Medication errors directly relates to LBJ's short staffing
“One of the problems that the hospital has when they are short staffed, is that there is no pool of nurses to call in, or a pool of doctors to call in, to help care for the additional patients. So, as one might suspect, the error rate for medication tends to go up during busy times,” said LBJ CEO Mike Gerstenberger, when he appeared before the Senate Hospital Committee, for a hearing after a complaint was raised in the Senate about physicians allegedly giving wrong medication to patients.
Gerstenberger was accompanied by DOH Director Motusa Tuileama Nua and LBJ Board member nominee Dr. Victor Tofaeono.
Senator Nuanualefeagaiga S. Nua asked hospital officials why this has happened repeatedly.
Gerstenberger provided Senators with a graph which indicated that the rate of medication errors at the hospital is 2.7% per one thousand patients — while at the national level there’s a 3.8 % medication error rate per one thousand patients.
“A medication error, in our definition, is either wrong patient, wrong drug, wrong dose, wrong time, or even if all of those are correct, the patient simply has an adverse reaction to that medication — even though we done everything correctly — we count that as medication error.
“The average medication error at LBJ is actually less than the national average, and for that being said, obviously the goal is to have no medication errors. However, it is a very human system, in which a physician writes an order, the nurse reviews the order and the pharmacist reviews and fills the order. It is the nurse, typically, who administers the drug order.
“The problems at LBJ have been discussed before and it’s because of chronic under funding… we have half the numbers of physicians that we need to have — so often they are overworked, which leads to errors. We have one third the number of registered pharmacists we should have, so not every medication order is reviewed by the registered pharmacists and we have a third the number of registered nurses that we should have… to provide all of the safety nets for the patient that should be there."
He continued, "The fact that our rate is low, even with all those constraints, the fact that our error rate is less than that of the national average, gives you some idea of how hard and what an excellent job the staff at LBJ does”.
However, Sen. Nua noted that 2% is a high percentage of medicine errors and this is due to bad practice by the doctors.
Gerstenberger disagreed with Nua, saying that the errors could be anywhere along the system — that it can be during the ordering of the drug or the dispensing of the drug.
Senator Nua further questioned Gerstenberger as to what action the hospital takes against doctors, who prescribe wrong medication.
The LBJ CEO noted there are a variety of committees that meet monthly to look at medicine errors. They look at all the recorded errors and even the 'near misses' — where the hospital catches an error before it is administered to the patient. Another committee looks broadly at the practice patterns of all physicians, still another committee looks at deaths within the hospital and their report is sent to the LBJ Medical Executive Committee. Afterwards, another report is then forwarded to the LBJ Executive Board of Directors, who do the overall review and they are the ones who take action.
Gerstenberger said that, “if we have 60,000 people, we should have at least a 100 doctors and currently we have 51 doctors. For the 150 beds at LBJ Hospital, there should be 160-170 registered nurses and we have about 50 nurses. We should have six or seven registered pharmacists, yet we have only two on island. The fact that our error numbers are low is attributed to the employees at the LBJ Hospital — they are doing a great job.
Last week, Sen. Soliai Tuipine Fuimaono shared with senators the case of a child who was rushed to Hawai’i last month due to the wrong medication being administered by a physician at LBJ Medical Center.
He noted that the problem of physicians allegedly giving wrong medication to patients continues to occur at the hospital, while the doctors involved are still working in the territory without any action being taken by the hospital or by the American Samoa Health Regulatory Board, which licenses physicians and other medical professionals to work in the territory.
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