INTRODUCTION

According to estimates from the Institute of Medicine, 44,000–98,000 patients die in U.S. hospitals annually because of injuries sustained because of errors. Unsafe and inadequate care in other settings such as physician offices, emergency departments, and nursing homes compounds the problem. This chapter will review three systematic approaches to preventing errors in the care of the elderly:

1. Improving coordination of care, especially during transitions of care

2. Reducing medication errors through improved guidelines and practices for prescribers, nurses, and pharmacists, and systems for tracking and reporting medication errors

3. Health information technology (IT), including computerized alerts and reminders and decision support systems, and electronic health records (EHRs).

COORDINATION DURING TRANSITIONS OF CARE

Problem

The Joint Commission on Accreditation of Healthcare Organizations (November 1999 Institute of Medicine [IOM] Report) reports that communication issues were the root cause of approximately 65% of the 2,966 sentinel events identified from 1995 to 2004, and approximately 64% of the 3,548 sentinel events reported by 2005.

“Hand-offs,” or transfers of patient care, are inevitable in health care. Home to facility, facility to facility, shift to shift, caregiver to caregiver intensive care and emergency department transfers or procedure back to floor and visa versa, and facility to home and/or home care are some examples of occasions when effective communication is critical or crucial to ensure that safe care is rendered. The potential for error then because of missed communication is multiplied when dealing with a geriatric population struggling with the complexities of comorbid disease conditions and health care treatments, confusing medical jargon, and the fear that can be associated with unfamiliar surroundings.