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Prescribing medications Assessing the environmental impact By Lowell J. Anderson, DSc, FAPhA
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hat portion of the medicines that are prescribed end up in our water supply? Consider that about 2.5 million pounds of amoxicillin was sold in the U.S. in 2009. Eighty-six percent of amoxicillin is excreted unchanged in urine. Less than 2 percent of amoxicillin is removed by water-treatment facilities. That means that 2,100,000 pounds of amoxicillin enter the environment every year! As health care providers, we bear some responsibility for that.
Diagnostic errors Avoiding negative outcomes By Ann Fiala, RN, BSN, CPHRM, CHC
“The best estimate from autopsy studies is that there are 40,000 to 80,000 deaths a year from diagnostic error.”
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Mark L. Graber, MD
n September 2015, the Committee on Diagnostic Error in Health Care released a report, Improving Diagnosis in Healthcare (hereafter known as “the committee’s report”) as a follow up to the Institute of Medicine’s Quality Chasm Series. The report states, “It is likely that most
people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.” A study published in BMJ Quality and Safety in 2013 reviewed 25 years of medical malpractice claims for diagnostic errors and found that, “Diagnostic errors appear to be the most common, most costly and most dangerous of medical mistakes.” Another study in Critical Care Medicine in 2012 found, “Significant discrepancies in Diagnostic errors to page 10
Medicines are designed to affect living organisms—they kill unwanted bacteria and viruses, alter metabolism, or change hormonal balances. They can have similar effects on other life forms when they enter our lakes and streams. We know that the presence of five parts per trillion of common contraceptive medications can cause the collapse of fish populations and that low concentrations of antidepressants in water can alter fish reproductive behavior. We can document DEET in 76 percent of sampled Minnesota lakes, amitriptyline in 28 percent of studied lakes, sulfonamides in surface water, and triclosan in treatment plant effluent. Iopamidol, a radiopaque contrast agent, was found in 73 percent of the lakes in the 2013 Prescribing medications to page 12