Medication Errors Continue to Plague Hospitals

Tragic news yesterday as a 23-month-old girl died following an overdose of a blood thinner (Heparin) at Nebraska Medical Center. The story says “hospital officials are investigating,” but we already know what they will discover. This tragedy was preventable.

Medication errors concern
Percentage of ANA nurses who "worry" about medication errors (2007 survey).

Just ask actor Dennis Quaid. It was announced today that he is starring in a new documentary to help raise awareness about medical errors — three years after his newborn twins were given a drug overdose (also happened to be Heparin) at an L.A. hospital — which almost killed them.

Following is an article I wrote a few years back on medication errors. It’s a sad commentary on our healthcare system that these errors are still so commonplace. Prescription errors are so prevalent in hospitals and long-term care facilities that it has been estimated an average of one mistake per patient per day is made. Of course, most of these errors are not so serious as to lead to serious injury or death, but just ask yourself: are non-lethal errors any more acceptable?

-Dr. Terry Rondberg

Hospital admission = medication errors

By Terry A Rondberg, DC

According to an article appearing in the Archives of Internal Medicine, hospital admissions commonly produce medication errors, some with the potential to be harmful. Background information pointed out that although the admission process routinely includes a medication use history, errors in the history may mean a failure to detect drug-related problems, or lead to interrupted or inappropriate drug therapy during a patient’s stay.

While previous studies had suggested these errors are a potentially serious safety issue, the current study was designed to identify unintended discrepancies between physicians’ admission medication orders and a comprehensive medication use history, and the potential clinical significance of the discrepancy.

Patricia L. Cornish, BScPhm, of the University of Toronto, and colleagues screened medical charts from three months of admissions to the general internal medical clinics at an affiliated hospital. One hundred and fifty-one patients were included in the study who reported use of at least four medications and were either able to communicate or had a caregiver who could communicate for them.

A pharmacist or trained pharmacy or medical student visited patients after allowing 48 hours for clarification of admission medication orders and corrections of problems in the normal course of care. The team member conducted a thorough history of the patient’s regular medication use, relying on a patient or caregiver interview, an inspection of prescription vials, and follow up with a community pharmacy.

Discrepancies between physicians’ admission medication orders and the follow-up history were divided into four types of discrepancies: a drug omission, incorrect dose, incorrect frequency of dose, and an incorrect drug.

These were then further judged to fall into one of three classes of potential severity: Class one – unlikely to cause patient discomfort or clinical deterioration; class two – having the potential to cause moderate discomfort or clinical deterioration; and class three – with the potential to cause severe discomfort or clinical deterioration.

53.6% of patients had at least one unintended discrepancy.

“We identified 140 unintended discrepancies among these 81 patients,” wrote the authors. “The most common error (46.4%) was omission of a regularly used medication. Most (61.4%) of the discrepancies were judged to have no potential to cause serious harm. However, 38.6% of the discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration.”

The authors concluded: “The data presented herein suggest that the processes for recording medication histories on admission to the hospital are inadequate, potentially dangerous, and in need of improvement. To improve patient care and minimize the potential costs of preventable adverse drug events, the health care system should explore ways to improve the accuracy of the hospital admission medication history.”

SOURCE: Patricia L. Cornish; Sandra R. Knowles; Romina Marchesano; Vincent Tam; Steven Shadowitz; David N. Juurlink; Edward E. Etchells: “Unintended Medication Discrepancies at the Time of Hospital Admission,” Archives of Internal Medicine, 165:424-429.

Back pain surgery results may be overrated

By Terry A Rondberg, DC

Months following spinal surgery for back pain, patients remember their initial pain as worse than they rated it at the time, reports a recent study in the journal Spine.

A research team, headed by Dr. Ferran Pellisé of Hospital Vall d’Hebron, Barcelona, Spain, concluded that studies relying on such after-the-fact ratings may overestimate the effectiveness of spinal surgery in relieving chronic back pain.

Lower back pain - spineThe researchers studied before-and-after ratings made by 58 patients who underwent lumbar fusion surgery for chronic low back pain. Before their operation, all patients completed standard evaluations of back pain and related disability. These prospective (“forward-looking”) ratings were compared with retrospective (“backward-looking”) ratings made an average of three years after surgery.

Patients consistently rated themselves worse than in their original questionnaires, when recalling their preoperative state. For example, on a simple 10-point scale, the patients’ original average pain rating was 7.0. On follow-up ratings, the patients recalled their pain as being significantly worse, with average rating of 8.2.

Based on the original ratings, surgery produced an average pain reduction of 3.3 points on the 10-point scale. Yet, if the recalled ratings were used, the average improvement would have been 4.6 points. Similar patterns were noted for other standard ratings of back pain and related disability.

Whether the time since surgery was shorter or longer, the extent of patient recall bias did not differ significantly. The ratings did not vary in any systematic way, so there was no way to adjust for them statistically.

Retrospective studies – in which patients are asked to remember and rate their state of health before treatment – are widely used in medical research. Few prior studies, however, have looked at how patients’ recollections measure up to actual pretreatment ratings. The use of retrospective studies to assess the results of spinal surgery has increased in recent years.

Relying on such after-the-fact pain ratings may give the impression that surgery for back pain is more effective than it actually is, the new results suggest.

“Our study shows that relying on a patient’s recall of his or her preoperative status a few months or years after surgery is not a valid method for establishing baseline status when treating low back pain,” Dr. Pellisé and colleagues concluded.

SOURCE: “Reliability of Retrospective Clinical Data to Evaluate the Effectiveness of Lumbar Fusion in Chronic Low Back Pain.” Pellise, Ferran MD; Vidal, Xavier MD, PhD; Hernandez, Alejandro MD; Cedraschi, Christine PhD; Bago, Joan MD; Villanueva, Carlos MD. Spine. 30(3):365-368

About the Author – Dr. Terry Rondberg
Terry A Rondberg, DC, is a tireless champion for drug-free chiropractic and mind-body wellness. As publisher of The Chiropractic Journal, on a monthly basis he reaches more than 70,000 chiropractors across the globe.

Chiropractic Research – Dr. Terry Rondberg

xray of human spineMillions of people around the globe have received chiropractic care and know its value. But the rest of the population dismisses the profession’s growth and patient testimonials as shoddy evidence.

Regrettably, scientists have only a few studies showing correlations between the quality-of-life changes and chiropractic care. Most scientific clinical studies suggest chiropractic as a treatment for adult low-back pain, thus limiting chiropractic care.

The public only hears: “…there is no evidence that any chiropractic treatment works for infants and/or kids.”  ( – or – “I am not aware of any chiropractic research that has led to any significant improvement in patient care.” (Stephen Barrett, MD)

Supporters of chiropractic care are aware of this false perception and its negative affects on the general public.

“The dearth of defensible information about chiropractic and chiropractors is still hampering our external ability to integrate successfully with the rest of the so-called health industry…. Let’s face it. We have a massive fact deficit in chiropractic.” (William Meeker, DC, MPH, FICC, director of the Palmer Center for Chiropractic Research)

“Whether the practice of chiropractic is of any value to the patient cannot be known with certainty until a scientific base has been established. …It is clearly apparent that it would be beneficial to the public for the profession to systematically study the subluxation as it relates to the health of the patient. Chiropractic can be observed and measured.” (The National Upper Cervical Chiropractic Research Association)

“The Committee believes additional research is necessary to further quantify the already‑known benefits of chiropractic care.” (US Senate Appropriations Committee hearings on ‘Health Care Access and Cost Containment Strategies’)

“Evidence of the value of spinal manipulation for problems other than low-back pain is less extensive, and the role that subluxation (of other forms of joint dysfunction) may play in causing and/or providing relief through adjusting is uncertain.” (“In the Quest for Cultural Authority,” Joseph Keating, DC, et. a., Dynamic Chiropractic, December 16, 2004.)

“The claim that loss of neural integrity influences ‘organ system function and general health’ is also unsubstantiated by currently available experimental data. … assertions may be appropriate as hypotheses (tentative assertions) and proto-theories (from which testable propositions may be derived), and deserve our critical attention by means of research. However, to assert their validity in the absence of hard scientific data is to engage in dogmatism.” (Joseph Keating, Dynamic Chiropractic, Dec. 16, 2004)

The answer lies in thoroughly conducted scientific research and observing the mechanisms surrounding chiropractic care such as stress reduction on the autonomic nervous system and wellness. The results must then be reviewed by chiropractic experts and other professionals with the appropriate credentials to write and review research reports.  At that time, reports should be submitted to major health journals for publication.

It’s insufficient to research solely manual manipulation’s effectiveness as a resolution for musculoskeletal conditions such as low-back pain. Such technicalities only reemphasize the false belief that chiropractic is just physical therapy that can be provided by regular physician and physical therapists. Should this remain to be the only field of chiropractic research, it will be utilized as evidence to limit chiropractic care.

The chiropractic theory claims that stress on the nervous system negatively impacts overall wellness.  Such health-like components like immunity, vitality, and well-being must be measured.  It is essential to conduct research to confirm this supposal.

Research must compare and contrast the individual’s state of health before and after receiving chiropractic care. Our goal is to develop a standard rating system measuring the severity of stress on the nervous system and integrating it to measure the noteworthy result of chiropractic care. With this rating system, the next step is to create a formula connecting outcome results and the impact on a patient’s level of stress.

This method has gained popularity in epidemiology. It is also used for studying sleep apnea severities. (Journal of Subluxation Research, 3:24-30, 1999.) Upon completion, this formula will function as a universal standard for chiropractic care and wellness.

A detailed analysis of database findings of millions of chiropractic patients can disclose direct links between stress and wellness. The findings could lead to ground-breaking information regarding the impact of chiropractic on the human nervous system and overall health.

About the Author
Terry A. Rondberg, DC, is a leading proponent of research to demonstrate the benefits of chiropractic care on patients, not only for back pain but also for the brain, the heart, the nervous system and total body wellness. He is a sought-after public speaker, author and advocate for millions of chiropractic patients and practitioners.

Benefits of Neurofeedback

Neurofeedback, like chiropractic, has proven effective for migraines and tension headaches, urinary incontinence, high blood pressure, anxiety, and other conditions. Increasing research indicates that neurofeedback, like chiropractic, is useful for attention deficit hyperactivity disorder, while helping manage patients with autism, brain injury, posttraumatic stress, seizures, and depression. Corporate executives, musicians, artists, and athletes, including some medalists from the Beijing Olympic Games, used neurofeedback and chiropractic to reach their peak performance during competition.

U.S. soldiers returning from war use neurofeedback to help with post-traumatic stress disorder. People suffering from chronic pain often find relief with neurofeedback. Even athletes are using it to gain better control over their bodies.

Students at Iowa State University have access to neurofeedback to help with stress management.  For over a century, millions of people have benefited from chiropractic care for stress reduction. The students sit in a quiet, dark room, wearing noise-suppressing headphones and sensors on their fingertips that measure their heart rate and skin conductance. They practice relaxation techniques while watching real-time graphics demonstrate how their body is responding. As a result, they see which techniques lead to actual relaxation.

Once users of neurofeedback learn what techniques alter their body’s physiology, they can practice until they have learned the techniques. Then they have tools to use when necessary.  Neurofeedback stress evaluation studies have demonstrated the enormous benefits of chiropractic care along with neurofeedback.

Neurofeedback addresses brain disregulation. This includes anxiety-depression, attention deficit, behavior disorders, various sleep disorders, headaches and migraines, PMS and emotional disturbances. It is also useful for organic brain conditions such as seizures, the autism spectrum, and cerebral palsy. Neurofeedback provides training for self-regulation. Self-regulation is necessary for good brain function and training allows the central nervous system to function more efficiently.

Regarding organic brain disorders, it can only be a matter of getting the brain to function better rather than curing the condition. When it comes to problems associated with disregulation, there is not a disease to be cured. Where disregulation is the problem, self-regulation may be the remedy.  But the word cure would not apply.

Over the years, many Neurofeedback (EEG) training protocols have been developed to help with certain problems such as attention, anxiety, depression, seizures, migraines, and cognitive function. There are different assessment tools available to help determine which protocols to use. These are simple neuropsychological evaluations. We use the NeuroInfiniti.

Some Facts About So-Called “Alternative Medicine” – By Terry Rondberg, DC

According to a recent national survey by the U.S. Centers for Disease Control and Prevention, more than one in nine children and teens use herbal supplements or some type of alternative medicine.

This is the first time children’s use of such remedies, including meditation and chiropractic care, has been measured. Adult use of alternative care remains about the same as it was in 2002 — more than one in three.

Given that children are generally healthy, the finding that one in nine uses alternative medicine is astounding.

The study is based on a 2007 survey of more than 23,000 adults who discussed themselves and more than 9,000 adults who spoke on behalf of a child in their home.

The adults most likely to report using alternative care were women, college graduates and those who live on the West Coast. Among most adults, alternative care was used equally by those with private health insurance and those without.

Children were five times more likely to use alternative care if a parent did. Those covered by private health insurance were more likely to use alternative care than children who were uninsured or covered by public programs.

In 2002, adult use was 36 percent, compared to 38 percent in 2009.

In this decade, many academic medical centers and other mainstream health care providers have integrated alternative care into their research and patient services. Chiropractors can be found in general hospitals. Insurance coverage and licensing of alternative care is on the rise.

There were differences in how the 2002 and 2007 surveys were conducted. Regarding herbal remedies, the 2007 study asked participants whether they had used such a product in the previous 30 days, while the 2002 study asked if they had taken it in the past year.

In both studies, herbal remedies were the most popular form of alternative care for adults. In the latest survey, nearly one in five adults reported taking a supplement in the previous month.

For adults, pain was the primary reason for seeking chiropractic care.

About the Author – Dr. Terry Rondberg
Terry A. Rondberg, DC, is a nationally recognized author, speaker and publisher on chiropractic care and wellness. He’s an outspoken proponent of chiropractic and drug-free healthcare.