Healthy People 2010 Focus Area 17 Medical Product

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

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

Adverse Medical Events • Definition Injuries due to medical management (rather than the disease

Adverse Medical Events • Definition 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

Overview • Adverse Medical Events • $58, 766 per event • $113, 280 per

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 -1 a Monitoring and analyzing

Medical Product Safety Objectives Monitoring and Analyzing Events 17 -1 a Monitoring and analyzing adverse events associated with medical therapies Electronic Medical Record (EMR) and Computerized Prescriber Order Entry (CPOE) Use 17 -2 a EMR use by health care providers in health care organizations 17 -2 b EMR use by pharmacists in managed care and integrated health systems 17 -2 c CPOE use by general and children’s hospitals 17 -2 d CPOE use by urban acute care facilities Consumer Receipt of Information 17 -4 Receipt of useful information about prescriptions from pharmacies 17 -5 a, b Receipt of oral counseling about medications from prescribers & pharmacists Blood Donation 17 -6 Blood donations Target met or exceeded Improving Little or no change * Percent of targeted change achieved is between -10% and 10%. * No trend data

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

ED Visits for Adverse Effects of Medical Treatment for Adults 65 Years and Over Visits per 1, 000 population All adverse effects Medical/surgical complications Drugs 1992 1993 -4 1995 -6 1997 -8 1999 -00 2001 -2 2003 -4 Note: ED is defined as an Emergency Department. SOURCE: National Ambulatory Medical Care Survey; National Hospital Ambulatory Medical Care Survey, CDC, NCHS. 2005

Adverse Drug-Related Events by Patient Age, 2004 Percent of patients Adverse Effects Accidental Overdose/Misadministration

Adverse Drug-Related Events by Patient Age, 2004 Percent of patients Adverse Effects Accidental Overdose/Misadministration Patient Age Distribution 0 -17 yrs 18 -44 yrs 45 -64 yrs 65+ yrs 17% 22% 34% 0 -17 yrs 18 -44 yrs 45 -64 yrs 65+ yrs 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 Monitor Adverse Drug Events Percent of hospitals Increase desired

General and Children’s Hospitals that Monitor Adverse Drug Events Percent of hospitals Increase desired 2010 Target: 90 1998 2001 2003 SOURCE: National Survey of Pharmacy Practice in Acute Care Settings, American Society of Health System Pharmacists (ASHP). Obj. 17 -1 a

er ce nt of pr ov id er s Electronic Medical Record Use by

er ce nt of pr ov id er s Electronic Medical Record Use by Providers in Health Care Organizations 40 Increase desired 30 20 2010 Target: 18 10 0 2001 2002 2003 2004 2005 2006 2007 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 -2 a

of h os pi ta ls Computerized Prescriber Order Entry Use by General and

of h os pi ta ls Computerized Prescriber Order Entry Use by General and Children’s Hospitals Increase desired 2010 Target: 6 * 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 -2 c

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

Computerized Prescriber Order Entry System Use by Size (General and Children’s Hospitals) Percent of hospitals Total 2001 <50 50 -99 100 -199 200 -299 300 -399 Number of Staffed Beds SOURCE: National Survey of Pharmacy Practice in Hospital Settings, American Society of Health System Pharmacists (ASHP). 2006 400+

ce nt of fa cil iti es Computerized Prescriber Order Entry Use by Urban

ce nt of fa cil iti es Computerized Prescriber Order Entry Use by Urban Acute Care Facilities Increase desired 2010 Target: 7 2003 2004 2005 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. 2006 Obj. 17 -2 d

ce nt of pa ti e nt s Patient Receipt of Verbal Counseling about

ce nt of pa ti e nt s Patient Receipt of Verbal Counseling about Medications 100 1998 90 2004 Increase desired 2010 Target: 95 80 70 60 50 40 30 20 10 0 Prescribers Pharmacists 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 -4, 17 -5 a 5 a && 5 b 5 b

Blood Donations, 2006 Increase desired Total Hispanic Black Asian White 18 -24 yrs* 25

Blood Donations, 2006 Increase desired Total Hispanic Black Asian White 18 -24 yrs* 25 -44 yrs* 45 -64 yrs* 65+ yrs* 2010 Target: 8 Female Male Persons w/Disability Persons w/o Disability 0 5 10 Percent (age adjusted) = 95% confidence interval. Note: Data are for adults aged 18 years and over who have donated blood in the past 12 months. * Not age-adjusted. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group. SOURCE: National Health Interview Survey (NHIS), CDC, NCHS. 15 Obj. 17 -6

Blood Supply Adequacy Millions of units 15 Collections 14 Available Collections 13 Transfusions 12

Blood Supply Adequacy Millions of units 15 Collections 14 Available Collections 13 Transfusions 12 11 10 0 1989 1992 1994 1997 1999 2001 2004 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.

Summary • Emergency department visits for adverse events (especially medical/surgical complications) among persons 65+

Summary • 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

Progress review data and slides are available on the web at: http: //www. cdc.

Progress review data and slides are available on the web at: http: //www. cdc. gov/nchs/hpho me. htm