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

2. 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 Adverse Medical Events

3. 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

4. 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%. ImprovingLittle or no change * Target met or exceeded No trend data

5. 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

6. 34%22%27%17% 65+ yrs45-64 yrs18-44 yrs0-17 yrs Patient Age Distribution Percent of patients Adverse Effects Accidental Overdose/Misadministration Adverse Drug-Related Events by Patient Age, 2004 45-64 yrs 65+ yrs 0-17 yrs 18-44 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.

7. 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). 2010 Target: 90 Increase desired 1998 2001 2003

8. 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 2010 Target: 18 Increase desired 2000 2001 2002 2003 2004 2005 2006 2007

9. 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 2010 Target: 6 Increase desired *

10. Percent of hospitals 2001 2006 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)

11. 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 2010 Target: 7 Increase desired 2003 2004 2005 2006

12. Prescribers Pharmacists 2010 Target: 95 Increase desired 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

13. 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 Increase desired 2010 Target: 8 0 5 10 15 Percent (age adjusted) Obj. 17-6 = 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.

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

15. 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

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