Medication safety has advanced substantially in recent decades, but much more remains to be done, said patient safety pioneer David W. Bates, the presenter of this year’s William A. Zellmer Lecture.
“Care is still much less safe than it could and should be. Medications still represent the leading cause of harm events both inside and outside the hospital,” Bates said Sept. 18 in Bethesda, Maryland, as he delivered the lecture during ASHP’s annual Policy Week activities.
Bates, the medical director of clinical and quality analysis at Mass General Brigham (MGB) and codirector of the MGB Center for Artificial Intelligence and Bioinformatics Learning Systems, is widely regarded as a pioneer in patient safety research. His lecture, The Current State and Future of Medication Safety, featured a recap of study findings, including his own team’s work, and a discussion of how artificial intelligence (AI) and other innovations may help make care safer.
“There are many opportunities to improve safety,” Bates emphasized.
One of his group’s recent contributions to the field of patient safety is the SafeCare study, which examined adverse events at 11 Massachusetts hospitals in 2018. According to results published in 2023, at least one adverse event occurred during 23.6% of 2,809 randomly selected inpatient admissions. Twenty-three percent of the events were classified as preventable, and a third were of serious or higher severity. Medication-related errors accounted for 39% of all adverse events identified during the study period, leading all other error types.
Additional findings from the study described patient harm in the outpatient setting. Bates and his colleagues reported that 7% of outpatient visits involved one or more instances of harm, and adverse drug events accounted for 63.8% of these incidents. In all, 23.3% of all adverse events were considered preventable.
Bates told lecture attendees that documenting instances of patient harm is essential to understanding its causes and making care better and safer. He said the widespread use of electronic health record (EHR) systems makes it easier to identify harm, and technologies such as barcode-assisted medication administration and computerized order entry have greatly reduced instances of serious medication errors.
He said one common EHR component — clinical decision support — has not lived up to its patient safety expectations, largely because of alert fatigue from unnecessary warnings that condition staff to disregard alerts.
“I would say that we’re just doing a terrible job with computerized decision support,” Bates said.
He did, however, speak favorably about a commercial product his hospital is testing that integrates with the EHR system to produce targeted, specific alerts. A retrospective analysis found that the tool may dramatically reduce inappropriate alerts in the inpatient and outpatient settings.
“We think this could substantially reduce alert fatigue and improve medication safety,” Bates said.
He also described his organization’s use of a commercial AI-based pharmacovigilance platform that identifies patients who are at high risk for polypharmacy-related complications and provides clinical decision support for medication changes. The biggest bottleneck in the project, he said, is adding enough clinical pharmacists to his team to reach out to patients and follow up with their care.
Bates said he expects AI to be helpful in healthcare for documentation of patient encounters, imaging analysis, stroke interventions, and improving diagnosis.
During a post-lecture discussion with ASHP Chief Operating Officer Kasey K. Thompson, Bates said hospitals are struggling with putting into place AI implementation plans and committees to oversee the safe use of the technology.
“Every organization is going to have to be thinking about this and have a concrete plan,” Bates cautioned. He predicted that as healthcare organizations begin to adopt AI tools, pharmacists will be responsible for evaluating AI-derived recommendations, evaluating whether they make sense for specific patients, and working with the patients to implement the recommendations.
Bates also took questions from the audience about integrating pharmacogenomics into pharmacy practice, fighting the elimination of medication safety officer positions, expanding access to inpatient EMR data in the community setting, AI data transparency, adding indications and height and weight data to prescriptions, and other topics.
Throughout the event, Bates voiced support for pharmacists, and he emphasized that patients are best served when pharmacists, physicians, and nurses collaborate and learn from one another.
“We really should all be working as a team to deliver the best care for patients,” Bates said.
He also expressed appreciation for the attendees’ Policy Week advocacy efforts and their work to make care better and safer for patients.
“Your policy recommendations will matter. It’s really important to think about where we should be going, and I’m delighted that you’re doing that,” Bates said.
The William A. Zellmer Lecture, established in 2010 by ASHP and the ASHP Foundation, recognizes exceptional leadership in healthcare-related policy that enables pharmacists to improve the safety and effectiveness of medication use.
