Medical Errors: Are You a Victim or Survivor?

There are many types of medical errors besides wrong drugs and surgery on the wrong limb. They also involve:

1. Diagnostic errors or misdiagnoses leading to an incorrect treatment plan or not ordering indicated tests or failure to act on abnormal results.

2. Equipment failure, especially IV pumps. The Joint Commission for Accreditation of Hospitals (JCAH) requires alarms to be audible enough to alert someone almost immediately. Most IV pumps are set to instill a medication within a certain period, as ordered. If not, there is a risk of a medical error, notify the healthcare provider for alarms on any equipment.

3. Infections originating in the hospital also called nosocomial infections.

4. Transfusing the wrong type or amount of blood

5. Not following physician orders such as special diets or getting the patient out of bed to prevent pneumonia

6. Not performing assessments and reassessments of a patient's condition, especially before and after pain medications.
(www.ahrq.gov/qual).

You can take an active role to avoid being a victim of medical errors and survive until discharged.

1. Participate in your care, particularly in decision-making. Frequently, medical teams make rounds, talk about the patient's condition, while ignoring the patient. Patients have Rights at every medical facility so know yours. Make sure you ask questions, if you cannot remember what to ask, write questions down prior to their visit. Find out who is the "quarterback" who consults other healthcare providers for assistance in a patient's care. Perform research on the qualifications of this person.

2. Inform doctors of all medications, even herbal preparations and over the counter drugs.

3. Make sure your allergies are on file.

4. All healthcare providers should wash their hands prior to providing care, even if they wear gloves. In addition, they must change the gloves between patients and after handling soiled articles.

5. Many hospitals have policies for identifying the correct limb for operation. The patient marks the limb prior to surgery and the medical team performs checks at different points prior to the actual operation.

6. If necessary, ask a family member or friend to act as an advocate and participate in decision-making.

7. Living wills are invaluable. They inform healthcare providers on whether you want life prolonging procedures or treatments when you are unable to make those decisions (such as if you are comatose or have a terminal condition).

An advance directive lets the medical team know your specific healthcare decisions regarding the kinds of treatments you do or do not want (such as tube feedings).

8. If possible, have a family member or friend act as your healthcare surrogate who can make decisions if you are temporarily or permanently infirmed. This person can authorize any emergency treatment or surgery you may need.

9. Ask the healthcare provider to explain test results in laymen's terms.

10. Choose a hospital known for the type of procedures or surgery you require. (www.ahrq.gov/consumer)

Some healthcare facilities have policies to help prevent medical errors, such as:

1. A computerized system for administration of medications requires scanning your armband to reveal your medication profile on the computer. Then they must scan the medication bar code to verify the right medication, right time, and the right dose for the right patient. This system is too expensive for some hospitals but it greatly reduces medical errors.

2. In blood transfusions, most policies require at least two healthcare providers to verify the correct blood for the correct patient. Both must sign the blood record. In emergencies, this step is not always feasible.

3. Doctors enter prescriptions in the computer for the pharmacist, eliminating the need to decipher their writing.

4. On-call house officers/residents/interns cannot work for extended hours without sleep. Many medical errors occur when the doctor is tired or sleepy.

These are examples of actual medical errors:

1. A 32-year-old female admitted for a c-section. During surgery, the anesthesiologist failed to place her on a ventilator. When she developed breathing difficulties, it was difficult to place a tube into her lungs. Consequently, she suffered irreversible brain damage and never had a chance to acknowledge her newborn nor her other two children after this incident.

2. A 16-year-old obese girl went to an emergency room complaining of stomach pain, unaware she was pregnant. The emergency room physician diagnosed a miscarriage and initiated a Pitocin drip to place her in labor. This is a normal medication given to expel the contents of the womb in miscarriages and for some pregnant women to induce labor in normal live births. The physician was not qualified in this field but he sent her to a ward and ordered the nurse to save anything delivered.

A nurse, unfamiliar with the ward, heard the girl screaming. Upon entering the room, the girl delivered, the nurse quickly placed it in a pan and attended to the girl, who was hysterical. The charge nurse entered the room and noticed a small but full term baby in the pan; she quickly cleared the nose and mouth. The baby survived this near miss with minimal nervous system deficits. The nurse defended her actions by claiming this was her first time on the ward and this is different specialty than her own.

3. An elderly man admitted for a full mouth extraction of his teeth. A few hours after surgery, he drowned in his own blood. The sleepy physician arrived too late, the patient died.

4. A nurse refused to enter a patient with AIDS room; he died a couple of hours between her rounds. When the physician asked why she did not know he died, she admitted that when she looked at him from the room's entrance, he appeared asleep.

5. A very confused patient with a brain tumor went into surgery to have it removed. Because of his confusion prior to surgery, he lacked sleep for a few days. After surgery, his nurse discouraged any visitors; he wanted the patient to sleep. Unfortunately, the patient slipped into a coma while asleep. He never recovered and died 3 days later. The doctor's order was to check his neurological status every 15 minutes for 1 hour.

6. An ICU patient arrived after surgery and appeared to have breathing difficulties. The physicians placed her in a medication coma and prepared to put a tube in her lungs and place her on a ventilator. The respiratory therapist noted the patient actually received air instead of oxygen, the physician reversed all actions and the patient survived.

7. A task oriented LPN performed a catheter insertion without paying attention to the patient in general. The patient's color turned bluish purple. Resuscitation attempts failed. This same nurse performed a blood sugar finger-stick on a patient experiencing mini strokes, the nurse did not notice. The patient survived after more attacks, nurses began to monitor his condition as ordered.

8. A female inmate went to court escorted by several guards. Apparently, she began bleeding so heavily from her womb; officers used at least three t-shirts to contain the blood and delivered her 5 miles back to the jail instead of ½ miles to the hospital.

Upon entering the clinic at the jail, the nurse interviewed the crack-addicted inmate who could not remember her last menstrual period but whose history included a miscarriage. She had a very low blood pressure on the verge of fainting. The nurse contacted the officer's supervisor, because over the nurse's protests, officers denied she needed medical attention. They refused to transport her to the hospital. When finally seen in the emergency room, the inmate delivered a nonviable fetus while undressing.

9. Prior to stricter policies on verification of the correct limb to amputate, an elderly patient lost the wrong limb; she still required amputation of the right limb. This made her a double amputee; she lived the rest of her life confined to a wheelchair.

Some of these medical errors and near misses were avoidable but could happen to anyone. Take an active part in your medical treatment, do what you can to avoid becoming a victim of medical errors. Be a survivor.

References:

Healthcare: 20 tips to help prevent medical errors: Patient fact sheet. (Feb. 2000). Retrieved September, 2007 from http://www.ahrq.gov/consumer/20tips.htm

Medical Errors: The scope of the problem. An epidemic of errors. Retrieved Sept. 2007 from www.ahrq.gov/qual/errback.htm

Weise, Elizabeth, USA Today. (2005, May 18). Medical errors still claiming many lives. Retrieved Sept. 2007 from www.usatoday.com/news/health/2005