מתוך medicontext.co.il
NEW YORK (Reuters Health) – All hospitals in California must adopt a formal plan to eliminate or substantially reduce medication-related errors by January 1 as a condition of licensure, according to guidance recently issued by the California Department of Health Services (DHS).
The California DHS outlined the essential principles required in medication error reduction plans in a letter sent to the state's 500 hospitals. A DHS advisory committee of healthcare providers, professional organizations, and consultants and DHS staff established the principles.
The committee wants each hospital to establish a system for addressing facility-wide reduction of medication errors. Hospitals are being instructed to conduct a baseline assessment of their error reduction plans and review the plans annually for effectiveness.In addition, hospitals must develop reporting mechanisms to ensure that medication-related errors are evaluated internally.
"Medication errors are a well-documented component of preventable adverse events," wrote DHS Deputy Director Brenda Klutz. "In 1993 medication errors were estimated to account for approximately 7000 deaths in the United States. Estimating that California has about 10% of the nation's population, an average of 700 Californians die each year from medication errors."
Hospitals must implement their medication error reduction plans by January 1, 2005. The requirement applies to every general acute care hospital, special hospital, and surgical clinic.
The DHS letter also cited the current best technology practices that hospitals may consider in developing medication error reduction plans. The technology practices include computerized prescriber order entry systems, personal digital assistants, and computerized pharmacy systems with automatic alerts to screen for individual allergic reactions and minimum-maximum dosage guidelines. DHS also pointed out the benefits of implementing a system of single-dose dispensing of all medications.
Compliance with the medication error reduction plan is required by Senate Bill 1875, sponsored by state Sen. Jackie Speier (D-San Francisco/San Mateo) and approved in California during the 1999-2000 legislative session.
The bill was enacted partially in response to the November 1999 report from the Institute of Medicine, which documented that about one-half of adverse events resulting from medical errors are preventable and recommended nationwide changes. (See Reuters Health report, November 30, 1999.) Improper administration of medication in hospitals was cited as one of the most common medical errors.
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