# Presentation: 689389

## Healthy People 2010 Focus Area 17:Medical Product SafetyProgress ReviewOctober 19, 2007

## Adverse Medical Events

- 	Injuries due to medical management
- (rather than the disease process).
-   Causes
-   Drugs/medications
-   Properly administered
-   Overdose/misadministered
-   Medical/surgical complications
-   Diagnostic/procedural errors
-   Medical devices
-    Proper use
-    Malfunctions

**Adverse Medical Events**

## Overview

** **_**Adverse Medical Events**_
**   ****$58,766 per event**
**   ****$113,280 per event involving negligence**
**   ****10.9 million ambulatory care visits**
**   ****Including 1.8 million (4.4%) ER visits**** **
**   **

**   **_**Adverse Drug Events (ADEs)**_
**   ****At least 1.5 million preventable ADEs in the US **
**    ****annually**
**   ****In hospital ADEs**

**   ****At least $3.5 billion in total annual cost**
**   ****Additional $8,750 per stay**

## Medical Product Safety Objectives

**Monitoring and Analyzing Events**
**17-1a****	**** **Monitoring and analyzing adverse events associated with medical therapies
**Electronic Medical Record (EMR) and Computerized Prescriber **
**Order Entry (CPOE) Use**
**17-2a****	**** **EMR use by health care providers in health care organizations
**17-2b****	**** **EMR use by pharmacists in managed care and integrated health systems
**17-2c****	**** **CPOE use by general and children’s hospitals
**17-2d****	**** **CPOE use by urban acute care facilities
**Consumer Receipt of Information**
**17-4          **Receipt of useful information about prescriptions from pharmacies
**17-5a, b    **Receipt of oral counseling about medications from prescribers & pharmacists
**Blood Donation**
**17-6          **Blood donations

**Medical Product Safety Objectives**

- * Percent of targeted change achieved is between -10% and 10%.

## ED Visits for Adverse Effects of Medical Treatment for Adults 65 Years and Over

**Visits per 1,000 population**

**ED Visits for Adverse Effects of Medical Treatment for Adults 65 Years and Over**

- Note: ED is defined as an Emergency Department.
- SOURCE: National Ambulatory Medical Care Survey;  National Hospital Ambulatory Medical Care Survey, CDC, NCHS.

**1992       1993-4      1995-6    1997-8    1999-00     2001-2   2003-4       2005**

**All adverse effects**

**Medical/surgical**
**complications**

**Drugs**

## Adverse Drug-Related Events by 

**Percent of patients**

**Adverse Effects**

**Accidental Overdose/Misadministration**

**Adverse Drug-Related Events by **
**Patient Age, 2004**

- Note: Adverse Effects are unexpected or negative effects of drugs properly administered in therapeutic or prophylactic dosage. Accidental Overdose/Misadministration refer to the wrong drugs being given or taken in error, or drugs taken inadvertently.
- SOURCE: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2004.

## General and Children’s Hospitals that 

**Obj. 17-1a**

**Percent of hospitals**

**General and Children’s Hospitals that **
** ****Monitor Adverse Drug Events **

- SOURCE: National Survey of Pharmacy Practice in Acute Care Settings, American Society of Health System Pharmacists (ASHP).

**            ****1998                                          2001                         2003**

## Electronic Medical Record Use by Providers in Health Care Organizations

**0**

**10**

**20**

**30**

**40**

**Electronic Medical Record Use by Providers in Health Care Organizations**

**Percent of providers**

- Note: Health care organizations include stand-alone and multi-system hospitals, physician offices, mental/behavioral health facilities, long-term care facilities, and home-health agencies.
- SOURCE: Annual HIMSS Leadership Survey, Healthcare Information and Management Systems Society.

**Obj. 17-2a**

** ****2000    2001    2002   2003   2004   2005   2006    2007**

## Computerized Prescriber Order Entry 

**Computerized Prescriber Order Entry **
**Use by General and Children’s Hospitals**

**Percent of hospitals**

- Note: * Data are not available for 2002. In 2004, in response to the crash, failure and subsequent placement on hold of one large hospital’s group CPOE system, several other hospitals and hospital groups followed suit and placed their implementation on hold.
- SOURCE: National Survey of Pharmacy Practice in Hospital Settings, American Society of Health System Pharmacists (ASHP).

**Obj. 17-2c**

*****

## Computerized Prescriber Order Entry System Use by Size (General and Children’s Hospitals)

**            ****Total         <50         50-99     100-199   200-299    300-399       400+**

**Number of Staffed Beds**

- SOURCE:  National Survey of Pharmacy Practice in Hospital Settings, American Society of Health System Pharmacists (ASHP).

**Computerized Prescriber Order Entry System Use by Size (General and Children’s Hospitals)**

## Computerized Prescriber Order Entry Use by Urban Acute Care Facilities

**Computerized Prescriber Order Entry Use by Urban Acute Care Facilities**

**Percent of facilities**

- Note: An urban acute care facility is defined as a short-term Medicare certified hospital.
- SOURCE: The Leapfrog Group Hospital Patient Safety Survey, The Leapfrog Group for Patient Safety.

**Obj. 17-2d**

**2003              2004             2005             2006**

## Patient Receipt of Verbal Counseling

**100**
**90**
**80**
**70**
**60**
**50**
**40**
**30**
**20**
**10**
**0**

**Percent of patients**

**Patient Receipt of Verbal Counseling**
** ****about Medications**

**Obj. 17-4, 5a & 5b**

**2004**

**2000**

**1998**

- Note: Estimates reflect patient receipt of information on how much and how often to take medication, precautions and* *side effects.
- SOURCE: National Survey of Prescription Medicine Information Received by Consumers, FDA

**Obj. 17-5a & 5b**

## Blood Donations, 2006

**Total**
**Hispanic**
**Black**
**Asian**
**White**
**18-24 yrs*******
**25-44 yrs*******
**45-64 yrs*******
**65+ yrs*******
**Female**
**Male**
**Persons w/Disability**
**Persons w/o Disability**

**Blood Donations, 2006**

**2010 Target: 8**

**0 ****	****                           5****	****	****         10                               15****	****                    Percent (age adjusted)**
**	**

## Blood Supply Adequacy

**Blood Supply Adequacy**

- Note:  Represents allogeneic collections. Available collections are composed of those units that have passed all laboratory tests and are available for transfusion.
- SOURCE:  2005 Nationwide Blood Collection and Utilization Survey Report, HHS.

**Collections**

**Available Collections**

**Transfusions**

## Emergency department visits for adverse events (especially medical/surgical complications) among persons 65+ are increasing
Consumer receipt of verbal counseling regarding medications remains far below the HP 2010 target
EMR and CPOE usage is increasing and has exceeded the HP 2010 targets
Demand is approaching supply for blood donations

- Emergency department visits for adverse events (especially medical/surgical complications) among persons 65+ are increasing
- Consumer receipt of verbal counseling regarding medications remains far below the HP 2010 target
- EMR and CPOE usage is increasing and has exceeded the HP 2010 targets
- Demand is approaching supply for blood donations

## http://www.cdc.gov/nchs/hphome.htm

**Progress review data and slides**
**are available on the web at:**

**http://www.cdc.gov/nchs/hphome.htm**