Patient Safety

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Reduce Your Risk for Medication Errors
(Fall 2006)

Access Editable Version of the Medication List

Medicine is prescribed to help you.  But it can harm you if you take too much or mix medicines that don’t go together.  Many people are harmed each year, sometimes seriously, because of taking the wrong prescription drugs or not taking these medications correctly.  A new report from the Institute of Medicine estimates that there is at least one medication error per hospital patient per day, with error rates varying widely across facilities.  Although not all errors lead to injury or death, the number of preventable injuries - 1.5 million - is staggering.  The extra medical costs of treating drug-related injuries occurring in hospitals alone is estimated at $3.5 billion, which does not take into account lost wages, productivity, or additional health care costs.

The good news is that new computerized systems for prescribing drugs show promise for reducing the number of drug-related mistakes.  Electronic prescribing is safer because it eliminates problems with handwriting legibility and alerts prescribers to possible interactions, allergies, and other potential problems.  The GIC is actively involved in a number of efforts to bring electronic prescribing to the Commonwealth.  However, statewide electronic prescribing is a few years off.

You can help reduce your own risk for medication errors.  You can alert your health care team (and family members if you are incapacitated) of all the prescription and over-the-counter medicines, vitamins, herbal and dietary supplements you are taking, their dosage and any side effects or allergies you may have.

Two pages in the fall 2006 newsletter, developed from materials supplied by the Massachusetts Coalition for the Prevention of Medical Errors, a coalition of health care professionals committed to reducing medical mistakes, will help you to avoid medication errors:

• Tear this out and fill it out completely
• Use it to ensure that you thoroughly understand the medications you take –who prescribed it, what is the dose, when do you take it, what’s its purpose, what are possible side effects, and other factors to consider. 
• Update it each time you are prescribed a new prescription. 
• Make sure to give each doctor you see an updated copy – consider giving family members a copy so that they can act as an informed advocate for you in the event you are incapacitated

Being an active member of your own health care team is the single most important way you can stay healthy.  For additional steps you can take, visit the federal Agency for Healthcare Research and Quality website.

Choosing the Right Hospital Can Make a Difference
(winter 2005)

Medical mistakes are the fifth leading cause of death in the United States. They cause more deaths than car accidents, breast cancer and AIDS. Even when mistakes made in hospitals are not fatal they still can have bad results. They can lead to injury, disability, longer hospital stays, or longer recovery.

The GIC is a member of the Leapfrog Group, a coalition of more than 150 organization devoted to improving patient safety. The Leapfrog Group works with medical experts all over the country to identify problems and offer solutions to improve hospital quality. Scientific evidence shows that the following four Leapfrog patient safety steps reduce death and injury. Consider choosing a hospital:

§ That requires doctors to use computerized systems for prescribing drugs
§ With proven results or lots of experience with specific procedures or diagnoses
§ With an Intensive Care Unit (ICU) that is staffed at least eight hours a day by specially trained doctors and other caregivers
§ That has a high "Leapfrog Quality Index". This means it has put in place up to 27 practices known to reduce preventable medical mistakes.

The GIC and our health plans continue to work with area hospitals to encourage reporting of their progress on these measures. The GIC will again provide Leapfrog safety information in our upcoming 2005-2006 Benefit Decision Guide. Expanded information will be available at the health fairs and on our website. For the latest Leapfrog patient safety information and additional details on these safety steps, see the Leapfrog Group's website. Keep in mind that most routine procedures are safely and conveniently performed at local hospitals. Talk with your doctor and health plan to obtain additional information about your hospital options.

Having Surgery?
What You Can Do to Minimize Surgical Infections
(winter 2004)

Postoperative infection is a major cause of patient injury, mortality and health care costs. Of the nearly 30 million surgical operations performed annually, infection rates run from 2.6% to 11%, depending on the operation. Overuse of antibiotics has made many strains of bacterial infection resistant to drugs that help fight these infections. As a result, these infections can become lethal with infected patients more likely to spend time in an intensive care unit and twice as likely to die as patients who are not infected. Patients having a knee replacement who get an infection are more likely to require amputation. It is estimated that each infection, on average, increases a hospital stay by seven days and adds over $3,000 in charges.

In August of 2002, the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control (CDC) began a health care quality improvement project to prevent postoperative infection. An expert panel, comprised of members of the medical community, provides input and advice. The goal of the project is to cut the number of surgical infections by 50% by 2005.

According to the project's participants, between 40% and 60% of surgical infections are preventable if doctors and hospitals follow the guidelines issued by the CDC in 1999. Unfortunately, in 25% to 50% of surgeries, doctors are not following these protocols:

· Use recommended antibiotics
· Start preventive antibiotics within one hour before making the surgical incision
· Discontinue the antibiotics within 24 hours of the end of surgery

Other guidelines include administering oxygen to patients after surgery, keeping patient body temperatures normal, and not shaving a surgical site before surgery. This last measure used to be a standard practice, but has been found to cause micro abrasions in the skin where bacteria can take over. Instead, the CDC recommends that the surgical site be sterilized and the hair not removed, or the hair shortened with clippers.

So what can you do as a patient? The best approach is vigilance. Although asking questions of your health care team can be uncomfortable, it is your life, or your loved one's life, that matters. The CDC recommends the following:
· Avoid elective surgery if you have an active infection
· Become informed about the recommended medications for your surgery by accessing the project's guidelines at the Medicare Quality Improvement Community's web site
· If hospital personnel do not wash their hands, ask that they do so.
· Do not let someone shave the surgical site. Or, if hair must be removed, request that electric clippers be used right before the operation
· Make sure you have a preventive dose of antibiotics an hour before surgery and that they are discontinued within 24 hours after the operation
· Request an antiseptic bath or shower the night before surgery
· Ask that people in the operating room be restricted to necessary medical personnel only and that no one have artificial fingernails or current infections
· Follow post operative instructions and medication orders and alert your doctor if you have any fever, weight loss, pain, oozing or swelling at the incision site

Leapfrog Group Honors Eight Massachusetts Hospitals
(summer 2003)

Eight Massachusetts Hospitals were recognized for their progress in implementing patient safety practices. The GIC hosted the presentations by the Leapfrog's Regional Employer Group, comprised of employers dedicated to improving patient safety. The feted hospitals have committed to the three Leapfrog patient safety standards, which are proven to reduce preventable medical errors in hospitals: computerized prescription orders, intensive care unit staffing by physicians certified in critical care medicine, and evidence-based referrals to hospitals that have extensive experience performing certain high-risk conditions and procedures.

Honored for meeting all 3 measures were:
· Brigham & Women's Hospital
· Massachusetts General Hospital
· Beth Israel Deaconess Medical Center

Honored for significant progress were:
· Baystate Medical Center of Springfield
· Berkshire Medical Center of Pittsfield
· Dana-Farber Cancer Institute
· Newton-Wellesley Hospital
· South Shore Hospital

For the latest patient safety progress of area hospitals, see the Leapfrog Group's web site.

Check Out Your Hospital Before You Have Surgery.
It Could Save Your Life.
(fall 2002)

It's in your best interest to check out your hospital options. Tools you need to research your hospital options are now available! You can now find out which area hospitals meet standards for patient safety by logging onto the Leapfrog Group's web site . The Leapfrog Group is a national coalition of large employers and government agencies committed to improving patient safety; the GIC was the first Massachusetts organization to join.

The following three measures could save up to 58,300 lives per year and prevent 522,000 medication errors if implemented by all non-rural hospitals in the United States, according to research conducted by Dartmouth Medical School.

· Physicians' use of computerized prescription ordering systems (CPOE)
· Selection of hospitals with extensive experience for certain high-risk conditions and procedures
· Staffing Intensive Care Units (ICUs) with board-certified critical care physicians

The GIC provides this information to you in our annual enrollment Benefit Decision Guide. The report is also available with the Mass Healthcare Purchaser Group's HMO Report Card, available at our annual enrollment health fairs, and on our web site. The Leapfrog criteria and other hospital comparison information, such as number of patients treated and mortality rates, are also available on our web site's Hospital Research Tool.

Leapfrog Expands Into Massachusetts -
Other Employers to Support GIC with Improving Patient Safety
(summer 2002)

Help is here to assist the GIC with our efforts to help reduce medical mistakes. In April the Leapfrog Group, a national coalition of large employers and government agencies committed to improving patient safety, expanded into Massachusetts. This means that other employers, including Fidelity, Verizon, and General Electric, will be seeking the same kind of patient safety information to report to their employees. "We cannot improve patient safety alone," said Dolores L. Mitchell, GIC's Executive Director. "We welcome the help and support of fellow Leapfrog members, who are similarly committed to helping their employees make informed decisions about where to seek care."

Tens of thousands of Americans die and many more are injured each year from preventable medical mistakes made in hospitals, according to the Institute of Medicine. The GIC was the first Massachusetts organization to join the Leapfrog Group (www.leapfroggroup.org). Our HMO contracts, which began on July 1, 2001, included a timeline for gathering, reporting, and communicating hospital data on three key safety measures developed by the Leapfrog Group, proven to reduce medical mistakes. Research conducted by Dartmouth Medical School indicates that these three improvements could save up to 58,300 lives per year and prevent 522,000 medication errors if implemented by all non-rural hospitals in the United States:

· Use of computerized prescription systems (computer physician order entry - CPOE)
· Selection of hospitals with extensive experience for certain high-risk conditions and procedures
· Staffing Intensive Care Units (ICUs) with board-certified critical care physicians

"Although we received this data for many of the area's hospitals, gaps and discrepancies remain," said Dolores L. Mitchell. "By gathering this information, with the help of our health plans and other health care purchasers, we will be able to reduce the number of patients harmed or killed by preventable medical errors across the Commonwealth," said Dolores L. Mitchell.

Our new Select Quality Care Tool, provided by CIGNA, includes Leapfrog data on a constantly updated basis (see page one for related article.) Indemnity, PLUS and Indemnity Medicare Extension Plan members also have access to Making Healthy Decisions, which also provides this information.

What You Should Ask Before You Have Surgery
(winter 2002)

The Agency for Health Care Policy and Research (AHCPR) developed the following list of sensible questions you should ask your doctor before you schedule any surgery. See their web site for more details and links to other resources:
1) What operation are you recommending? - Have the surgeon explain the procedure and ask if there are different ways of doing the operation.
2) Why do I need the operation? - What is the purpose of the surgery: is it to relieve or prevent pain, improve a body function, or diagnose a problem?
3) Are there alternatives to surgery? Sometimes nonsurgical treatments work. Ask about the benefits and risks of the surgery and these other choices.
4) What are the benefits of the operation and how long will the benefits last? - Ask is there is published information about the procedure outcomes.
5) What are the risks of the operation? Weigh the benefits against possible complications and side effects.
6) What if I don't have the operation? What will you gain or lose if you don't have the operation?
7) Where can I get a second opinion? Many health insurance plans require second opinions before non-emergency operations - call your plan for their policy. Bring your records and any test results from the first doctor to the second so those tests are not unnecessarily repeated.
8) What has been your experience in doing the operation? Ask how many of these procedures the surgeon has performed and what successes and complications has he or she had with this procedure.
9) Where will the operation be done? Some operations have higher success rates if they are done in hospitals that perform them frequently. Ask about the success rate at this hospital. Find out whether the hospital is accredited and its performance report by the Joint Commission on Accreditation of Healthcare Organizations www.jcaho.org.
10) What kind of anesthesia will I need? Find out the qualifications of the anesthesiologist or nurse anesthetist and ask him or her what the side effects and risks of having anesthesia are in your case.
11) How long will it take to recover? Find out if you will need supplies or equipment you will need at home and get these in advance to make the recovery easier. Ask about when you may resume work and exercise.
12) How much will the operation cost? Call your health plan to find out whether it will cover the surgery and what out-of-pocket expenses you will incur.

Others Join the Patient Safety Leapfrog Lilly Pad (fall 2001)

The Maine State Employee Health Commission and the Massachusetts Department of Medical Assistance took up the torch to improve patient safety. They joined The Leapfrog Group, a coalition of large health care purchasers devoted to improving patient safety. The GIC already joined the Leapfrog Group last October. Leapfrog is a group of employers who offer generous benefits to their employees and share a common interest in improving health care quality.

The group coalesced in an effort to do something about the startling 1999 Institute of Medicine report which estimated that medical errors kill more Americans than motor vehicle accidents, breast cancer, or AIDS. In response, the Leapfrog Group developed measurable standards to improve hospital safety. Members of Leapfrog pledge to educate enrollees about patient safety and recognize hospitals that meet the standards.

The GIC was the first Massachusetts organization to join Leapfrog. We incorporated the Leapfrog standards into our new health plan contracts. Beginning July 1, all GIC health plans began to gather hospital data on these standards. Once the GIC has received and reviewed these data, we will share them with enrollees to assist you with your hospital care decision making. In the meantime, talk with your doctor about hospital patient safety.

The following Leapfrog standards reduce hospital errors and improve patient safety:
· Inpatient computerized physician order entry of prescriptions
· Intensive care unit (ICU) staffing by physicians certified in critical care
· Hospital volume for five high-risk procedures and two high-risk deliveries.

GIC Takes a Stand -- Advocates Improved Patient Safety
(winter 2001)

Starting July 1, 2001, all GIC health plans will begin reporting patient safety information on key indicators established by the Commission. At October's Commission meeting, the Commission voted to require plans to provide information relating to hospital-based safety measures. We will eventually provide this information to you to assist you with your health care decision making.

In late 1999, the Institute of Medicine (IOM) reported that 44,000 to 98,000 Americans die each year as the result of preventable medical errors. Using the IOM's most conservative number, medical errors are the eighth leading cause of death, killing more Americans than automotive accidents. Extrapolating from these numbers, 33 to 89 state employees, or their family members, die annually from preventable medical errors.

As one of Massachusetts' largest health care purchasers, we are taking a leading role in tackling this problem. The GIC adopted standards for the new health plan contracts that will begin in July 2001, corresponding to those developed by the Leapfrog Group, a national coalition of large employers who are addressing patient safety. "These standards save lives," said Dolores L. Mitchell, GIC Executive Director. "We have an obligation to our enrollees, and the citizens of the Commonwealth to take a stand now, rather than later."

Beginning with the FY '02 fiscal year, GIC health plans will provide data to track the following three standards:

Computerized physician order entry of prescriptions in the hospital: As described in the IOM"s "To Err is Human", 7000 people die each year as the result of medication errors. More than one million medication errors occur every year in U.S. hospitals according to the Leapfrog Group. Computerized medication ordering (CPOE) has been shown to reduce serious prescribing errors by more than 50 percent. A Leapfrog Group study estimates that implementation of CPOE systems at all non-rural hospitals could prevent over 500,000 serious medication errors each year.

Physician Staffing in Intensive Care Units (ICU): ICUs and operating rooms are the highest risk areas in hospitals: 500,000 patients die in ICUs each year according to the Leapfrog Group. They estimate that ICU staffing by physicians certified in critical care medicine can reduce ICU mortality by 50,000 in metropolitan areas alone.

Hospital volume for seven complex treatments: Obtaining care for certain high risk procedures at hospitals that are not experience in handling them increases a patient's risk of dying by 26%, according to a 1999 study published in the New England Journal of Medicine. The following are the procedures that GIC's health plans will track by hospital by volume:
· Coronary artery bypass
· Coronary angioplasty
· Abdominal aortic aneurysm repair
· Carotid endarterectomy
· Esophageal cancer surgery
· Delivery with expected birth weight under 1500 grams or gestational age under 32 weeks
· Delivery with pre-natal diagnosis of major congenital anomalies

In addition to saving lives, these initiatives also lower health care costs. The IOM reported that medical errors cost the nation's health care system an estimated $8.8 billion annually. A 1996 Brigham and Women's Hospital study indicated that preventable adverse drug events occur in nearly two percent of its admissions. Added costs of $4500 per event result from longer stays and additional treatment. To its credit, the hospital has made great strides in installing CPOE error-prevention systems described above.

20 Tips to Avoid Medical Mistakes (fall 2000)

Last fall the Institute of Medicine (IOM) published an alarming report. "To Err is Human: Building a Safer Health System" revealed that 44,000 to 98,000 Americans die each year as the result of preventable medical errors. Using the IOM's more conservative figure of 44,000 deaths demonstrates the severity of this finding: medical errors rank as the eighth leading cause of death killing more Americans than motor vehicle accidents, breast cancer, or AIDS. The report emphasized that many of these errors are system failures, not just human errors, and they are therefore capable of being corrected.

Take charge of your health care. The U.S. government's Agency for Healthcare Research and Quality (AHRQ) recommends that patients do the following to reduce their risk of becoming the victim of medical mistakes:

1) Be an active member of your health care team: This is THE biggest predictor of getting the best health care results. Ask questions. Take part in every decision about your health care.

2) Make sure your doctor knows every prescription, over-the-counter medication, and dietary supplements, such as vitamins and herbs, you are taking.

3) Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.

4) When your doctor writes you a prescription, make sure you can read it. If you can't read it, your pharmacist probably can't either.

5) Ask questions of your doctor and pharmacist about your prescription. What is it for? How am I supposed to take it and for how long? What side effects are likely? What do I do if they occur? If this medicine safe to take with other medicines or dietary supplements I am taking? What food, drink, or activities should I avoid while taking this medicine?

6)When you pick up your prescription, verify that it is the correct drug prescribed. A study the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or wrong dose.

7) Clarify your understanding of the dosage instructions with the pharmacist. For example, does four doses daily mean taking a dose every 6 hours round the clock, or just during regular waking hours?

8)Ask for instructions on measuring liquid medicines. A household teaspoon may not accurately measure a liquid teaspoon; a syringe or other device will probably provide more accuracy.

9) Ask the pharmacist for written side effects your medicine may cause.

10) If you are having a procedure or surgery done at a hospital, choose a hospital with a lot of experience with your condition.

11) Consider asking all health care workers who have direct contact with you in a hospital whether they have washed their hands.

12) When you are being discharged from a hospital ask your doctor to explain about the medications you will be taking, and the activities you may safely engage in, at home.

13) If you are having surgery, make sure that you, your doctor, and your surgeon agree on exactly what and where the surgery will be performed. The American Academy of Orthopedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery, for example on the left knee.

14) If you have questions or concerns, speak up.

15) Make sure that one person, such as your personal doctor, is in charge of your care. This is especially important if you have many health problems, or are in a hospital.

16) Make sure that all health professionals involved in your care have important health information about you.

17) Ask a family member or friend to be there with you and to be your advocate: pick someone who will help get things done for you and speak up for you when you can't.

18) Know that "more" is not always better. Find out why a test or treatment is needed and how it can help you.

19) Ask about the results of all tests. Don't assume that no news is good news.

20) Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources. Treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse.

Senator Moore Presents GIC Senate Citation for Its Patient Safety Efforts (winter 2001)

Senator Richard T. Moore (D-Uxbridge) awarded and presented a Senate Citation to the Group Insurance commission at the December 2001 Commission meeting. Senator Moore, Chair of the Joint Committee on Health Care, applauded the Commission's leadership on pushing providers to improve patient safety. The GIC will require its plans to provide information relating to hospital-based safety measures beginning July 1, 2001.

The citation, passes unanimously by the Senate on October 30, 2000, congratulates the GIC for its commitment to improving patient safety and reducing medical errors in the Commonwealth. GIC's Executive Director, Dolores L. Mitchell, said, "The GIC appreciates Senator Moore's tremendous support and interest in patient safety. We were particularly pleased that he came to the Commission meeting to present the citation in person."

Health Research Reaps Benefits (summer 2000)

Startling news about the number of hosptial-based errors leading to preventable deaths was recently splashed across the news. The National Insitatue of Medicine reported that up to 98 thousand people die each year in the U.S. as the result of preventable hospital-based medical errors.

How did the Institute of Medicine learn about the magnitude of this problem and how will hospitals and other providers devise effective solutions? The answer is through careful medical research, using very large data bases, so that patterns can be found that are valid for very large populations. Using anonymous data, researchers study claims or hospital records to uncover patterns and find areas for improvement.
These include:

• Improved safety
  
• New and enhanced health management programs
  
• New benefits
  
• Reduced medical costs

The GIC's recently enhanced mental health parity benefit - expanding mental health coverage across all plans to equal other medical benefits - is a prime example of some of the payoffs of research. Our plans' Coronary Artery Disease and UniCare's diabetes management programs also came about as the result of research. These initiatives have improved enrollees' quality of life.

The bottom line - legitimate medical research that protects individuals' privacy is paramount to everyone's health.