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S  T@ dkdk {    v* J%%JJoo  T dkdk  ?   x* J%%JJooH  0.k ? 3380___PPT10.j P((    N1 dkdk {%  1  \* J%%JJoo  N1 dkdk  ?% 1  ^* J%%JJoo  T!1 dkdk {  1  \* J%%JJoo  T,1 dkdk  ? 1  ^* J%%JJooH  0.k ? 3380___PPT10.s H>0N0 PZ(  ~  s *     j  c BAHhslogo B copy C  s JA$logo5cFDA logo"` n   fA ? ??C * B  s *޽h ? ̙33y___PPT10Y+D=' ~ = @B + 0N0 % }(   y  <O  ?"6@ NNN?Nbo  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 Malfunctionsz 5 2%4 2$40224022 50F250F2350F2!5 2250F250F2 $$  3  !2r  <hc  "`~ JAdverse Medical Events H  0޽h ? ̙33J___PPT10i.m Q+D=' ~ = @B + `0N0 )Lz(  L L <  "`~ <Overview  I %L <  ?"6@ NNN?N{`F   Adverse Medical Events $58,766 per event $113,280 per event involving negligence 10.9 million ambulatory care visits Including 1.8 million (4.4%) ER visits 5 2g5 2+5 24022 4R& 4 'L <  ?"6@ NNN?N3 `  Nr Adverse Drug Events (ADEs) At least 1.5 million preventable ADEs in the US annually In hospital ADEsz5 245 2 40225 2U>&(3 )L <D  ?"6@ NNN?N @ K At least $3.5 billion in total annual cost Additional $8,750 per stay"L1 2LH L 0޽h ? ̙33J___PPT10i.m Q+D=' ~ = @B +0 )!p .0 (  f  Ni ?t d Monitoring and Analyzing Events 17-1a Monitoring and analyzing adverse events associated with medical therapies Electronic Medical Record (EMR) and Computerized Prescriber Order Entry (CPOE) Use 17-2a EMR use by health care providers in health care organizations 17-2b EMR use by pharmacists in managed care and integrated health systems 17-2c CPOE use by general and children s hospitals 17-2d CPOE use by urban acute care facilities Consumer Receipt of Information 17-4 Receipt of useful information about prescriptions from pharmacies 17-5a, b Receipt of oral counseling about medications from prescribers & pharmacists Blood Donation 17-6 Blood donationsh"0Q002T00!0000EfEf GfGfJGffTfGf>GfGfEGfGf-Gff)f fGf GfAGfC GfMGffff  6v "` $ Medical Product Safety Objectives P%0C"C CC`2  s *3f"`,$`2  s *"`,   6ԅ "`_  >* Percent of targeted change achieved is between -10% and 10%.0?0  >BF`2   s *"` ,B 8  8 . t   6"`    6    E Improving 0 2 C  60  B aLittle or no change *00 2CC n2  0"`H  Nn2  0"` M  6 !3 RTarget met or exceeded 0 2Cn2  03f"`M  6ȟ J8 I No trend data 0 2Cn2  0"`FF`2  s *"`b2`2  s *"` )y `2 + s *3f"`g+`2 , s *3f"`0 + `2 - s *"` ;@H  0޽h ? ff3ff3f33y___PPT10Y+D=' ~ = @B +0 '+T e(  T  T   `gֳgֳA ? ?L  T 6  "`m N$0(    T H  ?"6@ NNN?N iVisits per 1,000 population$$0fZC  T <\  "` OED Visits for Adverse Effects of Medical Treatment for Adults 65 Years and Over$P0(  P  T 0P B` 6"0  C :  T 0 `Z Note: ED is defined as an Emergency Department. SOURCE: National Ambulatory Medical Care Survey; National Hospital Ambulatory Medical Care Survey, ǿֹ, NCHS. 0   E T <  ?"6@ NNN?N' Q1992 1993-4 1995-6 1997-8 1999-00 2001-2 2003-4 2005.R0 2Q8    "T   B T  <D?"0@NNN?N  B T  <D?"0@NNN?N  B T  <D?"0@NNN?N  B T  <D?"0@NNN?N8 8 B T  <D?"0@NNN?Nf f B T  <D?"0@NNN?N  B T  <D?"0@NNN?N  B T  <D?"0@NNN?N   T BX  2 GAll adverse effects3f  T 6! 4  RMedical/surgical complications !T B`! e w L  ?Drugs0BSB #T <DM]Ԕ?"0@NNN?N  B &T @ 6D?"0@NNN?N {~ B 'T <D1?"0@NNN?N ~~ B (T <Do?"0@NNN?N- ` B )T <Do?"0@NNN?N  B *T @ 6D?"0@NNN?N x B +T @ 6D?"0@NNN?NN x] H T 0޽h ? 33___PPT10i.W+D=' ~ = @B +(& 0N0   )*/ 6 (      HA Q?  Qz `P ,   P` ,,$@0PN `P    `P B   61 ?"0@NNN?N`P PLN `P    `P HN `P    `P B   61 ?"0@NNN?N`P` B   61 ?"0@NNN?N P B   61 ?"0@NNN?N`  B   61 ?"0@NNN?N`@ @ N `P    ~\ ,   B!  ?"6@ NNN?N" 0  O34%00B www   Bd!  ?"6@ NNN?N0"  O22%00B www   B!  ?"6@ NNN?Ni0  O27%00B www   B\"!  ?"6@ NNN?N`0i  O17%00B www    B&!  ?"6@ NNN?N" @ 0 U65+ yrs20B www   B$!  ?"6@ NNN?N@" 0 W 45-64 yrs2 0 B www   B.!  ?"6@ NNN?Ni@0 W 18-44 yrs2 0 B www   B4!  ?"6@ NNN?N`@i0 V0-17 yrs2 0B www   BA!  ?"6@ NNN?N`P @ dPatient Age Distribution00Bwww  6J!  "`) N$0(     TL! Ԕ?R OPercent of patients 0   <P! $  KAdverse Effects 0C`  s *"`0 f  0"`  <S!   o%Accidental Overdose/Misadministration.&0%C   6 Z!  "` 1Adverse Drug-Related Events by Patient Age, 2004 202 F `      `    H4a! Ԕ?~ ~  G 45-64 yrs" 0     HLe! Ԕ?   E65+ yrs"0    T8h!  ??` P  F0-17 yrs" 0   !  H l! Ԕ? J  G 18-44 yrs" 0   " 0p! Ege 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, 2004.0 2 # B ?"6@ NNN?NP@2 $ B ?"6@ NNN?N  @ % <r!  ?"6@ NNN?N :&0(2www2 & B ?"6@ NNN?N0P P2 ' B ?"6@ NNN?N %]Az  > -   >,$D02 .  B Ԕ?"6@`NNN?N^2 /  B Ԕ?"6@`NNN?N ^K >H  0޽h ? >*?>*y ___PPT10+07>D' ~ = @B D' = @BA?%,( < +O%,( < +D' =%(Dh' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+#.<* %(D' =4@BBBB%(D' =1:Bvisible*o3>+#.<*- %(+0 `76(  r  6A ? ?NP   6ĉ!  "`m N$0(     H!  ?"6@ NNN?N > X Obj. 17-1a$ $0fZ C   H!  ?"6@ NNN?N bPercent of hospitals$$0fZC X  <!  "` General and Children s Hospitals that Monitor Adverse Drug Events $E0(  E   0|! B` 6"0  C   0h! ` zSOURCE: National Survey of Pharmacy Practice in Acute Care Settings, American Society of Health System Pharmacists (ASHP). {0  { 3l r@ )r@,$D0  <Գ!  ?"6@ NNN?NP  c2010 Target: 90($0fZG___BBB  <D___p?"0@NNN?Nr@@T ;  # @  ! B!  ?"6@ NNN?N0_ hIncrease desired($0f<G___ 0AAB " BD___o?"0@NNN?NX # B ?"6@`NNN?N;S $ <!  ?"6@ NNN?NP [ 1998 2001 20032\0 2 wwwPB % 6D?"0@NNN?N  B & 6D?"0@NNN?N  B ' 6D?"0@NNN?N H  0޽h ? 33___PPT10n.W+R$DB' ~ = @B D' = @BA?%,( < +O%,( < +D4' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+#.<*)%(+#0N0 -%", q(  l  0A ??,Y @ е C  Y_@ ѵ C  Y_@ ҵ C  Y_@ ӵ C  Y _:B ܵ 3 i+  @@ :B ݵ 3 i+    :B ޵ 3 i+   :B ߵ 3 i+  :B  3 i+  0 0 :B  3 i+   :B  3 i+   :B  3 i+     <t!   pE S060Ewww  <,!  1   T1060Ewww  <!  }  T2060Ewww  <0!  h T3060Ewww  <L!   T4060Ewww  < !  "`~ GElectronic Medical Record Use by Providers in Health Care Organizations"H0 H   6d"  "` N$0(      <Z"   PPercent of providers 0 2   0"  SNote: 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.0    <"   D Obj. 17-2a 0 /l 0`  0` ,$D0   s BFCDEF ? F@"` .   <L"  "`> 8  M2010 Target: 18"0___T ; 6# 0`  7 B,"  ?"6@ NNN?N0_ hIncrease desired($0f<G___ 0AAB 8 BD___o?"0@NNN?NX 9 B ?"6@`NNN?N;1 : <|."  ?"6@ NNN?N  9 2000 2001 2002 2003 2004 2005 2006 20072:0 2www94B  # i+    <6" ?"6@`NNN?NL{D  :&0(2www`  HPp|vyd޽h @ ? ̙33~___PPT10^+DB' ~ = @B D' = @BA?%,( < +O%,( < +D4' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+#.<*%(+0N0  pQ(  pr p 6A 2? ?} 2f p <I"  "`~ Computerized Prescriber Order Entry Use by General and Children s Hospitals"M0 M  p 6Q"  "`y N$0(    p <ZZ"   PPercent of hospitals 0 2 p 0^" x 0Note: * 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).}0}  p <g"   D Obj. 17-2c 0 (l r` pr`,$D0 p 6@m" "`;3 L2010 Target: 6"0___  p s BFCDEF ?F@"`r=2T ;  p# `   p Bo"  ?"6@ NNN?N0_ hIncrease desired($0f<G___ 0AAB  p BD___o?"0@NNN?NX  p B ?"6@`NNN?N; p <x"  ?"6@ NNN?N    =* 0(24B p # i+ )) ` p HPp|vyd޽h @ ? ̙33~___PPT10^+)ȷDB' ~ = @B D' = @BA?%,( < +O%,( < +D4' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+#.<*p%(+ 0N0 P#2< 0 a(  <  < 6|"  "`v N$0(   < 6L"  "` N$0(   2 < B ?"6@ NNN?NP@2 < B ?"6@ NNN?N  @  < <\"  ?"6@ NNN?N :&0(2www2 !< B ?"6@ NNN?N0P P *< <"  ?"6@ NNN?N P :&0(2www #<  NA ? J``J 8 _ 2< _ <  Zt" Ԕ?_ PPercent of hospitals 0 T  @  )< # `_ <  B(" =  @2001 0Cn <  03f"`  t <  6"`  <  B̤"  @  N2006.0C U '< B"  ?"6@ NNN?N W Total <50 50-99 100-199 200-299 300-399 400+2X0 2 wwwL +< BS"  ?"6@ NNN?N  TNumber of Staffed Beds"0(2 ,< 0" H& zSOURCE: National Survey of Pharmacy Practice in Hospital Settings, American Society of Health System Pharmacists (ASHP). {0 { | 1< 6 "  "`} Computerized Prescriber Order Entry System Use by Size (General and Children s Hospitals)$Z0(  ZH < 0޽h ? >*?>*yy___PPT10Y+D=' ~ = @B +>0N0 H @ ! (  r  6A U? ?02 U  <,"  "`~ FComputerized Prescriber Order Entry Use by Urban Acute Care Facilities"G0 G   6"  "`0 N$0(     <Z" 0  QPercent of facilities 0 2U  08" A; 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.0   <d" d D Obj. 17-2d 0 (l `t `t,$D0  s BFCDEF ?F@"`,bt   6$" "`03 L2010 Target: 7"0___T ;  # `    B8"  ?"6@ NNN?N0_ hIncrease desired($0f<G___ 0AAB   BD___o?"0@NNN?NX   B ?"6@`NNN?N;  <`"  ?"6@ NNN?N@ t82003 2004 2005 2006 90 29`  HPp|vyd޽h @ ? ̙33~___PPT10^+]KDB' ~ = @B D' = @BA?%,( < +O%,( < +D4' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+#.<*%(+0N0 (+ L(      BA ? ?"`2z ^L  )  # {V   <- ?"6@`NNN?N )0  K Prescribers$ 08A2    < - ?"6@`NNN?Np 4 K Pharmacists$ 08A2  l`  # l`,$D0T l  # l   68- "` M2010 Target: 95"0___   s BFCDEF ?F@"`lT ;  # `    Bp-  ?"6@ NNN?N0_ hIncrease desired($0f<G___ 0AAB   BD___o?"0@NNN?NX   B ?"6@`NNN?N;X  <4#-  ?"6@ NNN?Nt  100 90 80 70 60 50 40 30 20 10 0r0(2 08n208208ZA08(n08<i08Ki08(s082  <Z3- w  OPercent of patients 0 2  <6-  "`~ 7Patient Receipt of Verbal Counseling about Medications"80 8   <@- p LObj. 17-4, 5a & 5b0  <x"-  ?"6@ NNN?Ni y B2004"0(2  <TH-  ?"6@ NNN?N  B2000"0(2~  Hff1?"`] {  <DL-  ?"6@ NNN?N>N  B1998"0(2~  H1?"`;~  H1?"` P {  6 Q-  "` N$0(    * 0Y- I ,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, FDA60t  f  + <|`-  IObj. 17-5a & 5b0`  HPp|vyd޽h @ ? ̙33~___PPT10^+P!wDB' ~ = @B D' = @BA?%,( < +O%,( < +D4' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+#.<* %(+0 P)!$ 0 ](   r   6A '? ?  '  68o-  "` p N$0(     <hq-  ?"6@`NNN?N[P  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 f$8fP $(f0}0P0x0n"0s 0i0n0A000P0C  www   4   4   4  4 CCCC CCC hL    # 6lfTB   c $DTB   c $D  TB   c $D   B ?"6@ NNN?Ni)  <y-  "`~ kBlood Donations, 2006$0(   L H  #  m    B-  ?"6@ NNN?Nl hIncrease desired($0f<GMMM 0AAB  B BD___o?"0@NNN?N+   B ?"6@`NNN?NHB  BD___>?"0@NNN?NI   B|-  ?"6@ NNN?N ^  `2010 Target: 8($0fFG___   <-  ?"6@`NNN?Nh "| z0 5 10 15 Percent (age adjusted) 8y$0f}$0f{C 8 . $ .@ . # .   <-  "` N$0(      N -  ?"6@ NNN?NP! W Obj. 17-6$ $0fZ C }   6- -N.  = 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), ǿֹ, NCHS. 0  pT    # HcTB   c $DTB   c $D  TB   c $D :F r    l;h   6A +? ?"`r  +B   <D?"0@NNN?N  B   <D?"0@NNN?NA A  B   <D?"0@NNN?N  B !  <D?"0@NNN?NG G B "  <D?"0@NNN?N  H  0޽h ? 33___PPT10i.P+D=' ~ = @B +n50N0 m4e4)+- 3(     H2  ?"6@ NNN?NL _Millions of units$$0fZC   6 2  "`x N$0(     <2  "`~ kBlood Supply Adequacy$0(    " 02 @ lNote: 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.<0  C  N  QL G  # G  2  `A ? ?RA  2 N E z    E z B   6D?"0@NNN?NE E B   6D?"0@NNN?NH H B   6D?"0@NNN?NG G B   6D?"0@NNN?NU U B   6D?"0@NNN?Na a B   6D?"0@NNN?Nb b B   6D?"0@NNN?Nz z QN G   G,N U G   U G   <` 2  ?"6@ NNN?NU0 @1989 0 2   <T$2  ?"6@ NNN?NO * @1992 0 2   <((2  ?"6@ NNN?NV1  @1994 0 2   <+2  ?"6@ NNN?Nd ?  @1997 0 2   <,/2  ?"6@ NNN?Nk F @1999 0 2   <22  ?"6@ NNN?NiD @2001 0 2   <62  ?"6@ NNN?NlG @2004 0 2   <0:2  ?"6@ NNN?N  =0 0(2   <=2  ?"6@ NNN?N i  >10 0(2   <A2  ?"6@ NNN?N   >11 0(2   <4E2  ?"6@ NNN?N  >12 0(2   <H2  ?"6@ NNN?N >13 0(2   <L2  ?"6@ NNN?N V= >14 0(2   <8P2  ?"6@ NNN?No >15 0(2  BS2  ?"6@ NNN?NOT K Collections$ 0 2   BW2  ?"6@ NNN?Na! UAvailable Collections$0 2 ! BDV2  ?"6@ NNN?N7 Z L Transfusions$ 0 2 B # BDo?"0@NNN?NN  B $ BDo?"0@NNN?N  ^L .[   % # .   &   0e0e    BCDEF$ Ԕ 8c8c     ?A)BCD|E|| e @s "0e@    @ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN 5%  N 5%  N    5%    !"?N@ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `ab7    '   0e0e    BC@DEF$ Ԕ 8c8c     ?A)BCD|E||8@  7@s "0e@    @ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN 5%  N 5%  N    5%    !"?N@ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `ab.[  (   0e0e    BCDEF Ԕ 8c8c     ?A)BCD|E|| @s "0e@    @ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `abN 5%  N 5%  N    5%    !"?N@ABC DEFGHIJK5%LMNOPQRSTUWYZ[ \]^_ `ab  B ) BDjJ?"0@NNN?Ny  B , <D1?"0@NNN?N  B - <D1?"0@NNN?N_  H  0޽h ? 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