Adverse Drug Reactions
A new study published in the Journal of the American Medical Association finds that 100,000 deaths in hospitals each year are caused by adverse drug reactions. The study was conducted by University of Toronto researchers, who analyzed data from 39 U.S. hospitals for patients who received services between 1966 and 1996. The findings do not include random mistakes, but rather patient reactions to properly prescribed and administered drugs. The study did not identify what types of drugs are most likely to be associated with an adverse drug reaction, although previous studies have shown a correlation between pain killers given to hospital patients and the unexpected deaths. Bruce Pomeranz, M.D., author of the study, called for better reporting procedures as well as additional research to determine which drugs are causing the worst problems.

Medication Error Prevention Urged
The National Patient Safety Partnership, which includes the American Hospital Association, other healthcare organizations, and government agencies, recently urged providers to adopt practices that will reduce medication errors in clinical settings. The partnership's recommendations are intended to end errors associated with prescribing, purchasing, dispensing, and administering medications.

The coalition estimates as many as 8% of hospitalized patients will have an adverse drug effect and that about 100,000 injuries or deaths each year can be attributed to drug interactions or dosage errors.

To reduce the occurrence of adverse drug events (events that can cause, or lead to, inappropriate medication use and patient harm), the coalition recommends that patients should tell physicians about all medications (both prescribed and over-the-counter) they are taking, why they are taking the medications and responses/reactions to them, and ask for information in terms they understand before accepting any prescribed medications.

Provider organizations and practitioners can help if they will:

• educate patients;
• note allergies and medications on patient records;
• stress the need for dose adjustment in children and older persons;
• use protocols to ensure proper use of high-hazard drugs (e.g. concentrated potassium chloride, chemotherapeutic agents, and anticoagulants);
• computerize drug order entry;
• use pharmacy-based I.V. and drug mixing programs;
• avoid abbreviations. If abbreviations are used by a facility, they should be standardized throughout the facility;
• standardize drug packaging, labeling, and storage; and,
• use "unit dose" drug systems (packaged and labeled in standard patient doses).

The purchasers' role in eliminating errors should be to require machine-readable labeling (Bar-coding); buy drugs with prominent display of name, strength, and warnings; buy "unit of use" packaging (also known as "unit dose"); and, buy I.V. solutions with two-sided labeling.

Don't Stockpile Drugs, Supplies
The American Hospital Association (AHA) and the Association for Healthcare Resource and Materials Management are urging hospitals and health systems to not stockpile or hoard pharmaceutical and medical/surgical supplies because of concerns over the Y2K "millennium bug."

The AHA suggests that the responsible approach to Y2K materials management is to: identify which supplies are mission critical for patient care delivery and what your normal purchasing requirements are for those supplies; develop contingency plans with your suppliers and distributors to support your normal inventory needs for those mission-critical supplies and to plan for managing potential supply disruptions; and form a safety net agreement between community providers--by either expanding existing emergency compacts to include Y2K or developing a new memorandum of understanding--to be backup for each other in the event of a supply chain disruption.

Web to Feature HIV Treatment Data
The American Association of Health Plans (AAHP) is spearheading an Internet-based project that will help bypass lengthy HIV treatment clinical trials and put clinical data quickly into researchers' hands. The project aims to keep tabs on the way so-called AIDS cocktails (combinations of drugs to hold the AIDS virus at bay) work in individual patients.

The AAHP announced the upcoming launch of the new HIV Treatment Data Project at its Managed Care Institute meeting in June.

HIV-positive patients will be selected from three test sites and will update data about their treatments and outcomes on-line. Aggregate data, which will not identify patients, will be included in a database available to participants, their physicians and researchers. The data will be measured and compared with other clinical studies. Sherrie Kaplan, co-director of the Primary Care Outcomes Research Institute at the 349-bed New England Medical Center in Boston, will coordinate the research.

The three pilot sites are Morris Heights Health Center, Bronx, New York; the private practice of Howard Grossman, M.D., a New York primary-care physician who specializes in AIDS care; and a Kaiser Permanente HIV clinic in Santa Clara, California.

The project will be rolled out nationally in early 2000, with thousands of HIV-positive patients reporting their data on an Internet site accessible to the public.

State's Nurses Oppose Collective Bargaining
The Arkansas Nurses Association (ArNA) House of Delegates held a rare, called meeting last May to discuss issues that could affect its relationship with the American Nurses Association (ANA). Relations between the two organizations have chilled recently, a result of the ANA's apparent re-emphasis on collective bargaining as a core function.

During a November, 1998 meeting of the ANA Constituent Assembly--the presidents and executive directors of all state nurses associations--representatives from state associations which function both as professional associations and collective bargaining units proposed that ANA create a new unit that could assist nurses with collective bargaining in all states.

Essentially, the proposal calls for the ANA to restructure, setting up a national labor entity, the United American Nurses (UAN). Once in place, the UAN would allow ANA to affiliate easily with a national labor union such as the AFL-CIO.

Representatives from the ArNA and several other state nurses associations opposed placing any emphasis on collective bargaining and suggested other structural changes. ArNA officials proposed that the ANA create an arm specifically for nurse advocacy.

If adopted, this structure, Professional Advocacy Nurses (PAN), would insulate states like Arkansas where nurses associations are involved with professional advocacy issues but don't wish to participate in collective bargaining. ArNA's proposal also contains a provision that the ANA decertify as a union and re-institute its original multi-purpose mission.

The ArNA decertified its collective bargaining program in 1989, based on a mandate from its members. According to ArNA policy, collective bargaining does not concur with the association's mission, values, and the state's cultural climate.

The ArNA board of directors has officially stated that any ANA restructuring to allow one of its components to come to the state for the purpose of organizing nurses would be in direct conflict with its 1989 mandate. It would also require that ArNA either change its relationship with the ANA, or have no formal relationship. ArNA continues to emphasize its Workplace Advocacy Program as an effective alternative to unions.

CBO: Home Health Payments Headed Lower
Medicare spending on home health seems headed even lower this year than previously projected, according to the latest Congressional Budget Office (CBO) figures. In line with its testimony last month, the CBO now calculates that overall Medicare spending in FY '99 will be $4 billion less than it predicted in March.

The July 1 estimate did not say how much of the reduction reflects lower payments to home health agencies. But it does say "most" of the shortfall in the eight months through May 31 was due to "lower payments for home services" and a drop in the hospital case mix index (which measures the relative costliness of Medicare patients treated in acute care hospitals).

That seems to indicate Medicare reimbursement for home health will dip below $14 billion this year. Such a reduced level of home health spending would be more than a third below the nearly $22 billion the CBO originally thought Medicare would be paying home health agencies in FY '99 and about one-fourth what the Health Care Financing Administration (HCFA), in February, projected for the current year.

The CBO attributes the drop in the use of home health services to anti-fraud activities and an unexpectedly cautious response by home health agencies to the per-beneficiary limit under the interim payment system. Another factor was the hold-up of claims caused by HCFA's sequential billing requirement that has now been terminated.

Free Service Offers Hospital Care Information
A free on-line service launched by the U.S. Agency for Health Care Policy and Research offers information about inpatient hospital care. With HCUPnet, users can choose specific conditions, diseases, or procedures and request data such as discharge status, lengths of stay, and total charges.

Data from about 6.5 million hospital stays at more than 900 hospitals in 19 states are drawn from the 1996 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP). The service is available at http://www.ahcpr.gov under "HCUPnet Interactive Tool for Hospital Statistics."

Life Can Change Forever in One Day
By Rev. Rex Horne, senior pastor, Immanuel Baptist Church, Little Rock

I was ready to leave Baptist Medical Center in Little Rock when I noticed a special friend of mine. She told me she was checking in (at nearly 9 in the evening) for surgery the next day. Of course, I asked how long she had been having trouble, expecting this to be a procedure at the end of an extended period of time. She told me she had been sick for one day!

Dan Clark, in his book, Puppies for Sale, tells of a teenage boy and his dissatisfaction after moving to another town in the middle of his junior year in high school. He leaves his friends, girlfriend, and spot on the basketball team -- just to name a few reasons for his disappointment.

Paul, the new kid in town, has a birthday. Although it appears at the beginning to be just another day, Paul's dad performs a small deed that reaps big rewards. Dad notices a boy about his son's age in the neighborhood and invites him over that afternoon for cake and ice cream. This young man tells his mother, who has noticed Paul playing basketball in the driveway. She determines to use this day to invite a few other potential friends and two basketball coaches to give Paul and his family a real welcome.

Paul is very excited when his dad arrives home from work. "Dad, this has been one of the best days of my life." Dad doesn't know just how despondent his son has been and the dreadful thoughts he has entertained. His concern for his son and the invitation change not only the day, but also a boy!

Most days comprise small things, routine things, we would claim. We also say-- quite regularly if children are still in our home--that small things can become big things. This is usually couched in a negative context. Perhaps today's column will place small things in a more positive role.

My friend said she didn't plan on spending her Wednesday in surgery. I didn't expect to see her in the hospital, but it did give me an opportunity to say that I care and to pray with her and her husband.

Your friend may not expect that call or note from you today. Some surprises are good ones...It only takes a moment to do that small deed!