Ending medication mistakes

"The biggest red flags are those transition points," says Dr. Neil MacKinnon, who has been selected as a 2007 Harkness Associate. (Abriel photo)

Medication error is 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. 

Now a Dalhousie University researcherÕs efforts to tackle the widespread problem has 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 is the first Canadian pharmacist ever to receive this honour, and the first recipient from the Maritime provinces.

As a Harkness Associate, 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.

ÒThere are obviously many benefits to medication, which can often replace surgery or greatly improve a patientÕs quality of life,” says Dr. MacKinnon, associate director for research and associate professor at DalhousieÕs College of Pharmacy.

Gaps in the process

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 Ð many people canÕt 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.  Dr. MacKinnon co-authored a study that estimated the cost of preventable adverse drug-related outcomes in CanadaÕs seniors to be $11 billion per year. 

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.

ÒThe biggest red flags are those transition points,” says Dr. MacKinnon. ÒThere 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 werenÕt having lab work done to monitor their thyroid levels, and ended up in emergency rooms or were hospitalized as a result.

'Matter of a phone call'

ÒA lot of the solutions arenÕt horribly complicated; itÕs 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 looks forward to building on his research as a Harkness Associate, which will allow him to collaborate with international colleagues and learn more about the situation in other countries. This September in New York, heÕll participate in the first of five major meetings with other Harkness fellows from around the world, as well as top health care decision-makers and policy analysts. He plans to incorporate the experience into his teaching at Dalhousie, where he is a faculty member in the College of Pharmacy, the Faculty of MedicineÕs Department of Community Health & Epidemiology, and the School of Health Services Administration. ItÕs a vitally important area of research, considering medication is CanadaÕs second-largest health care expenditure.

ÒWe spend more on drugs in Canada than we do on physicians or medical equipment. Drugs are also the fastest growing component of health budgets and thatÕs a challenge, obviously, for the patients and the payers,” he says.