Sunday, August 13, 2006

NHS drug error 'crackdown' urged

Hospitals have been told to do more to cut out medication errors after figures showed 40,000 mistakes a year are made. Most errors caused no harm, but 2,000 led to moderate or severe harm, or death, as in 36 cases. The Healthcare Commission urged the NHS to improve how it prescribed and dispensed drugs as it published ratings for all 173 hospital trusts in England. The watchdog classed 85 trusts as fair or weak. NHS chiefs said hospitals needed to be honest about the problems.

The medication errors figures, given to the Healthcare Commission by the National Patient Safety Agency, cover incidents in England and Wales the 12 months to July. They showed about 80% caused no harm, 15% low harm and 5% moderate or severe harm. Only 18 trusts in the watchdog's review of medicines management were rated as excellent, while 70 were good, 73 fair and 12 weak. The Healthcare Commission said more needed to be done to discuss side effects with patients, to give out written information as required by law, and to minimise risks from injected drugs.

Trusts were measured in 21 areas, including whether patients had had a comprehensive medicines review and if they had a complete medicine record for their stay in hospital. The review did find areas of good performance, including 40% of trusts prudently using antibiotics to help cut MRSA rates. But the watchdog said there was a need for improvement, including making sure patients understand the purpose and potential side effects of medicines.

The report said pharmacists also needed to spend more time on the wards to minimise errors, with 11 of the 12 trusts that scored weak overall performing poorly in this area. Other areas needing attention included hospital patients not being given control of their medicines, even though they managed perfectly well at home - 69% of trusts said this was not possible on a fifth of their wards.

Parkinson's disease patients were cited as a group who often preferred managing their medication as timing of dosing is vital. Commission chief executive Anna Walker said while many trusts were getting the basics right, there was still "some way to go when it comes to involving patients in decisions about medicine". "Trusts need to do more talking to patients about their medicines and their potential side effects. "They need to make sure patients feel empowered to discuss any concerns."

Steve Ford, chief executive of the Parkinson's Disease Society, added: "Difficulties could be avoided if ward staff had a better understanding of the condition and of why the timing of Parkinson's drugs is crucial."

Maria Nyberg, policy manager at the NHS Confederation, which represents NHS trusts, said there were some examples of good practice, but the publication was a positive as "identifying weaknesses or problems" helped to tackle them. "The only way the service will achieve real improvements for patients is by being frank about the problems and challenges that it faces." And a Department of Health spokeswoman added: "Hospitals are working very hard to ensure that patients are getting the most from their medicines. "There is, however, room for improvement in some areas."



Two current articles below

Little improvement at Queensland Health despite increased funding

Queensland public hospitals are continuing to report insufficient staff numbers, staff fatigue and reduced and restricted services, says leaked internal Queensland Health documents. The documents, dated July 21, not only identify current shortages being experienced in public hospitals, but predict these will continue into next year. In response to questions about likely future impact of current employment status and vacancies, hospital administrators have written "lack of physicians is compromising surgery; service unsustainable in current form; insufficient medical officers to support ongoing total services and sustain safe roster; and significant fatigue of core staff". Another question asking whether shortages of medical staff are anticipated in January 2007 finds that little improvement is expected.

At the beginning of the year, Premier Peter Beattie said he would quit his job by the end of the year if the crisis affecting the state's hospitals was not fixed. This pledge was later withdrawn by Mr Beattie, who in March declared his Government had "turned the corner" in its efforts and had "made very significant advances".

Health Minister Stephen Robertson said yesterday the figures, contained in minutes and attachments to Queensland Health's Central Area Medical Workforce Advisory Group, were "in line with what the Government has been saying publicly for months". "We continue to recruit aggressively, but we need more doctors as there are several vacancies that still exist. That is why the Premier and I led two separate overseas recruitment drives this year," Mr Robertson said. "Latest figures show there are 4863 doctors in our public health system - that is an increase of 311 on June 2005. "As our recruitment efforts progress, we continue to target the key medical vacancies that exist in our hospital such as emergency medicine, mental health, obstetrics and surgical specialties."

Deputy Coalition Leader and health spokesman Bruce Flegg said the documents were very significant and "remove any doubts that nothing has changed". "Mr Beattie has not fixed the system and continues to cover up the real position," Dr Flegg said. "There is a threat to services across the board because the Government has failed to reform the culture of Queensland Health. It is far too bureaucratic and there is enormously low morale."


One victim of negligent Queensland Health regulators

Jack McDougall thought he was one of the lucky ones after federal Nationals MP De-Anne Kelly's claimed in Parliament that Mackay Base Hospital had allowed a surgeon to undertake operations he was not fit to perform. Mr McDougall, 45, was in pain for almost a year after about 10mm of mesh was left rubbing against his abdominal muscles.

Abdalla Khalafalla performed a double hernia operation on Mr McDougall on February 15 last year. Despite repeated post-op consultations with Dr Khalafalla, during which he was advised to "wait it out", Mr McDougall opted to pay for a private surgeon. "When they went in to do it they saw about 8 to 10mm of mesh was rubbing . . . so they nipped that, pulled the extra mesh out and I was as good as gold," he said. Mr McDougall said he considered himself lucky because his affliction was relatively minor. "Some of the other cases she (Ms Kelly) talked about sounded a lot more serious. It makes you wonder."

The Courier-Mail tried to contact Dr Khalafalla yesterday, but a Queensland Health spokeswoman said he was still "too upset" to speak publicly about the matter. But Craig Margetts, the district executive director of medical services, said the hospital had responded correctly to concerns raised by Dr Khalafalla's peers. Dr Margetts said the situation in Mackay was far removed from that of Jayant Patel in Bundaberg. "There are a number of differences (to the Patel case), the first and probably most important difference is that Dr Khalafalla himself has been very co-operative and has been working very strongly with us in terms of making sure that his range of practices are limited to very safe procedures," he said.

Dr Margetts said he was not aware of any problems with Dr Khalafalla's competence before he arrived in Mackay. Bundaberg Patients Support Group founder Beryl Crosby yesterday urged patients to come forward with their experiences at Mackay Base Hospital.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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1 comment:

Ken Farbstein said...

Yes, Parkinson's patients depend on getting medications like Sinemet at particular times. It is often difficult for hospitals to give them the medication on time when Parkinson patients first arrive in hospital, as this story shows.