The National Inpatient Medication Chart: Fill & Download for Free

So far — I’d have to say that the greediest thing Big Pharma has ever done is the man-made catastrophe we’ve come to know as the “opioid epidemic.”There were multiple pivotal events, of course, but if there was a ground zero, it was a relatively minor one that can easily be seen today as the “smoking gun.” The event was a 100 word letter that appeared in the prestigious New England Journal of Medicine. It’s so short — I can embed it right here (bold emphasis mine):Addiction Rare In Patients Treated With NarcoticsRecently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients who were monitored consecutively. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well documented addiction in patients who had no history of addiction. The addiction was considered major in only one instance. The drugs implicated were meperidine in two patients, Percodan in one, and hydromorphone in one. We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.Now, keep in mind. This was a letter. Not a scientific study. No “randomized controlled trials.” No placebos or control groups. The year was 1980 — and the letter was authored by Jane Porter and Hershel Jick of the equally prestigious Boston University Medical Center.Harmless — right? A couple of MD’s write a letter that is published in the NEJM.The full consequences took a while, of course, but as the opioid epidemic grew into a national crisis — the NEJM circled back and published a very real study in 2017 that traced the direct references to this letter as it percolated into the scientific literature and community through the decades.From 1980 to 2017 the 100 word letter was cited over 600 times — and over 70% of the time, it was cited as actual scientific evidence. In effect, it went on to become accepted fact that addiction was “rare in patients treated with narcotics” — and specifically opioids. Even worse was that over 80% of the time, there was no reference that the “current files” that Porter and Jick “examined” were all for hospitalized patients. The clinical difference between an inpatient setting and an outpatient one was completely lost — 80% of the time.For comparison, the 2017 analysis of the citations also found that for similar letter’s published at the same time — the number of citations was a mere 11. Not 600. Pharma wasn’t just leaning on the letter — they were leveraging it with as much force as they could.In effect, this 100 word letter gave an entire industry the exact “legal” cover they needed to aggressively market — and sell — opioids at an unprecedented scale. And just how unprecedented was that scale?In 2017, the Pulitzer Prize for investigative journalism went to Eric Eyre for a 3-part series he wrote in 2016 for the Charleston (W. Va) Gazette Mail. The headlines were compelling — but only the teaser into the scale of this colossal — and entirely man made — pharmacological hellscape.December 18, 2016 — 780M pills, 1,728 deathsDecember 19, 2016 — Pill rules not enforcedMay 23, 2016 — Drug firms fueled ‘pill mills’ in rural W.Va.The December 18th article opens with these paragraphs:Follow the pills and you'll find the overdose deaths.The trail of painkillers leads to West Virginia's southern coalfields, to places like Kermit, population 392. There, out-of-state drug companies shipped nearly 9 million highly addictive — and potentially lethal — hydrocodone pills over two years to a single pharmacy in the Mingo County town.Rural and poor, Mingo County has the fourth-highest prescription opioid death rate of any county in the United States.The trail also weaves through Wyoming County, where shipments of OxyContin have doubled, and the county's overdose death rate leads the nation. One mom-and-pop pharmacy in Oceana received 600 times as many oxycodone pills as the Rite Aid drugstore just eight blocks away.In six years, drug wholesalers showered the state with 780 million hydrocodone and oxycodone pills, while 1,728 West Virginians fatally overdosed on those two painkillers, a Sunday Gazette-Mail investigation found. [1]Now, in order for this catastrophe to happen at this scale, literally every segment of the industry (affectionately known as “Big Pharma”) was complicit — because it was all so lucrative. How can I say that with such certainty — and conviction? Because the pharmacy industry is heavily regulated (especially for prescription narcotics) and that means that records are kept at every point in both the manufacture and distribution of narcotics. Who knew?Drug manufacturers (obviously)WholesalersDistributorsDrug RepresentativesDoctors (some abusing their prescribing authority — but often not)So called ‘pain clinics’Retail pharmaciesNational chains (like Rite-Aid, Walgreens, Walmart and CVS)Federal Government (through legally required reporting by pharma)Payers — who saw the insurance claimsEveryone knew — because they saw the numbers. They saw the number of pills — and the revenue.The pictures alone are just horrific — and haunting.At the end of last year, The New York Times captured the truth in a quote as a part of their headline.Obviously, not all of these deaths are the direct result of overdosing on oxycontin (or even other legally manufactured opioids), but here’s the thing. As the industry began to scale back on LEGAL opioids (in feeble attempts to curb the addiction they had created), those who were addicted were forced to turn to ILLEGAL replacements that often included Fentanyl (or heroin laced with Fentanyl). Fentanyl is so potent — this small amount is considered lethal. Law enforcement agents are advised to wear protective gloves when handling Fentanyl — even when it’s containerized.Death toll aside — and that chart is still climbing — the fiscal liability for all this human carnage has been equally devastating. So much so, that the White House Council of Economic Advisors had to recalibrate everyone’s first estimates with this update in November of 2017:That’s not a typo. The White House CEA — itself a collection of expert economists — estimated the one year (2015) cost at $504 billion. One. Year.For comparison, in 2017, our ENTIRE National Healthcare Expenditure (NHE) for all 320 million Americans was about $3.5 trillion. The math is bone simple. “The economic cost of these deaths using conventional economic estimates for valuing life routinely used by U.S. Federal agencies” — was over 14% of our entire NHE.All by leveraging a 100 word letter as cover to evade legal prosecution. In their greed — Big Pharma acted as if this massive destruction was “perfectly legal” because in the technical sense — it was.So yea, I think the opioid epidemic qualifies as the greediest thing Big Pharma has ever done.So far.[1] Drug firms poured 780M painkillers into WV amid rise of overdoses

The results can range from minor errors, such as a slightly different dosage, to fatal consequences. As are a result of persistent problems due to poor handwriting many medical systems are converting over to entirely keyboard entered records and prescriptions.Many studies have been done to track the incidence of poor handwriting in medical settings. To quote from several:Results: From the 300 measurements, 88% of the doctors read the prescriptions correctly, compared with 82% of the nurses and 75% of the pharmacists. A potential fatal error was lorazepam injection 4 mg, which was read as 40 mg (lethal dose) by 20% of healthcare workers (HCWs). With the IntelliPen® only 39% of the prescriptions were readable. Only 65% of prescribers could be identified from their handwriting or the name stamp used.Conclusion: Pharmacists read the prescriptions worst and they are the people who must dispense the prescriptions. Some of the reading mistakes were critical and could be lethal. Many of the prescriptions did not meet the legal requirement for prescriptions. (Illegible handwriting and other prescription errors on prescriptions at National District Hospital, Bloemfontein)Clearly this is bad news!Poor handwriting undoubtedly contributes to a high incidence of medical errors [3] In Britain, medical errors were estimated to cause deaths of up to 30 000 people per year [3] and in the USA up to 100 000 per year.[3] Other authors have cautioned that illegible handwriting in prescriptions may lead to fatal consequences [4] and is a leading cause of medication error. [5] (What’s wrong with doctors’ handwriting? Chaturvedi SK)Clearly a problem worldwide!Physicians’ handwriting has long been a joke. However, poor handwriting among healthcare providers is increasingly being diagnosed as a threat to patients. Nearly all of the prescriptions issued each year in the United States are written by hand. According to the Institute for Safe Medication Practices, indecipherable or unclear prescriptions result in more than 150 million calls from pharmacists to physicians asking for clarification, a time-consuming process that costs the healthcare system billions of dollars per year in wasted time. Experts say that up to 25 percent of medication errors may be related to illegible handwriting: A pharmacist misreads an illegible prescription; one drug is mixed up with another. (For Doctors’ Scrawl, Handwriting’s on the Wall - Self-Insurance Programs)Is the incidence of medical errors being reduced by efforts to switch away from handwritten prescriptions and medical notes? Computerized provider order entry (CPOE) should be able to reduce the vast majority of problems:A classic study of inpatient medication errors found that approximately 90% occurred at either the ordering or transcribing stage. These errors had a variety of causes, including poor handwriting, ambiguous abbreviations, or simple lack of knowledge on the part of the ordering clinician. A CPOE system can prevent errors at the ordering and transcribing stages by (at a minimum) ensuring standardized, legible, and complete orders. (Computerized Provider Order Entry)However, the attempted fix has created new problems. This article delves into some of the reasons that the electronic records system may be just as bad as the system it was meant to replace. Death By 1,000 Clicks: Where Electronic Health Records Went Wrong The U.S. government claimed that turning American medical charts into electronic records would make health care better, safer and cheaper. Ten years and $36 billion later, the system is an unholy mess. Inside a digital revolution that took a bad turn. (Death By 1,000 Clicks: Where Electronic Health Records Went Wrong)Software is only part of the story. Medical culture is also part of the problem. In this discussion of medical errors, Dr. Gallagher, executive director of the Collaborative for Accountability and Improvement is quoted:When he started studying medical error and disclosures two decades ago, “the prevailing notion was that doctors weren’t being more open with patients because they worried about being sued, but this myth has been debunked,” Dr. Gallagher continued. In keeping with the idea that hurt feelings are the impetus for more lawsuits than actual medical malpractice, several studies have indicated that disclosing errors is not associated with increased liability or costs. (When Mistakes Happen… - ASH Clinical News)There is some evidence of success. A meta-analysis conducted in the United States found a reduction in prescribing error:Specifically, CPOE appears to be effective at preventing medication prescribing errors. A 2013 meta-analysis found that the likelihood of a prescribing error was reduced by 48% when using CPOE compared with paper-based orders, which translates into more than 17 million medication errors prevented yearly in United States hospitals. (Computerized Provider Order Entry)However, the same report cautions:The effect of CPOE on clinical adverse drug event rates is less clear. Other reviews have found that CPOE does not reliably prevent patient harm, and high rates of adverse drug events persist in some hospitals with entirely computerized order entry systems. One interpretation of these results is that clinical decision support is the key intervention in reducing errors, and that, in the absence of CDSS, CPOE may prevent mostly clinically inconsequential errors. However, usability testing has demonstrated that CPOE systems with clinical decision support still allow unsafe orders to be entered and processed, and that clinicians can bypass safety steps with little difficulty. Another interpretation is that a significant proportion of medication errors occur at the dispensing and administration stages, and CPOE may not prevent these errors. (Computerized Provider Order Entry)Clearly bad handwriting is not to be taken lightly, but there are many layers in our complex medical systems and overall medical error has not been significantly reduced.

Anyone who has to write quickly and all the time is susceptible to poor handwriting. Indeed, many people find that their handwriting deteriorates while they are in college or university. In the case of medical doctors, this can happen in medical school.The results of illegible handwriting are significant. Measures are being taken to replace hand written notes with digital ones, but the problems remain.The results of poor handwriting can range from minor errors, such as a slightly different dosage, to fatal consequences. As are a result of persistent problems due to poor handwriting many medical systems are converting over to entirely keyboard entered records and prescriptions.Many studies have been done to track the incidence of poor handwriting in medical settings. To quote from several:Results: From the 300 measurements, 88% of the doctors read the prescriptions correctly, compared with 82% of the nurses and 75% of the pharmacists. A potential fatal error was lorazepam injection 4 mg, which was read as 40 mg (lethal dose) by 20% of healthcare workers (HCWs). With the IntelliPen® only 39% of the prescriptions were readable. Only 65% of prescribers could be identified from their handwriting or the name stamp used.Conclusion: Pharmacists read the prescriptions worst and they are the people who must dispense the prescriptions. Some of the reading mistakes were critical and could be lethal. Many of the prescriptions did not meet the legal requirement for prescriptions. (Illegible handwriting and other prescription errors on prescriptions at National District Hospital, Bloemfontein)Clearly this is bad news!Poor handwriting undoubtedly contributes to a high incidence of medical errors [3] In Britain, medical errors were estimated to cause deaths of up to 30 000 people per year [3] and in the USA up to 100 000 per year.[3] Other authors have cautioned that illegible handwriting in prescriptions may lead to fatal consequences [4] and is a leading cause of medication error. [5] (What’s wrong with doctors’ handwriting? Chaturvedi SK)Clearly a problem worldwide!Physicians’ handwriting has long been a joke. However, poor handwriting among healthcare providers is increasingly being diagnosed as a threat to patients. Nearly all of the prescriptions issued each year in the United States are written by hand. According to the Institute for Safe Medication Practices, indecipherable or unclear prescriptions result in more than 150 million calls from pharmacists to physicians asking for clarification, a time-consuming process that costs the healthcare system billions of dollars per year in wasted time. Experts say that up to 25 percent of medication errors may be related to illegible handwriting: A pharmacist misreads an illegible prescription; one drug is mixed up with another. (For Doctors’ Scrawl, Handwriting’s on the Wall - Self-Insurance Programs)Is the incidence of medical errors being reduced by efforts to switch away from handwritten prescriptions and medical notes? Computerized provider order entry (CPOE) should be able to reduce the vast majority of problems:A classic study of inpatient medication errors found that approximately 90% occurred at either the ordering or transcribing stage. These errors had a variety of causes, including poor handwriting, ambiguous abbreviations, or simple lack of knowledge on the part of the ordering clinician. A CPOE system can prevent errors at the ordering and transcribing stages by (at a minimum) ensuring standardized, legible, and complete orders. (Computerized Provider Order Entry)However, the attempted fix has created new problems. This article delves into some of the reasons that the electronic records system may be just as bad as the system it was meant to replace. Death By 1,000 Clicks: Where Electronic Health Records Went Wrong The U.S. government claimed that turning American medical charts into electronic records would make health care better, safer and cheaper. Ten years and $36 billion later, the system is an unholy mess. Inside a digital revolution that took a bad turn. (Death By 1,000 Clicks: Where Electronic Health Records Went Wrong)Software is only part of the story. Medical culture is also part of the problem. In this discussion of medical errors, Dr. Gallagher, executive director of the Collaborative for Accountability and Improvement is quoted:When he started studying medical error and disclosures two decades ago, “the prevailing notion was that doctors weren’t being more open with patients because they worried about being sued, but this myth has been debunked,” Dr. Gallagher continued. In keeping with the idea that hurt feelings are the impetus for more lawsuits than actual medical malpractice, several studies have indicated that disclosing errors is not associated with increased liability or costs. (When Mistakes Happen… - ASH Clinical News)There is some evidence of success. A meta-analysis conducted in the United States found a reduction in prescribing error:Specifically, CPOE appears to be effective at preventing medication prescribing errors. A 2013 meta-analysis found that the likelihood of a prescribing error was reduced by 48% when using CPOE compared with paper-based orders, which translates into more than 17 million medication errors prevented yearly in United States hospitals. (Computerized Provider Order Entry)However, the same report cautions:The effect of CPOE on clinical adverse drug event rates is less clear. Other reviewshave found that CPOE does not reliably prevent patient harm, and high rates of adverse drug events persist in some hospitals with entirely computerized order entry systems. One interpretation of these results is that clinical decision support is the key intervention in reducing errors, and that, in the absence of CDSS, CPOE may prevent mostly clinically inconsequential errors. However, usability testinghas demonstrated that CPOE systems with clinical decision support still allow unsafe orders to be entered and processed, and that clinicians can bypass safety steps with little difficulty. Another interpretation is that a significant proportion of medication errors occur at the dispensing and administration stages, and CPOE may not prevent these errors. (Computerized Provider Order Entry)Clearly bad handwriting is not to be taken lightly, but there are many layers in our complex medical systems and overall medical error has not been significantly reduced.