Medical Errors, Polypharmacy in Elderly: Team Alice Cause

In March, she got the chance to speak to a collective gathering of more than 200 medical, pharmacy and physical therapy students from the University at Buffalo, as well as physician assistant students from D’Youville College.

“The beauty of this event was the interprofessional approach. I really hope we can see robust teamwork with medical professionals, between physicians and nurses and pharmacists and physical therapists all working together. Communication is key because there was a shocking lack of communication in my mother’s case,” said Brennan-Taylor, who spoke as part of Patient Awareness Week.

In vivid detail, she discussed her mother’s harrowing and ultimately tragic story.

Alice Brennan was a vibrant, active, 88-year-old who lived independently, drove her own car, managed her own finances, enjoyed a busy social calendar and was known for taking a uniquely humorous approach to life.

She was admitted to a community hospital in early July 2009 for gout. At the time, Alice was on three prescription drugs. A few weeks later, Brennan-Taylor found that while in the hospital and a rehab facility, her mother had been prescribed and was taking 26 prescription drugs.

An independent physician who Brennan-Taylor asked to review the case called it “the worst case of polypharmacy I’ve ever seen.” At one point, as a result of being prescribed cyclobenzaprine for muscle spasms, Alice was hallucinating that people were trying to kill her and her daughter. Cyclobenzaprine is on the Beers Criteria, a list of medications that can be inappropriate for the elderly. She had also stopped eating and drinking. By the time the drug was stopped — at Brennan-Taylor’s insistence — the damage was irreversible.

Forty-eight days after admission to the hospital, Alice passed away from multiple health care-associated infections compounded by medication errors, all of which were preventable. According to Consumer Reports magazine, deaths due to medical errors are one of the leading causes of death each year in the United States.

“No one should die from sepsis today,” said Brennan-Taylor, an adjunct faculty member in the Department of Family Medicine and Patient Safety Action Network charter member. “My mother trusted the health care system, and it failed her. There was an utter breakdown in the system.”

After Brennan-Taylor’s talk, the students broke off into interdisciplinary working groups to analyze what happened in Alice’s case.

“This was a very meaningful part of the afternoon,” said Ranjit Singh, MB Bchir, associate professor of family medicine, director of the Primary Care Research Institute at the Jacobs School of Medicine and Biomedical Sciences and a member of Team Alice.

“It really engaged the students to look at a real-life case. This isn’t a made-up case study; it’s a real case that has so many different problems in it. It encouraged them to identify what they think they would have done if they had been on the care team,” Singh added.

The students were required to identify and research one issue in Alice’s case. One group identified a study reported by Spanish researchers that found that 73 percent of patients older than 65 were taking an inappropriate medication. Another group found that when the pharmacist in an institutional setting visited the patient personally to discuss medications, medication errors were reduced by half.

“The students were challenged to work together to come up with creative, evidence-based solutions so that this tragic outcome is not repeated,” Singh said.

The faculty who facilitated the event took the occasion to announce the formal launching of Team Alice, an innovative research and advocacy initiative based in the Center for Successful Aging. Team Alice was inspired by Alice’s story and Brennan-Taylor’s tireless efforts to work for changes to the health care culture that caused her death.

“Alice’s case was initially used as interprofessional instruction for our medical students,” said Robert G. Wahler, PharmD, clinical assistant professor of pharmacy practice in the School of Pharmacy and Pharmaceutical Sciences and a member of Team Alice. “It has now expanded to a research team of more than 15 interprofessional faculty, staff and students from various health disciplines all focused on working to reduce medication harm in the elderly through a variety of approaches.”

“This is a team approach, as opposed to individual disciplines. This is what we have been hoping to do for a very long time,” said Brennan-Taylor, who has told her mother’s story to policymakers locally and nationally in hopes of changing both health care culture and policy.

Through Team Alice, Brennan-Taylor, Singh and Wahler are developing a partnership in Western New York focused on deprescribing — reducing the prescribing of unnecessary and sometimes harmful medications in the elderly.

“My concern is the ageism that exists in health care with regard to senior citizens — the devaluing, the painting everyone with one brush,” Brennan-Taylor said. “I really want those involved in the health care field to be sensitive to that and to realize that their senior patients are not any different than them — and to think before they prescribe.”

Team Alice also has a research component.

“We’ve been examining the problem of potentially inappropriate medications from different perspectives to see what barriers are there and what are the best practices in effectively removing a medication from a patient’s medication list,” Wahler said.

In addition, the group is partnering with Erie County’s Department of Senior Services to convey to patients and caregivers that they should bring a healthy skepticism to prescription medications and that they may benefit from a non-drug alternative, if one exists.

“I look at everything through the would-this-have-saved-my-mother lens. That’s what I hope will happen, that these burgeoning medical professionals will be able to speak up if they see something that is going wrong, that they will hold one another accountable, that they will work as a team and that they will include the patient as part of the team and have an equal voice — which didn’t happen in my mother’s case,” Brennan-Taylor said.

The event took place March 14 at the M&T Auditorium at the Jacobs School of Medicine and Biomedical Sciences building and was sponsored by UB’s Office of Interprofessional Education in collaboration with the Department of Family Medicine, the School of Pharmacy and Pharmaceutical Sciences and the Center for Successful Aging.