S.2378 by Senator Grassley, would establish a non-punitive medical error reporting system under Medicare and Medicaid.
"The Patient Safety and Errors Reduction Act," S. 2738, by Senator Jeffords was recently attached to the Senate Labor, Health and Human Services appropriations bill. Reporting of medical errors is voluntary in this legislation and a non-punitive system is used. The legislation calls for establishing a Center for Quality Improvement and Patient Safety which would research the causes of medical errors, develop approaches for the clinical management of complications from medical errors, and develop strategies to prevent or reduce errors. The legislation calls for establishing a National Patient Safety Database for reporting of errors that would be used only for research purposes.
The American Nurses Association was supportive of mandatory reporting during Senate hearings held earlier this year. The American Medical Association has leaned more towards the voluntary reporting of medical errors. The Labor, Health and Human Services appropriations bill may be vetoed by the President, but the legislative language by Senator Jeffords for medical errors may remain in any further revisions of the
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