Preventing Medical Errors
How can you avoid a medical mistake? “Patients are the center of the healthcare team,” says Cathy Barry-Ipema, spokesperson for the Joint Commission, a nonprofit organization that evaluates the quality of healthcare. “You need to be an active participant. You need to be informed, and if something does not seem right, ask the question. We think that can help in reducing errors.”
Prevention is Key
Think defensively. Mistakes can occur anywhere—at the doctor’s office, the pharmacy, or the hospital. Errors may result in a wrong diagnosis, medicine, or surgery, or an infection or serious complication.
Avoiding Medicine Mistakes
“Medicine 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.
“The complexity of medicine has reached a point where there has to be teamwork,” says Doni Haas, RN, a director of the National Patient Safety Foundation. By participating, she adds, you can help prevent errors simply by being one more person reviewing treatments before they are started. Keep these tips in mind when you are prescribed medicine:
- If the color, shape, or size of a medicine you have been taking changes, be sure to ask about this before taking the new medicine and be sure you receive an explanation that you trust.
- If you have medicine allergies be sure that anyone giving you a new medicine is aware of that allergy. Ask whether this medicine might be something a person with your allergy should not take. For example, you may have an allergy to sulfa drugs (a kind of antibiotic). This may mean that you are also allergic to some diuretics (“water pills”), as well as some medicines to treat diabetes.
Avoiding Diagnostic Mistakes
Problems with diagnosis are another kind of error that you can help your 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 clearly explains what evidence 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 have 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 mind up firmly to change it easily. If the doctor offers a diagnosis that seems unlikely to you, you can help prevent error by asking the doctor:
- What other alternative diagnosis were considered
- What tests or other evidence helped him choose among them
- Whether further testing should be done
A uniquely avoidable error is when doctors or nurses misidentify you as another patient and try to give you the treatment intended for that person. 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 for you.
“Studies show that people get better healthcare if they are involved participants in their own care,” says Karen Migdail, spokesperson for the Agency for Healthcare Research and Quality.
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 is a good hospital,” says Christine Kovner, RN, PhD, FAAN. “Ask about Magnet Hospital status, then get care from doctors who are associated with good hospitals.” The Magnet Nursing Services Recognition Program for Excellence in Nursing Services was developed to recognize facilities that provide outstanding nursing care.
Despite nurses’ importance, hospitals may be understaffed. 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 does. For certain procedures, such as ]]>coronary artery bypass surgery]]> , hospitals with more experience have better results. The US Department of Health and Human Services offers a website where you can compare hospitals all over the country. Consumer Reports also has ratings information on hospitals, but you will need to subscribe to receive this information.
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 providers time to think.
“It can be physically and emotionally tough for the family or friends,” according to Kerr. “But it is quite rewarding to feel you have done something important. And the staff generally appreciates it.”
Davis also suggests that patients preparing for surgery should talk with the surgeon, anesthesiologist, and nurse to remind them about the surgical plan.
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 will ever join.
US Department of Health and Human Services
The Joint Commission
Canadian Patient Safety Institute
Canadian Institute for Health Information
Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/ .
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Mayo Clinic. Drug allergy. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/sulfa-allergy/AN01565. Accessed July 1, 2010.
Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med . 2002;346:1715-1722.
Nurse staffing and postsurgical adverse events: an analysis of administrative data from a sample of US hospitals, 1990-1996. Health Serv Res . June 2002.
Nurse staffing levels and adverse events following surgery in US hospitals. Journal of Nursing Scholarship . 1998.
Redelmeier DA. Improving patient care. The cognitive psychology of missed diagnoses. Ann Intern Med . 2005 Jan 18;142(2):115-20.
Last reviewed July 2010 by ]]>Brian Randall, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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