The US health care system faces with a number of challenges and probably requires reforming. These issues are extremely complicated. To date, the problem of medication errors in drug therapy is not only unexplored but formidable. Medical practitioners try to avoid the discussion of the topic. It does not receive enough attention from the medical press, despite the obvious relevance and social significance of the problem. Moreover, the issue of medication errors is relevant for all countries in every continent. However, only developed countries have taken a proactive approach to curb it. This paper will examine the problem of medication error in the medical organizations of the USA and propose a number of approaches to resolving it.
Firstly, medical error in prescribing means an inaccurate diagnosis of the disease. Also, it includes improper prescribing of medical substances in the form of duplication of drug prescriptions by doctors of several specializations, without taking into account the possible interactions of drugs and age characteristics of the patient and pharmacokinetics and pharmacodynamics of medications prescribed. It also relates to unjustified prescribing of such drugs as antibiotics, cardiac glycosides, anticoagulants, and diuretics. Neglect of the possible risk of side effects in pharmacotherapy; drug prescription without taking into account the potential drug interactions, as well as possible adverse interactions of the medication and food, can be considered a severe medication error. Also, inadequate communication of the doctor and the patient in the form of insufficient clarification and beliefs of the patients in necessity, effectiveness, and duration of treatment and its side effects, as well as the commitment and adherence of physicians to specific treatment algorithms without considering the peculiarities of the organism and the patient's personality lead to the incorrect prescribing of drugs.
Figures on the Problem
Prior to this century, most Americans received all health care at home (Weitz, 2015). Now they seek for medical help in hospitals. For certain degree, paradoxically, this tend endangers the patients. Every year, half a million Americans become victims of errors associated with the improper use or misuse of medicines. About 7 thousands of them die due to the negligence of doctors and pharmacists. Errors associated with choosing a drug and its dose by a physician occupy the leading place in the statistics and account up to 56%. The second position is taken by errors related to the incorrect change of dose and duration of drug therapy, which constitue34% (Montesi & Lechi, 2009). Moreover, in the United States, medical errors rank the fifth place among the leading causes of death leaving behind such common diseases as diabetes, pneumonia, Alzheimer's disease, and renal failure (Nute, 2014). Only in 2005, 98 thousand of deaths that resulted from oversights of physicians were registered (Nute, 2014). Therefore, in the country, due to the fault or negligence of doctors or medical personnel, five people die every 15 minutes.
Errors are observed at all levels of interaction with a patient. For example, each year, in US hospitals, wrong medications are prescribed, and the wrong doses of medicines or even wrong harmful drugs are given to the patients 400 thousand times. In nursing homes, kindergartens, etc. 800 thousand of such errors occur per year (Nute, 2014). Totally, American physicians have at their disposal an arsenal of 15,000 drugs. In 2007, about ten percent of all patients were hospitalized due to the side reactions. Complications of drug therapy occurred in 1317650 patients, of which 33% had severe consequences and 1.4% resulted in death (Nute, 2014). Moreover, this situation is being continuosly observed during the recent years.
Factors Effecting the Issue
Despite the overwhelming significance of the problem, there is no official statistics provided, and it is unlikely to appear in the nearest future. Primarily, this situation because the inspectors and the inspected are part of the same structure. Therefore, no one is interested in clarifying the real scale of the issue.
Previously, organizations for the protection of consumers' rights have accused major pharmaceutical companies of the unfair advertising, which harms people. While in the majority of the world markets, direct advertising of medicines distributed on prescription is prohibited, companies use workaround ways to promote their products. In particular, the producers assure potential buyers that they are suffering from a certain ailment. As a result, people ask physicians to prescribe them drugs imposed by pharmacists which, in fact, are unnecessary.
In addition, pharmaceutical companies bribe doctors and improperly interpret the results of clinical tests on drugs. Among the new techniques, there is an organization of conferences on specific diseases when sponsorship of the pharmaceutical giants is not advertised (Montesi & Lechi, 2009).
Attempts to Solve the Problem
The problem of medication errors is not new. However, in the past, it did not receive proper attention. The first works devoted to the description and study of the problem of medication errors began to appear in the 90s. One of the first significant studies on the issue was organized and conducted by the Institute of Medicine. In addition to other facts, this study showed that enormous financial costs are associated with the medication errors. The report of the Institute of Medicine of the USA noted that medical errors cost the country about $ 37.7 billion per year, of which $ 17 billion are associated with the costs that could be prevented (Brunetti & Suh, 2012). It means that approximately half of these funds are spent on the treatment of the consequences of medication errors that could not happen.
The reaction from the country's leadership on the data obtained by the Institute of Medicine occurred in December 1999. US President Bill Clinton's by Executive Order has established the Interdepartmental Working Group on the coordination of the quality of the health care. He required to provide him with the recommendations aimed at improving the degree of safety in the treatment of patients within 60 days. The recommendations developed by the Presidential Commission were released by the White House (Brunetti & Suh, 2012).
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Proposition of Measures to Solve the Problem
Problem-Based Pharmacotherapy Training through the Institute's Programs
The pharmaceutical industry has played a key role in solving this issue since the industry markets not only drugs but also ideas about what is a disease and how it should be treated (Weitz, 2015). Quality basic education of pharmacotherapy in the training program of future doctors and paramedics may significantly affect the prescription drugs. Rational pharmacotherapy training, working with clinical guidelines, and a list of necessary medicines helps to develop good skills in prescribing in future doctors. The effectiveness of training will be higher if it is held on the specific clinical examples (problem-oriented method) and take into account the knowledge and skills of students directed to the formation of their self-critical approach to the prescribing of medicines.
Direct Measures in the Medical Organizations
Ensuring the Safety of Medicines at the stage of prescribing and use of drugs is largely dependent on such factors as the level of training and awareness of professionals as well as the diligent performance of their duties. During their long years of training, doctors learn both technical information and a set of medical norms expectations for how doctors should act, think, and feel (Weitz, 2015). To ensure a high-quality treatment audit and feedback as well as supervision over the use of drugs are necessary. Supervision involves private communication of inspectors and medical professionals. This approach will be much more efficient and better accepted by the doctors than the inspection and punishment. Effective forms of supervision should include the audit of prescribing, providing feedback, comparison, and discussion of the results of treatment with colleagues.
The audit of prescribing and feedback should present the analysis of correctness of decisions with the subsequent conclusion of the commission. It will indicate what actions of the physician differ from the actions provided in the manuals and other infringements if present. A collective approach is that doctors themselves identify problems associated with prescribing the institution, and develop measures to address them. This approach requires the coordinator responsible for the organization of work.
Besides, to ensure effective and safe treatment of patients with the advisory support of drug therapy prescribed to the patient in accordance with the established standards of medical care, appropriate authorized person should be appointed in each medical organization. This person should be a clinical pharmacologist. In case if such person is absent in a medical organization, a doctor should be appointed as a clinical pharmacologist. In addition to training in his or her basic specialty, an authorized person should undergo training in the specialty of clinical pharmacology in the established order.
A central and particularly important activity of such authorized person should be to analyze the medical and pharmaceutical personnel errors in the prescribing of drugs and the development of measures for their prevention. This person should note all the errors of medical and pharmaceutical staff within the appointment process and the use of drugs. The area of his or her focus should include incorrect dosing, noncompliance appointments, lack of consideration of the possibility of interactions with other medicines and food, incorrect technique administration of drugs; and failure to comply with the procedure, etc.
In addition, the computerization of medical institutions will eliminate errors in writing and remembering instructions. Employees should be protected from the psychological factors such as stress, fatigue, forgetfulness. Successful teamwork, cooperation among doctors, nurses, and pharmacists is the key to reducing the number of errors. Now, clinicians have become more concerned with and in documenting their allegiance to guidelines, however, they should become any more concerned with following those guidelines (Weitz, 2015).
Measures on the State Level
For some industries corporate efforts are not typical since competition in the environment is extremely high. Traditionally, doctors try not to draw the public attention to the facts of the death of patients due to their fault. However, many developed countries began to implement special national programs on the quality of care and patient safety. It seems evident that patient safety issue should be resolved at the state level.
The government should approve laws in all the states that require hospitals to report to the authorities about serious errors. The list of errors to be included in the report should contain the most frequent mistakes that result in the death of patients. It should be aimed at identifying cases of wrong decisions, improper prescribing, and use of defective medical devices. It would be made not to count the specific number of errors, but to explore and examine the negative experience to avoid a repetition of tragic experiences in the future. Besides, the prevention of medical errors and providing quality care should be included in the curriculum of medical training.
In the US medical organizations, a campaign to reduce medical errors can save the lives of thousands of patients. In the health care system, serious reforms must begin. The work of physicians is associated with the most complex natural object, which is the human body. Unfortunately, knowledge and experience cannot guarantee inerrancy of action of a physician. The uniqueness and numerous combinations the symptoms of illness are so diverse that it is hard to envisage all the issues even in the most conscientious attitude. Thus, the attitude should be realistic. The total absence of errors will never be reached since it is impossible to eliminate them completely. The doctors were wrong and will be wrong, and reluctance to recognize it means refusing to see the objective reality.