tions, dispensing of medications, and administration and monitoring of medications.

Establishing an Environment That Enables Health Care Organizations to Deliver Safe Care

Many important systems, including accreditation, information technology, education, and knowledge generation, foster safe medication use. Important developments have occurred in each of these areas since the release of To Err Is Human. The medication-related National Patient Safety Goals and associated requirements established by JCAHO are an example in the area of accreditation. With regard to information technology, several IOM reports have stressed the need for an information infrastructure to support the delivery of quality health care. A key element of this infrastructure is the development and implementation of national health care data standards. In May 2004, Secretary of Health and Human Services Thompson announced 15 health care data standards for use across the federal health care sector, building on an initial set of 5 standards adopted in March 2003 (DHHS, 2004). In 2003 the Accreditation Council on Graduate Medical Education promulgated new residency training work-hour limitations (ACGME, 2003), drawing on published research on the relationship between fatigue and errors. And in response to To Err Is Human, Congress apportioned $50 million to support patient safety research; in early 2005, AHRQ published the results of this research (AHRQ, 2005).


Attempts to improve medication safety must be considered against the background of a number of important contextual issues. First, it is essential to recognize the ubiquitous nature of the use of prescription and OTC drugs and of complementary and alternative medications in the United States. In the 2004 Slone Survey (Slone, 2005), 82 percent of adults reported taking at least one medication (prescription or OTC drug, vitamin/mineral, or herbal supplement) during the week preceding the interview, and 30 percent reported taking at least five medications. The three most commonly used drugs were all OTC—acetaminophen (used by 20 percent of the adult population in the week prior to the interview), aspirin, and ibuprofen. In 2003, 3.4 billion prescriptions were purchased in the United States; on average there were 11.8 prescriptions per person (Kaiser Family Foundation, 2004). Fifty-


The discussion here, as well as elsewhere in the report, draws on a paper commissioned by the committee: “Trends in Medication Use: Implications for Medication Errors,” by Brent Petty, MD, The Johns Hopkins Hospital.

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