CATHY BARRY-IPEMA: Thank you for joining us today. The Joint Commission and the health care organizations we accredit are committed to patient safety and have many initiatives under- way. Avoiding the number one problem of medication mistakes is one more initiative.
Everyone has a role in preventing medication mistakes - from the physician who writes a prescription, to the pharmacist who dispenses the medication and, finally, to the person who takes it. This new campaign will help Americans protect themselves from medication mistakes. It is part of the Joint Commission SpeakUp™ patient safety series urging individuals to take an increasingly active role in their own health care.
Today, we have with us the following four experts to bring attention to this issue of educating people to avoid medication mistakes:
- Chuck Mowll, executive vice president for the Joint Commission
- Gerry Shea, assistant to the president for government affairs for AFL-CIO
- Sheryl Niebhur who is the manager for Total Compensation Research Center for the 3M Corporation
- Martha Lanning who is the senior director of employee benefits programs and strategies at COSE
Each of our speakers will offer brief remarks about how the support of employers and educating employees about some very simple steps can help American workers protect themselves from a variety of common medication mistakes. The speakers will then be happy to take your questions.
There is a press kit, which includes the news release, the SpeakUp brochure, the wallet card, biographies for today's speakers, and much more information that's available on our website at www.jcaho.org.
CHUCK MOWLL: Thank you for joining us. Pharmaceutical interventions are an integral part of our health care system, and they enhance the lives obviously of millions of people each year. Medications help people lead better and healthier lives, whether it's blood pressure medicine or simple cold remedies that relieve pain and suffering.
Just a few numbers: Each year more than 2.5 billion prescriptions are filled by U.S. pharmacies in hospitals. About 5.8 billion drug administrations occur each year. So the numbers are large. This obviously creates an opportunity for concern and potential mistakes to occur. In addition, millions of over-the-counter medicines, vitamins, herbal remedies and dietary supplements are used. All of these medicines create potential for mistakes that can cause illness, injury or death. Studies have indicated that thousands of people, about 7,000 each year, die as a result of medication mistakes.
This is why the Joint Commission today is launching a new SpeakUp campaign. SpeakUp will help individuals take charge of their health by doing things that can prevent medication mistakes. Joint Commission is enlisting the help of the business community with this initiative by sending the SpeakUp information to Fortune 1000 companies and asking that employers encourage their employees to consider the ways that they can help to prevent medication mistakes.
Employers play a critically important role in developing informed health care consumers among their employees. SpeakUp will provide them with an additional tool that they can use to accomplish this task. The SpeakUp materials and advisory materials will help individuals better understand the steps they can take to prevent medication errors or their harm. This information can help people who are first taking medicines as a result of a visit to a doctor's office or their local drugstore, or if they have a family member that has been hospitalized, or they themselves may be hospitalized in the future.
The SpeakUp advisory emphasizes four key steps:
- First, individuals should list all of the medications that they're taking and keep a detailed record of all of the medications. This means prescriptions, over-the-counter medicines, vitamins, and herbal remedies such as ginseng and the like. The Joint Commission is offering a free wallet card entitled, "My Medication List," that people can fill out and carry with them. This list can be useful in emergency situations and serve as a ready reference so that an individual won't have to rely on their memory when they visit their doctor's office, or their hospital, or pharmacy.
- Secondly, make sure that they can read the handwriting on a prescription that they are given. It is okay to ask questions. The SpeakUp campaign is about encouraging individuals to ask questions so that they're informed and understand what medications have been prescribed to them. Remember, if the individual can't read the prescription, the pharmacist may not be able to read it either.
- Thirdly, ask questions. If you are taking a lot of medicines, ask your doctor if it is safe to take those medicines together and do the same thing with vitamins, herbs and other supplements.
- Fourth, speak up if you have any questions or doubts about a medicine. This is really the most important facet of the Speak-Up program. An individual needs to let someone know if they think they were given a wrong medicine, or if they have had a reaction to a medicine in the past, or if they don't feel well after taking a medicine. The bottom line is that people have an important role to play in preventing common medication mix-ups and protecting themselves from potential harm of these mistakes.
I'll be happy to answer any questions as we move through this press conference, but first let me turn it over to Gerry Shea.
GERRY SHEA: This list of practical suggestions is a real service – a public service – to patients and consumers. But more than that, coming from the premiere organization that accredits health care organizations in the country, it puts the stamp of approval on the notion that consumers should be proactive.
Unfortunately, we have a mistake-prone culture in medical care which has been documented substantially over the past few years, and while consumers don't represent the solution to that, it really lies with the people we trust with our care, whether it's physicians, or nurses, or hospital managers.
Consumers can play an important role by being empowered, as this list of specific suggestions does for them, to participate in the care that they're given, and we think it's a big step forward.
We look forward at the AFL-CIO to working with our affiliated union organizations representing 13+ million workers and their families and with the employers that we negotiate health care benefits with to disseminate this information. And now Sheryl Niebhur will provide comment.
SHERYL NIEBHUR: Increasingly many employers are very eager to provide their employees to assist them as health care consumers, with tools such as those that are available through the SpeakUp campaign. These tools help us support our employees and their dependents in managing their personal health and ensuring that they get safe, quality, effective health care. When that happens, we all win. Our employees enjoy better health and well-being, and as an employer and a self-insured purchaser of health care, it helps us avoid costs that may be related to adverse events involving medication errors.
So, again, we are very eager to provide our employees with high-quality, very relevant and easy-to-apply tools to assist them in their day-to-day lives. And, with that, I will turn the comments to Martha Lanning who's with the employee benefits programs and strategies.
MARTHA LANNING: I represent a group purchasing program for small employers in the greater Cleveland area called "COSE," C-O-S-E which stands for the Council of Smaller Enterprises. We currently group purchase health care for over 14,000 small companies in the greater Cleveland area covering about 83,000 employees, and when you add in spouses and dependents, we cover about 200,000 covered lives. Our average company has about six employees, and companies that small simply don't have the personnel, the benefits or the HR personnel, to provide much support to employees relative to health insurance.
All businesses, large and small, are certainly reeling under the cost of health insurance, but it really affects small businesses quite heavily and quite dramatically. And as we work in our organization to provide affordable, accessible health care to small businesses, we also find it necessary in this age of consumer responsibility in health care to provide our members, small employers, with the tools that they can pass along to their employees to help control costs.
This campaign about medication errors and things to be aware of regarding personal medication use is going to go a long way towards helping our members over time save money.
About 770,000 people are injured or die every year in hospitals from adverse drug events, and patients who do experience those adverse drug events are hospitalized an average of eight to 12 days longer and cost between $16,000 and $24,000 more. For a small business looking at a health insurance renewal each year, the cost can be devastating.
So we are very supportive of the SpeakUp campaign and this campaign, in particular, as a way to provide more information to our small employer groups to pass along to their employees so that they have better information to be a well-qualified and well-informed consumer and to keep health care costs as low as possible.
REPORTER: Martha, you gave a figure of 770,000. Was that injured or that die from interaction with drugs?
MARTHA LANNING: Injured or die each year. So it's both. You know, it's interesting. I ran across an article from Reuters. It stated on January 19, 2005, and there was some research done on death certificates from 1979 through 2000, and it showed that deaths attributed to prescription drug errors increased 25 percent in the first week of each month compared to the last week of each month. And they're attributing that to pharmacies that are busy because of folks particularly on government-assistance programs that are filling their prescriptions at the beginning of the month. So, again, interesting and unfortunately very sad research proves that poor communication, drug name confusion, and human error can unfortunately result in tragedy.
CHUCK MOWLL: If you want the reference for that study, it's David Bates, The Cost of Adverse Drug Events in Hospitalized Patients, and the numbers that were just shared with you. His study found that two out of every 100 patients experience a preventable adverse drug event.
MARTHA LANNING: It's important that employers understand that this is something that they need to get behind. If you're looking at 7,000 medication deaths per year and equate that or compare that to 6,000 workplace deaths a year, and the emphasis that certainly we put on worker safety and on our worker's compensation protections, this certainly is an important thing for our employers to get behind relative to cost control and employee protection.
GERRY SHEA: Just to follow up on that point. Once we got serious many years ago about occupational safety problems and we passed national legislation which established a set of standards and an inspection process through the Occupational Safety and Health Act in the mid-70s, we've cut workplace deaths and serious injuries in half. And it wasn't easy. It wasn't always pleasant because of the regulations and the requirements, but they really achieved an enormous amount of improvement. And that's the kind of big change that we need to get to and aspire to in terms of patient safety.
SHERYL NIEBHUR: And if I may, I'd like to just add another dimension to this. We've been focusing on for employers the value of attending to this issue from a cost-containment perspective. I'd like to just add the other dimension of this that relates more indirectly which is around productivity.
We know that more and more of our workforce are family caregivers, and not only of the younger people and their families, but of elders. And, in many instances, our experience is that employees are very eager for this kind of information, not only to support their personal health management and that of their family, but as they strive to support and assist the older members of their family. They're very eager for those tools. We know that whenever there is any kind of an adverse health issue involving those elder family members for whom they're caregiving; it's a distraction for them. And the more that they can feel well-armed, well-informed, well-equipped to support them, again; it's a benefit to our employees. It's also a benefit for us from the standpoint of their ability to be productive and contribute the best while they're at work.
MARTHA LANNING: Absolutely, and I would also add from a small employer perspective, if your average company in our program has six employees, if you lose one either because they're not focused on their work or they're not there because of the caregiving role that Sheryl just described, it is very detrimental to the productivity of the company and the morale of the workforce.