Preventing Medical Errors

The Extent of the Problem

An estimated 22 million Americans say they or a family member have been victims of a medical error, according to a 2002 report by The Commonwealth Fund. To Err Is Human: Building a Safer Health System, a 1999 study by the Institute of Medicine, pegged the number of deaths attributable to medical errors as high as 98,000 annually in the US.

Patients need to think defensively. Mistakes can occur anywhere—at the doctor’s office, the pharmacy, or the hospital. Errors may result in a wrong diagnosis, medication, or surgery, or an infection or serious complication.

“Medication errors are one of the most common medical errors. One way that can be avoided is if patients know exactly what they are supposed to be getting and how to take it,” says Ron Davis, MD, an American Medical Association (AMA) trustee. He explains that the AMA supports patients becoming more involved as part of the healthcare team.

Hospitals, doctors, and nurses strive to avoid errors. But with patients who are sicker, nurses who are fewer in number and busier, and a healthcare system that is stressed by financial constraints, mistakes are bound to occur.

“The complexity of medicine has reached a point where there has to be teamwork,” says Doni Haas, RN, a founding director of the National Patient Safety Foundation. By participating, she adds, the patient helps prevent errors simply by being one more person reviewing treatments before they are rendered.

• If the color, shape, or size of a medication you have been taking changes, be sure to ask about this before taking the new medication and be sure you receive an explanation that you trust.
• If you have significant medication allergies be sure that anyone giving you a new medication is aware of that allergy, and ask whether this medication might be something a person with your allergy shouldn’t take.
  • For example, allergy to sulfa drugs (a kind of antibiotic) are not uncommon, but patients with sulfa allergy may also be allergic to some diuretics (“water pills”) as well as medications used to prevent high altitude sickness.

Problems with diagnosis are another kind of error that patients can help doctors avoid. Even experienced doctors can forget to think of a diagnosis under some circumstances. If you think you know what might be wrong with you insist that the doctor explain clearly to you exactly what evidence s/he has that makes that diagnosis unlikely. One of the most common kind of medical errors is called “premature closure”. This occurs when doctors come to a firm conclusion before they’ve considered all of the alternatives—even when one of these alternatives is the correct diagnosis. Even the best and most experienced doctors are at risk for premature closure, and our experience with human nature tells us that it can be very difficult for someone who has made his or her mind up firmly to change it easily. If the doctor offers a diagnosis that to you seems unlikely, you can help prevent error by asking the doctor what other alternative diagnosis were considered, and what tests or other evidence helped him or her to choose among them. Ask if any further testing could be useful.

A uniquely avoidable error is when doctors or nurses misidentify you as another patient and try to give you the treatment intended for that individual. Be sure you know what treatments or tests you are expected to receive. If you think something unexpected is being done to you be sure to confirm that this is what your doctor intended, and intended for you.

You can make a difference.

“Studies show that people get better healthcare if they’re involved participants in their own care,” says Karen Migdail, spokesperson for the Agency for Healthcare Research and Quality.

Be Prepared

Decreasing your risk of a hospital error begins before you need care. Learn about your condition, so you can make informed decisions. Share your medical information with all providers. Ask questions.

“People need to find out what’s a good hospital,” says Christine Kovner, RN, PhD, FAAN. She is a professor in the Division of Nursing at Steinhardt School of Education, New York University. “Ask about Magnet Hospital status, then get care from physicians who are associated with good hospitals.”

The American Nurses Credentialing Center developed the Magnet Nursing Services Recognition Program for Excellence in Nursing Services to recognize facilities that provide outstanding nursing care.

Dr. Kovner’s studies show lower nurse staffing levels increase adverse postoperative events. JCAHO recently found that nurse staffing levels have been a factor in 24% of the serious errors hospitals reported to that organization. A study published in the New England Journal of Medicine found that higher levels of care provided by registered nurses results in better care for patients, fewer hospital-acquired urinary tract infections, and lower rates of other complications.

Despite nurses’ importance, a severe scarcity exists. Hospitals are short about 126,000 nurses. Therefore, it is vital to understand nurse staffing levels and overtime policies. A tired nurse is more likely to make a mistake. Does the hospital rely on temporary nurses? Unfamiliarity with the unit or care needed increases error risk.

Find out how many procedures like yours the hospital performs. For certain procedures, such as coronary artery bypass surgery, hospitals with greater experience (eg, one prominent recommmendation is for more than 250 bypass cases per year) enjoy better results. Hospital-specific data on heart procedure volumes and mortality are publicly available for at least New York, Pennsylvania, New Jersey, and California. Where such public data is not available, you may wish to pay attention to more general assessments of hospital quality such as those provided by US News and World Report.

While hospital “report cards” have been strongly criticized and almost certainly do not accurately reflect error rates, you can purchase general “quality” reports on specific hospitals and doctors from firms like Healthgrades.com and Checkbook.org. Consumer Reports also has useful online information about the value of attempting to assess hospital safety and quality. .

Even though many efforts to enhance patient safety have led to increased availability of important information, it is still very hard for anyone to accurately compare hospital safety performance. Ask if the hospital uses new technologies to help prevent errors. For instance, do doctors order medications through a computer or do they still write their orders by hand? Do nurses electronically scan a bar code on your name tag before giving drugs? These computer-based systems (direct to-the-computer doctor order entry and patient bar coding) have been shown to reduce the risk of medication errors and will likely be standard practice at the safest hospitals.

While in the Hospital

Enlist a friend or family member as an advocate, prepared to politely inquire if anything seems amiss. Haas says that raising questions puts the brakes on possible mistakes and gives the healthcare provider time to think.

Dr. Kovner hired a nurse to stay with her dad during a recent hospital stay. Even so, pain medication controlled by the staff nurse arrived late.

Clark E. Kerr, president of the nonprofit organization, 21st Century Consumer, shared shifts with his sister during their father’s recent hospitalization and said he prevented a fall after his dad’s blood pressure dropped too low.

“It can be physically and emotionally tough for the family or friends,” according to Kerr. “But it’s quite rewarding to feel you have done something important. And the staff generally appreciates it.”

Davis suggests that patients preparing for surgery should talk with the surgeon, anesthesiologist, and nurse to remind them about the surgical plan.

“You’d hope you wouldn’t have to do that, but why not be on the safe side?” says Davis.

Take an Active Role in Your Healthcare Team

Medical miracles happen regularly in surgical suites and modern hospitals, but so do mistakes. Investing time and effort in your own care helps ensure positive outcomes. Welcome to the most important team you’ll ever join.