Medical Errors & Patient Safety
Medical Errors Can Be Prevented and Patient Safety Improved
Computerization of medical records, barcoding for medications, evidence-based medicine and other approaches have been shown to limit injuries and illnesses caused by medical providers and hospitals. Although medical literature frequently reports on techniques that can reduce medical errors, practitioners and institutions have not embraced them very speedily.
Hospitals in particular have been reluctant to implement these error-reduction strategies because many are either expensive, time-consuming or both. But numerous studies have shown that even slight adjustments in how medical care is delivered can lead to improved patient outcomes and increased patient safety.
There is no shortage of knowledge about common medical mistakes and how to fix them. What follows are the top errors and how hospitals and providers might address them.
Medication errors: Errors such as giving the wrong medication or the wrong dose or not administering prescribed medication at all could be reduced through barcoding, automated drug dispensing, robots and CPOE, or computerized physician order entry. CPOE has been shown to reduce prescribing errors by 55 to 88 percent. And even small hospitals and clinics could implement processes that don’t require significant capital outlay: analysis after mistakes and near-misses, readback (verbal orders are repeated back to the prescribing physician), proactive risk assessment. These and other nontechnological safeguards could be started without large investments in software and hardware.
Failure to diagnose: The number of patients injured because of a failure to diagnose and treat could be reduced if more doctors practiced evidence-based medicine and coordinated patient care with other medical providers involved in a patient’s case. Adhering to established protocols is key to reducing diagnosis errors.
Failure to supervise: Students, interns, nurse practitioners and physician assistants who are not properly supervised can be the source of errors and poor outcomes. The management of residency programs should be standardized and supervisory roles spelled out in detail.
Delayed treatment: Treatment can be delayed because of an incorrect diagnosis or because a patient waited on a gurney in the ER corridor without seeing a physician. Solutions to this problem include common-sense office management strategies: tickler systems, logs and mandatory check-in points, and incorporating follow-up calls into standard operating practice so that faxes and phone messages do not get lost.
Failure to obtain consent: Medical providers who fail to explain the risks and consequences of a particular treatment put patients in jeopardy. Solutions to this surprisingly common problem include using videotapes, computer programs and CD-ROMS to introduce standard issues to patients. This ensures that all patients facing a particular procedure receive the same information.
Lack of skill or training: Solutions to the problems created by improperly trained physicians include mandating simulations and practice, requiring doctors to attend refresher courses, and establishing professional standards for allowing practitioners to deliver specific treatments and services.
Unexpected death: Doctors know that they cannot keep their patients alive forever. However, some hospital and surgical deaths can be prevented by taking complete histories and digging deep into recent life events, especially before surgery. When an unexpected death occurs, hospitals should analyze the event thoroughly to identify danger points that could have been avoided.
Infection: The solution to this problem is so simple it is hard to accept that hospital-caused infections continue to be a significant reason for poor patient outcomes. It has been proven that hospital infections decrease as hand-washing increases. The use of clean gloves with each patient is another proven method of improving patient outcomes and reducing infections.
Failure to communicate: When medical team members fail to report observations, especially during critical events such as surgery and childbirth, they contribute to the endangerment of the patient. Some hospitals have a culture that discourages nonphysicians from making statements that could be perceived as critical of physicians. For communication to improve, everyone involved in patient care must be empowered to speak up.
Hospitals that address problems such as these are taking positive steps toward improved patient safety. Many of the solutions are low-tech and require little investment beyond a commitment to changing the environment that allows medical errors to occur.