Thursday, June 3, 2010

More Medication Errors in July

We medical folks have always known that July is the worst time for a patient to be admitted to the hospital.  It has nothing to do with nice summer weather or staff vacations.  Although it cannot be proven, we think the answer to the mystery of July hospital errors is human...yes it's the new interns.

A new study published in the June issue of the Journal of General Internal Medicine looked at all U.S. death certificates from 1979 to 2006.  They found that in teaching hospitals, on average deadly medication mistakes surged by 10% each July.  The good news is they did not find a surge in other medical errors, including surgery or in non-teaching hospitals.

So lets break this down.  Every July a new crop of medical interns hit the wards.  Eager, motivated, and anxious to do well in their new white coats and carrying smart phones, they start seeing hospitalized patients.  Each intern is paired with a Medical Resident...a young doctor a little further along in training.  Some Residents micromanage the interns...some are hands off.  Some interns have very little supervision and have no experience in patient safety.  With thousands of medications and tens of thousands of drug interactions, I am not surprised in the surge of mistakes in July.

In my day our pockets were stuffed with little notebooks and guides to diseases.  The Merck Handbook, the Washington Manual were lugged from place to place so we could access information.  It was laborious and not very effective.  The new interns have iphones and ipads with medical information accessible through the touch of a screen.  If they order medications though a computer, there are fail safes built in to help prevent medication errors. We will see if that makes a difference.

Everyone, patients and clinical educators, needs to be aware of the "July Effect" and be extra cautious.  Interns need increased supervision and nurses and patient families need to question everything!  Hospital Pharmacists should be making rounds with the teams and double checking all orders.   The learning curve for Interns is swift.  We need to help them learn, while protecting patients.

7 comments:

KM said...

Doesn't a Hospitalist, or patient's Internist or Family Practice physician still over see and coordinate care with what the intern and resident are doing?

Michael Kirsch, M.D. said...

I am sure that nurses in teaching hospitals could relate many outrageous examples of the 'July effect', which for many interns, may extend to September and October. I wonder why these hospitals do not make special arrangements in July, as common sense would dictate?

Toni Brayer, MD said...

Michael Kirsch: You are so correct and I have never even heard of making accommodations, even though everyone knows there are more dangers. They could have all med orders reviewed by pharmacy. They could staff extra nurses and have education about patient safety and the July effect. It is a simple solution that might (?) be effective.

KM: Yes the attending physician does oversee but the thousands of orders and decisions that are made minute by minute are usually done by the intern and resident...leaving room for unintentional mistakes.

Unemployed Dragon said...

While I appreciate that the influx of new residents does put a strain on hospitals, and that this can result in more errors, I' really concerned that stories like this, plant unnecessary fear in the minds of so much of the general public; people with little experience with the healthcare setting. The facts is that errors do happen, but they can happen at any time of year. Patients need to be vigilant all year, not just in the summer time.

I've been the beneficiary of care that was beyond excellent at teaching hospitals all over the country, most recently, last summer when I had a scheduled surgery at San Francisco General Hospital, and spent four days there. I wouldn't hesitate, ever, to go to a teaching hospital.

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