The task force, which Herzog co-chaired with Miles F. Shore, M.D., put forth 10 recommendations in its report that were approved by the APA Board of Trustees. These recommendations ranged from designating patient safety as a major programmatic priority for the association to encouraging the American Association of Directors of Psychiatric Residency Training to develop curricula that include safety instruction.
This year, the new APA committee will focus on three primary areas of concern: preventable adverse medication events, restraints and seclusion, and patient suicides.
"We don't mean to limit our interest to those three areas," Herzog said. "We'd rather try to accomplish some specific goals than kick off the program with an unachievable goal like solve world hunger. We will try to accomplish three things first."
According to the task force report, the issue of medication errors is common to virtually all of medicine. It cited a study by the Leapfrog Group, a consortium of businesses that purchase health services, showing that "nearly one million serious medication incidents occur annually in the U.S. and ... nearly half of them may be preventable."
These errors include dispensing the wrong drugs, administering drugs to the wrong patient, selecting the wrong route of administration, or administering the wrong dose or amount.
David Bates, M.D., chief of the division of general medicine at Brigham and Women's Hospital in Boston, met with the committee and reported his research into the field of medication errors. He defined a medication error as related to the "processes of ordering, transcribing, dispensing, administering, or monitoring medications, irrespective of their outcome, which brings to bear close call events as well as injurious errors."
Bates and his colleagues studied medication errors at a psychiatric facility in the Northeast and found:
Excessive use of antipsychotics å and polypharmacy leading to confusion in diagnosing organic versus pharmacological cognitive impairment. In addition, research investigators uncovered failures to achieve ictal threshold with [electroconvulsive therapy] because of competing medications in the body, as well as the dispensing of lethal amounts of drugs to potentially suicidal patients. The error rate was 7%, and nearly a third of these were preventable.