Monitoring

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Monitoring Reporting Medication Errors in
Long-Term Care Facilities Across Canada

• Annette Down
• Dalhousie University
• April 4, 2002

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Research Question

• What are the primary areas of focus to consider
  in implementing a reporting structure for
  medication errors that will reduce this problem
  in long-term care facilities?

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Methodology

• Literature Review
• Meeting with Metro Administration Group
• Interviews with Directors of Nursing, long-term
  care pharmacists, LPN licensing body registrar,
  pharmacy registrar, Nova Scotia Department of
  Health licensing employees, CEO of ISMP Canada

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Long-Term Care System

• 1917 long-term care facilities across Canada
  148, 562 beds - mainly in Ontario
• National reporting guidelines are found in
  accreditation standards
• Less than three quarters of all facilities are
  accredited
• Provincial legislation regarding pharmacy
  services and nursing home operation
• Role of licensing bodies

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What is a Medication Error?

• A preventable event that occurs in the process of
  medication use prescribing, dispensing and
  administration
• Medication errors are usually caused by human
  errors that are manifested in drug distribution,
  drug names, labeling, computer program design and
  drug delivery design
• Source ISMP Canada

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Medication Errors vs. Other Similar Terms

• Adverse drug reaction (ADR)
• Adverse drug event (ADE)
• Drug-related problem (DRP)
• Drug-related morbidity (DRM)
• Preventable drug-related morbidity (PDRM)

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Scope of the Problem

• No national reporting system in Canada
• The magnitude of the problem in hospitals has
  been well-documented not so in the LTC setting
• The problem of other drug-related complications
  (ADEs, DRM, PDRM, etc) has been studied in the
  LTC setting so there is reason to expect
  medication errors are also a problem in this
  setting
• Medication errors are dramatically underreported
  in all settings

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Current Progress to Date

• Various initiatives in acute care sector (I.e.
  Capital Health Patient Safety Advisory Group)
• Active role of ISMP Canada
• New initiative by Health Canada
• Implications for the LTC setting?

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Why Should Long-Term Care Administrators Care?

• Economic implications
• direct and indirect costs
• role of pharmacist
• Quality management
• performance indicators
• facility pharmacy reporting structure
• Risk management/resident safety

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Why do Medication Errors Happen?

• What human factors research tells us
• The Eight Essential Elements of a Safe and
  Effective Drug Therapy System often one or more
  of these elements are missing
• Perceptions of long-term care
  providers and pharmacists

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Risk Factors in Residents

• Elderly have a higher average number of
  prescriptions compared to general
  population
• Physiological changes related to aging
  place seniors at a higher risk for a
  drug-related problem
• Knowing the risks is essential to reducing the
  potential for error!

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Common Medications Associated with Error

• Role of specific drugs
• Beers Criteria for Determining Inappropriate
  Medication Use in Nursing Home Residents
• McLeods Criteria of Inappropriate Practices in
  Prescribing for Elderly People
• ISMP list of high problem medications

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Barriers to Reporting

• Organizational policies and procedures
• Strive for error-free practice
• Level of fear
• Traditional reporting for trending purposes
• Lack of statutory protection
• Lack of awareness
• Incentive to report?

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Barriers to Reporting in the Long-Term Care
Setting

• Fear of reprisal
• Time to fill out the reporting form
• Complexity of the reporting form
• Fear of being viewed as incompetent
• Overcome obstacles by
• simplifying the form
• accepting that human error occurs
• eliminating disciplinary action

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Consequences of Not Addressing the Problem

• Error will continue to occur
• Negative economic outcomes
• Lack of accountability
• Negative impact on humanistic
  outcomes
• Legal implications

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Strategies to Reduce Medication Errors

• The role of the Canadian Council on Health
  Services Accreditation
• Improve AIM indicators
• The role of the federal and provincial/territoria
  l governments
• Improve their role
• Develop national reporting structure
• Implement minimum best practice standards

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More Strategies

• The role of individual long-term care facilities
• Promote seamless care
• Promote a culture of resident safety, not blame
• Promote physician participation
• Implement technology that has the potential to
  reduce error

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Conclusion

• Medication errors are a serious problem
• Reducing medication errors should be a priority
  of LTC administrators and health professionals
• System-wide approaches are warranted
• Encouraging news The medication-use system can
  be improved and doing this has many benefits
• A national reporting structure would be beneficial

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Acknowledgments

• Neil MacKinnon
• Darlene Boliver
• David U
• Candace Allison
• Barb Anderson
• Chris Allbrook
• Joanne Wilson
• Kim Fleming
• Linda Pullen

• Susan Wedlake
• Dawn Frail
• Soili Helppi
• Nancy Keddy
• Peggy Bissonnette
• Ann Mann
• Denise Pellerine
• Carol Goodine
• Natasha Rodney

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Questions?