Wednesday, January 20, 2010

Children’s lives 'being put at risk by high rate of prescription errors in British hospitals'

Children’s lives are being put at risk in hospitals across the country, according to a new study which found mistakes in one in eight drug prescriptions. Experts warned that although many of the errors would not have caused serious harm, some could have proved fatal. Much more needs to be done to improve prescribing, especially when children are involved, they said.

The study is the largest to look at errors in prescriptions given to children in British hospitals. One in 10 of the mistakes uncovered involved youngsters being given either too much or too little of a drug. “Some of these errors could have ended up being fatal,” said Dr Maisoon Ghaleb, from the University of Hertfordshire, who led the study, carried out in five London hospitals.

In one case the researchers found that a six-month-old had been prescribed 5mg of the powerful painkiller morphine, more than 50 times the 96mcg dose that should have been prescribed. The mistake was picked up by the nurse administering the drug. “The nurse intervened and questioned the prescription, but if she had not it could have been fatal,” said Dr Ghaleb.

The researchers also found cases where doctors had forgotten to write down how much of a drug a child should be given, or whether it should be administered as a pill or as an intravenous drip.

Giving drugs to young people often involves complex calculations based on a child’s weight and their medical condition. By contrast, many adult patients are given standard doses.

Overall, mistakes were made in 13 per cent of prescriptions given to children, the study found. However, on one hospital ward the rate of errors was much higher, 32 per cent or almost one in three. Most of the errors, 41 per cent, involved incomplete prescriptions, including those where no dosage was given. In almost one in four cases of errors, 24 per cent, doctors used an abbreviation, the research also found, while 11 per cent of mistakes involved the wrong dose.

The study also found that mistakes were commonly made when the drugs were being given to the children. These included errors in how the drugs were prepared or the rate at which they were given intravenously. Overall there was some kind of mistake in 19 per cent of cases, the study found. On five occasions the researchers intervened to prevent the patient suffering harm.

During the study pharmacists reviewed almost 3,000 prescriptions written on children’s wards in the hospitals, which agreed to take part on the condition of anonymity, over a two-week period. Trained observers on the wards also watched how 1,554 doses of medicine were given to children, mainly by nurses. In all the study, carried out in 2005, picked up 391 prescription errors and 429 administration errors. Of these only one mistake was reported to the hospital’s risk management department, in charge of preventing errors.

The research team, which also included experts from the University of London School of Pharmacy believe that their findings show a general picture across Britain. They called for a system of electronic prescribing to be introduced in hospitals, which could pick up signs of mistakes being made, as well as better education for doctors on how to prescribe drugs.

The hospitals which took part included one specialist children’s hospital, three general teaching hospitals, and one non-teaching general hospital.

The study suggests that errors are more common when drugs are given to children than adults. A study last year by the General Medical Council warned that almost one in ten prescriptions for hospital patients contained mistakes.

Norman Lamb, the Liberal Democrat health spokesman, said that the study raised “serious concerns” about the safety of children in hospitals. “Everyone understands that occasional mistakes will be made but the scale of errors reported here is very worrying," he said. “Many parents will now fear that proper safeguards have not been put in place to ensure the safety of their children in hospital.”


National Health ID for Australia: Risks acknowledged from the outset

THE same people who claim a new national health identity system will be safe from fraud will be able to get fake ID to keep their own records secret. While every Australian will soon be assigned a 16-digit health ID number, politicians and other "well-known personalities" will be able to take advantage of false identities to stop their records falling into the wrong hands.

The 16-digit health number is a "building block" towards national electronic health records, which will be eventually shared among health professionals. The federal agency responsible for the rollout yesterday conceded the safeguards would be built into the system to "mitigate against the potential risks of exposure to this information". But access to the extra level of protection offered by the false IDs, known by the federally funded National E-Health Transaction Authority as "pseudonymisation", will not be widespread. "Pseudonymisation is not intended to be a generally available option," a spokeswoman for NEHTA said.

She said there was a "need to provide special protection for vulnerable people such as "well-known personalities" and victims of domestic violence. "With the universal allocation of individual healthcare identifiers to all Australian residents, there is a need to provide some form of special protection for vulnerable individuals to mitigate against the potential risks of exposure of this information," the spokeswoman said. The numbers, called "individual healthcare identifiers", or IHIs, will store only names and dates of birth and will not contain clinical information. The numbers will "tag" medical results such as blood tests and X-rays. The process is designed to ensure the right results are about the right patient.

Someone with one of the false IDs would be given a token which they could use the same way as they would their own identifying number. Although every Australian will be issued with an IHI number, they can choose not to use it. But people who did want an IHI number with an alternative identity would have to make a special application.

Despite the concession that an extra level of protection would be given to some, the NEHTA says the system is secure. NEHTA clinical head Mukesh Haikerwal said the system would include an audit trail, which would mean any individual would know where someone had accessed their records. Dr Haikerwal, a former president of the Australian Medical Association, said: "You will never satisfy everyone in regards to privacy, but I have far more confidence in the future of e-health and the security of its records than I do in the current system. "If confidentiality of the doctor-patient relationship is in any way compromised, I would have no part in it." [Haikerawal is a fine man so he is no doubt sincere. Whether he underestimates the crooks is another matter, however]

Currently, Australians can access anonymous medical care by simply not using their Medicare card. Health Minister Nicola Roxon did not comment yesterday but has previously said e-health would have strict, legislative protocols to protect patients' medical histories.


Prognosis Darkens For ObamaCare

With Scott Brown's victory in Massachusetts, the hill that health reformers were storming got a lot steeper

Republican Scott Brown's improbable victory Tuesday in the Massachusetts special election to fill Ted Kennedy's Senate seat is more than a shot in the arm for opponents of ObamaCare. It's more like a successful triple bypass, plus new hips, knees and a facelift. What looked like an inevitable legislative victory now looks sketchy, after Brown campaigned against Democrat Martha Coakley promising to be the 41st vote against ObamaCare and beat her by about five percentage points.

On Christmas Eve, the Senate overcame a Republican filibuster and passed the $871 billion health overhaul bill 60 to 40. With one of those blue seats turning red, the Democrats face tough choices. Several of the "yea" voters, including Nebraska's Ben Nelson and Connecticut's Joe Lieberman, are already threatening to pull back their support if the combined House-Senate bill that is scheduled to be voted on later this month ends up being more liberal than the Senate version.

Sen. Al Franken promised Tuesday that the legislation will pass "one way or another." Here are some of the different scenarios: Find a Republican Vote in the Senate: Not likely--the Democrats haven't had any support from the other side of the aisle since mid-October, when Sen. Olympia Snowe of Maine voted for an earlier version of the bill in the Senate Finance Committee.

Refill the Tank: The Democrats could take a break and, as New York Times columnist David Brooks recommends, "spend the next year showing how government can serve a humble, helpful and supportive role." Then, with renewed humility and political capital, they could try again. The problem with this is that failure could mean a loss of momentum, the appearance of impotence and even the loss of seats during this year's midterm elections.

Rahm it Through: Obama's chief of staff, Rahm Emanuel, has always hinted that the Democrats could pass the bill through the Senate with only 51 votes by passing a compromise version through the House and then simply voting on it not as new legislation but as a budget reconciliation in the Senate. Such a move would avoid a filibuster. But using a shortcut to pass such a controversial bill could cause problems politically, not to mention set a bad precedent the next time Democrats are in the minority. In the past, reconciliation has mostly been used to pass tax bills.

Keep The Senate Bill: Franken mentioned that one option would be to have the House vote on the Senate bill without modifying it. That would avoid the need for a second Senate vote. This is the most intriguing option, but will the House pass a bill that it didn't help write? Especially after witnessing other Democrats lose seats?


Federal health care foes plot for state opt-outs

Congress can pass a federal health care bill and President Obama can sign it, but that doesn't mean the states plan to abide by it

Lawmakers in 30 states are pressing for constitutional amendments to exempt individuals from the requirement to purchase health care, a pivotal piece of the legislation under debate in Congress. In Colorado, organizers of a proposed ballot measure filed language with the state elections office Friday. They would like the state legislature to place the amendment on the ballot, but given that both houses are controlled by Democrats, that's unlikely. "I want Colorado to become a sanctuary state for good health care," said Jon Caldara, president of the Independence Institute, who is leading the ballot effort. "People are angry, and rightfully so. If the legislature's not going to step up and do something, then we're going to have to."

Mr. Caldara's group plans to kick off its ballot campaign with a rally Tuesday outside the state Capitol. His group drafted its own language, but many states are using versions of legislation developed by the American Legislative Exchange Council.

Nineteen states have filed or pre-filed legislation using the organization's legislative language, known as the Freedom of Choice in Health Care Act, said Christie Herrera, ALEC's director of health and human services task force. Ten others have announced their intent to introduce similar bills this session. "It's all about preserving the right of people to choose health care for themselves," said Ms. Herrera.

Opponents of the opt-out movement argue that it shows no regard for the uninsured. They also question the motives of state lawmakers, accusing them of being more interested in embarrassing the president and weakening the Democratic Party's chances in 2010 midterm elections than in true reform. "This is a classic case of 'follow the special interests.' If you look at the people orchestrating this effort, it's exactly the same people who were behind the tea parties and who organized rallies against the stimulus and cap-and-trade," said Michael Huttner, chief executive officer of ProgressNow, a liberal advocacy group.

"These people have nothing better to do than hammer this administration and everything they do," he said. "This is just the issue that's been in the news. If it were some other issue like energy, this entire campaign would be on a completely different thing."

More here

Why Dems' Health Reform Hopes Are 'Hanging by a Thread'

As the New Year unfolds and congressional Democrats meet with the President behind closed doors trying to reconcile the differences between the House and Senate versions, they also appear to have lost a good deal of the optimism they had just a few weeks ago about health reform's prospects. Sen. Chris Dodd (D-Conn.) recently said that healthcare reform was "hanging by a thread." And on the other side of the Capitol, Rep. Charlie Rangel (D-N.Y.) said, "We've got a problem . . . A serious problem." Negotiations over a final bill may well drag into February.

This discord within the Democrats' ranks offers Americans a renewed opportunity to learn about the sweeping changes augured by the congressional reform package. What they'll discover is a bill that hikes taxes to pay for "reform," making health care more expensive and less responsive to patients' needs.

New insurance regulations form the core of the reform plan. Paramount among these new rules is an individual mandate, which would require all Americans to maintain coverage. Proponents of the idea claim that it will bring healthy, previously uninsured young people into the insurance pool. Premiums from these folks would help lower the premiums of older, sicker Americans -- or so the thinking goes.

Unfortunately, these regulations would make both the uninsured and the majority of the middle class worse off. Most uninsured Americans go without coverage not because they want to but because they can't afford it. The Democrats' reform package does nothing to address this problem. In fact, health insurance costs would grow faster under the Senate bill than they would without reform.

People who refuse to buy insurance would be fined anywhere from $95 to $2,250 a year. By the time the fines are fully implemented, a typical individual insurance policy is expected to cost about $5,000, according to the Congressional Budget Office (CBO). Americans faced with the choice of forking over thousands of dollars a year for unaffordable coverage or paying a fine will likely opt for the latter. Other proposed regulations on insurance policies make such an outcome even more likely. Case in point: the reform plan's requirement that insurers accept all applicants, regardless of their health status or medical history.

That may sound fair, but such a provision encourages people to go without insurance until they actually need it. Why put out $5,000 on coverage you may never use if you can just pay $95 and pick up a policy down the line if you become ill?

These and other new insurance rules would increase the price of coverage for everyone -- not just the uninsured. Consider a 25-year old male living in Richmond, Virginia, for instance. Research using actual enrollee data from WellPoint, a large insurer, revealed that the major health insurance reforms under consideration would cause this hypothetical man's premiums to increase by 155 percent.

His peers in other states would experience similar increases. A healthy young man in Indianapolis, Indiana, would be saddled with a 178-percent premium hike. And a similarly situated man in Los Angeles, California, would see his premiums go up 106 percent. Families with children would also get hit with higher insurance bills. The same series of studies found that a two-child family living in Milwaukee, Wisconsin, would see its insurance tab more than double. A family with two kids in Richmond would face an insurance bill that's 82 percent higher. Other portions of the reform package would send health costs even higher. Medical device makers are being slapped with $20 billion in new taxes, and pharmaceutical companies are expected to kick in $80 billion to fund reform. These firms will undoubtedly raise their prices in order to offset the cost of these new government levies. And if insurers face steeper charges for their beneficiaries' drugs or medical devices, it's only natural that premiums will go up too.

Last week union leaders met with President Obama to complain about the Senate bill's 40 percent excise tax on "Cadillac" plans and how that would negatively affect their members. Now it appears that a tentative deal has been reached which would exempt unions' collective bargaining agreements from this tax. In order for the plan to be deficit neutral, revenue will have to be raised from other sources. A likely target will be the Medicare payroll tax, which was already going to be increased by 0.9 percent to 2.35 percent in order to fund the previously raised exemption. If accepted, the Medicare payroll tax will have to be raised even higher to cover the lost funding.

The give-and-take of the legislative process rarely produces perfect results, but the health reforms offered by congressional Democrats aren't just less-than-perfect -- they're worse than the status quo. Americans should hope that the thread from which the Democrats' reform package is hanging snaps soon.


A Cadillac Exemption From a Cadillac Tax From an Edsel Administration

This past Sunday marked the first time President Barack Obama graced a Washington, D.C., church with his presence since Oct. 11, but apparently it was not to sit in a pew and worship. Instead, he was doing the sermonizing and politicking -- gloriously intermingling church and state as only liberals are allowed to do in this country.

Don't get me wrong; I'm no scold when it comes to the church-state separation mania, which I think has been grossly expanded by liberals not to preserve the constitutional protection of religious liberty, but to selectively suppress it. But here I am digressing before I've even gotten started on the main focus of today's rant.

Instead of quibbling over the propriety of Obama's turning the church service into a political rally for health care, let's focus on the outrageous substance of his message.

He told the congregants at Vermont Avenue Baptist Church that Obamacare would help more than 30 million Americans -- "men and women and children, mothers and fathers" -- to get health insurance. "This will be a victory not for Democrats," he said. (He's got that one right.) "This'll be a victory for the United States of America." (Yes, once he and his party get thrown out on their ears for this monstrosity.)

But it's another one of his statements that really sticks in the craw: "This'll be a victory for dignity and decency, for our common humanity." Oh? How dignified is it for Obama to cram this extraordinarily unpopular scheme, replete with backroom deals and political payoffs, down Americans' throats? How decent of him is it to have made (and broken) an insincere pledge to televise these health care negotiations on C-SPAN, only to have his arrogant press secretary, Robert Gibbs, glibly duck all questions about it?

How common does Obama think our humanity is, when he's always abusing the power of his office to select certain categories of that humanity as winners and others as losers?

Does he think union members are more common, say, than nonunion members? Or are some workers, in the words of George Orwell's "Animal Farm" -- a fitting analogy for this socialist administration -- more equal than others? I think that goes without saying, but I'll say it anyway, because some people remain too stubborn to hear.

Obama first proposed a "Cadillac tax" on health plans whose benefits were more generous than he, in his dictatorial discretion, could tolerate. This tax was un-American enough in its own right, as well as a breach of his promise not to interfere with patient choice and the quality of health care, because it would use the tax code to encourage uniform coverage and prevent employers and individuals from operating in a free market.

But even this good socialist couldn't apply his principle of equal treatment for the entire proletariat. It seems the other Marxist imperative of glorifying union workers had to trump the principle of equality.

Just outside the reach of C-SPAN's video cameras, Obama agreed to exempt union workers from this Cadillac tax until at least 2018 -- at the estimated cost of $60 billion. What possible justification does he offer for this unjustifiable act? None; he doesn't have to justify himself. He is the flawless post-partisan, post-racial, post-George W. Bush president.

It's a good thing for him that he has exempted himself from scrutiny just as he is exempting unions from his Cadillac tax. For there is no rationale to set unions aside for special beneficial treatment any more than there was for the bribes to Sen. Ben Nelson of Nebraska and Sen. Mary Landrieu of Louisiana -- other than that Obama is in bed with unions and wants to reward them and swell their ranks with our money.

How's he going to make up for that $60 billion shortfall? No problem. Just applying his "common humanity" principle again, he'll extend the 2.9 percent Medicare payroll tax to capital gains, and according to The Washington Times, he'll extract $15 billion more from hospitals and $10 billion more from pharmaceuticals. There must be no rush in the world that compares with transferring billions from certain groups to others with a flick of the presidential pen.

To borrow another word from the Obama vernacular, can you imagine the audacity of this guy's lecturing us about decency, dignity, common humanity and health coverage for the "uninsured," when he has turned this entire health care issue into a poster child for Chicago-style political corruption and payoffs? Oh, the sweet irony of an overdue comeuppance courtesy of the Commonwealth of Massachusetts.


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