How often are doses of medication ordered in hospitals and skilled nursing facilities given in error? Trained observers accompanied nurses as they prepared and administered medications and witnessed the administration to the patient, and then they compared what they saw with the physicians' original orders to identify discrepancies. The 3216 doses studied were those given (or omitted) during at least 1 medical pass on a high medication–volume nursing unit in a stratified random sample of 36 institutions (18 in Georgia and 18 in Colorado). The results showed that medication errors are more common than suggested by previous studies, which were conducted mostly in teaching hospitals. Those rated potentially harmful by a physician panel occurred at the rate of 40 per day in the typical 300-bed facility, confirming that defective medication administration systems are widespread.
Patients taking warfarin occasionally present with asymptomatic but dramatic elevation of their international normalized ratio (a measure of the intensity of anticoagulation). This survey uses mock patient scenarios to assess the current practice of anticoagulation clinics facing this dilemma. The data presented suggest that there is substantial variability with respect to the use of oral vitamin K (phytonadione), an intervention recommended (for certain patients) by the American College of Chest Physicians, the American College of Cardiology, and the Anticoagulation Forum.
Patients in intensive care units are likely to receive large panels of "routine" diagnostic tests. However, the literature suggests that many of these tests are unnecessary. An intervention to reduce unnecessary testing was performed in a coronary care unit at a large teaching hospital. This intervention consisted of guideline development, computerized order template design, and educational efforts. There were no significant changes in length of stay, readmission to the intensive care unit, or hospital mortality.
Costs of care for heart failure are high, but it is unclear what factors contribute to these costs. In this study, 1098 health maintenance organization patients were evaluated following a first hospitalization with a primary diagnosis of heart failure. Depression and heart failure status were determined through diagnostic, laboratory, and pharmacy records. Actual utilization and cost values were derived from administrative data. After adjusting for age, sex, medical comorbidity, and length of stay at index hospitalization (as proxy for heart failure severity), costs were 26% higher in the antidepressant group and 29% higher in the depression diagnosis group compared with the no depression group (both P<.001). Increased inpatient and outpatient utilization both contributed to the increased costs. Depression may make a significant contribution to the high costs of care for heart failure.
Depression group costs by 6-month intervals. 1, No depression group; 2, antidepressant prescription only group; and 3, antidepressant prescription and depression diagnosis recorded group.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2002;162(16):1804. doi:10.1001/archinte.162.16.1804