The proper dose

Technology can reduce the risks and costs associated with the delivery of medications at hospitals worldwide

A doctor operates on the wrong leg. A nurse leaves a sponge inside a patient's chest cavity. A heart surgeon bypasses the wrong artery. These kinds of dramatic medical errors not only grab headlines, but underline the fact that hospitals are high-risk environments where frightening stories do happen. And more often than we would like to think.

In fact, medical errors are the third leading cause of death in the US, after heart disease and cancer, according to research by Johns Hopkins University. Their study published last May concludes that more than 250,000 people die every year due to medical mix-ups. Other countries report similar results.

In Brazil, preventable adverse events at hospitals are the leading cause of death, with more than 434,000 cases in 2015, according to a study by the Minas Gerais Federal University and the Institute of Supplementary Health Studies. The cost: up to US$4.7 billion. In Canada, adverse events affected 138,000 people in 2014-2015 and cost the health system about US$685 million, according to the Canadian Institute for Health Information.

The numbers are staggering. And they include one silent risk factor -- errors in delivery and administration of medications-- that doesn't get nearly as much attention as the more colorful and gruesome surgical gaffes.

As many as 100 million medication errors happen around the world every year, resulting in up to 35 million preventable adverse drug events. The costs may be as high as US$115 billion, McKinsey & Co. concluded in its 2012 Strength in Unity study.

Patients undergoing cancer treatment are particularly vulnerable to medication errors. Cancer drugs can be highly toxic and they don't arrive at hospitals in ready-made packages. Their preparation involves a series of steps when mistakes can easily occur. They are prepared according to each patient's individual characteristics and needs, following precise clinical and lab parameters.

From the time a doctor prescribes the medicine, several procedures are necessary for the right preparation to reach a patient: the drugs are ordered from the pharmacy's storage at the hospital, doses must be perfectly measured and mixed with the correct solution. Preparation must be carefully timed considering that most drugs have a short life and must be administered within a specific time frame after dilution. Some medications are sensitive to light, or must be kept at low temperature to preserve stability. At every step in the drug preparation process, any minor mishap can lead to a potentially serious mistake.

The World Health Organization registered 14 million new cases and 8.2 million cancer-related deaths in 2012. It estimated that the number of cases could increase by 70% through 2032. As the number of cancer patients receiving treatment increases, hospitals around the world are seeking ways to improve patient safety, to emphasize traceability and raise efficiency in their cancer treatment processes.

Barcelona's Vall d'Hebron hospital, one of the world's top cancer treatment centers, was the first hospital to adopt a new software that manages the complete life cycle of a drug: its inventory, its prescription, its preparation at the hospital pharmacy and its administration to the patient.

Vall d'Hebron joined forces with Spanish software firm Lug Healthcare Technology in 2008 to develop a process to make chemotherapy drug delivery error-free and to improve its patient safety levels. The software led to a 10% reduction in the cost of cancer treatments when compared with the manual control of preparations, and helped lower liability costs for the hospital.

"We practically eliminated the risk of errors in the production and administration of chemotherapy, we have complete traceability of intravenous preparations and of treatment of patients," Julio Martínez Cutillas, chief pharmacist at Vall d'Hebrón, said in a December 2016 press release.

Additionally, the software's traceability features allow it to collect detailed information about the preparations dispensed, creating a database of cancer treatment that can be used for research purposes.

The software is the brainchild of José María Argüello, Lug's founder and a software engineer from Spain, whose previous experience was in the management of quality control in the food industry. He developed the product in response to a very personal experience.

"I had cancer and while getting a round of treatment, I noticed that I was about to receive a dose that was twice what I had been given the previous session. That made me wonder if there were controls in place to prevent that from happening," he said. Argüello realized that controls were minimal, and were mostly done by pharmacists with no backup safety systems.

Now, when a pharmacist is working at a safety chamber preparing a cancer drug, she will not only see all the instructions and checks on the computer screen, but hear commands and instructions at every step of the process. The system verifies that the prescription is correct, according to international protocols for preparation of cancer drugs. In Spain, Lug found that 40% of errors in cancer treatment were related to incorrect prescriptions. The same study found that Spain could save up to EUR1.8 billion per year by installing this traceability solution at hospitals.

The software, which is used to control not only cancer medications but a wide variety of drugs and intravenous solutions, is currently used in six hospitals in Spain and is being tested in several more, both in Spain and Latin America. As demand for better controls of cancer treatments increases, more and more hospitals around the world are expected to implement similar software-driven, fail-safe medication delivery systems.

About the Authors
Brazilian-born Ed Morata is partner and co-founder of Eneas Alternative Investments, a private equity firm based in Madrid, and President of Lug Healthcare Technology. He has over 30 years' experience in international corporate banking and asset management in Latin America, Asia, Europe and the US. He currently resides in Boston, MA.

Mónica Sala-Valdés is Brazil country manager at Lug Healthcare Technology. Monica, who has a PhD in immunology, began her scientific career in her native Spain at Hospital de la Princesa and at the Spanish National Cardiovascular Research Center in Madrid. She completed her post-doctoral research on cancer cell movements at the INSERM in Paris. Mónica is also a psychologist with a master's degree in Clinical Psychology. She currently resides in São Paulo, Brazil.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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