Friday, September 28, 2007

Halifax pharmacy researcher explores medication errors in Canada

It’s the fourth leading cause of death among North Americans and costs billions of dollars each year in unnecessary health expenses, just for Canadian seniors alone. A Dalhousie University researcher is tackling the widespread issue of medication errors, and his efforts have landed him a prestigious international opportunity.

Dr. Neil J. MacKinnon has been selected as a 2007 Harkness Associate, a fellowship administered by the U.S. Commonwealth Fund and the Canadian Health Services Research Foundation. The Harkness program is limited to 13 individuals worldwide each year, including a maximum of two Canadians.

Dr. MacKinnon will embark on a major study to determine whether government and private payer drug policies improve safety and quality or unintentionally contribute to the problem of medication mistakes.

“There are obviously many benefits to medication, which can often replace surgery or greatly improve a patient’s quality of life,” says Dr. MacKinnon, associate director for research and associate professor at Dalhousie’s College of Pharmacy.

But the health care system is so complex, there are inevitably gaps in the process, he adds. These might include an incorrect diagnosis, insufficient lab work or a lack of patient monitoring. Surprisingly, a major barrier to proper medication in Canada is access – many people can’t afford it, and end up splitting tablets and reducing dosages without informing their doctors or pharmacists. Resulting problems from medication errors, such as adverse drug reactions, are the fourth-leading cause of death in Canada and the U.S.

One of his main research efforts is an examination of the many points of transfer in patient care. When patients are admitted to a nursing home or discharged from a hospital, a number of people and steps are involved in the transfer of their medications: nurses, physicians, order clerks, pharmacists, pharmacy technicians, the patients and their family doctors.

“The biggest red flags are those transition points,” says Dr. MacKinnon. “There could be 15 or more different handoffs between when the medication order is written by the physician and the time the patient actually puts the first pill in his or her mouth.”

He cites his 2005 study that found discrepancies in one out of every 11 medication orders at a Halifax hospital. In another one of his studies, one patient with multiple medication errors had 46 unnecessary emergency room visits in a nine-month period. In yet another of his studies, 519 seniors with thyroid conditions were taking their prescriptions properly, but weren’t having lab work done to monitor their thyroid levels, and ended up in emergency rooms or were hospitalized as a result.

“A lot of the solutions aren’t horribly complicated; it’s simply a matter of a phone call or a fax, and better communication,” says Dr. MacKinnon. He outlines a number of useful strategies for front-line health care professionals and scholars in a new book he edited, Safe and Effective: The Eight Essential Elements of an Optimal Medication-Use System, released last month in Ottawa.

Dr. MacKinnon teaches at Dalhousie, where he is a faculty member in the College of Pharmacy, the Faculty of Medicine’s Department of Community Health & Epidemiology, and the School of Health Services Administration.