WHO will launch a global campaign to create awareness of patient safety and urge people to show their commitment to making health care safer.
“Errors are an inevitable and unfortunate reality of medical practise”.
The complete Healthcare System is an interlocked system. Many factors contribute in making of a Healthcare system. So an error in any step will have an influence on another action. Most medical errors are not due to improper care by doctors or nurses but because of system failure. It is wrong to blame only doctors or nurses. The problem is not bad people in Healthcare – it is good people working in bad systems. The people working in health care are the most educated and dedicated people in any industry. However, the consequences of errors in medical practise are potentially serious for both doctors as well as the patients alike.
During old times doctors were considered next to Gods and they were rarely accused of an error made during the practise. But now as medical technology has advanced so has patient’s expectations and a slightest error can drag a doctor in court of law.
44,000 to 98,000 Americans die every year due to medical error whereas in India 5 lacs death occur every year, according to a study by Harvard university.
An Error is defined as the failure of a planned action to be completed as intended (i.e. Error of execution) or, the use of a wrong plan to achieve an aim (i.e. Error of Planning).1
Errors can be:
- Medication Errors
- Diagnostic Errors
- Treatment procedure Errors
- Clerical Errors
- Errors due to Equipment failures
- Preventive Errors
- Other errors
- MEDICATION ERRORS:
They can be either due to Doctor’s, Nursing staff’s or Pharmacist’s mistake. A Doctor can make a mistake while prescribing a Wrong drug, a drug which the patient is Allergic to, Unnecessary drug, Failure to recognise Drug- Drug interaction, Inappropriate dosage form, Inappropriate route, Wrong indication, ordering of Contraindicated therapy, Orders for the wrong patient, Orders missing information required for the dispensing and administration of the drug.
A nurse can give a wrong drug, wrong dosage, wrong route of administration, or to a wrong patient. They can sometimes fail to monitor drug transfusion.
A pharmacist can give wrong drug due to illegible prescriptions, similar sounding medicine names.
- DIAGNOSTIC ERRORS:
It can be a delayed diagnosis, wrong diagnosis, Improper management of correct diagnosis or a missed diagnosis by the doctor. Misdiagnosis can result in Incorrect choice of tests and incorrect treatment which can harm the patient.
- TREATMENT ERRORS: Such errors occur mostly in surgical procedures due to fault of surgeons or anaesthetists. Some of the examples are; Operating on the wrong patient/ site, leaving sponges/ instruments inside the patient’s body, Not taking proper post op care, not checking all OT machines before starting the surgical procedure etc.
- CLERICAL ERRORS: These types of errors can occur by wrong labelling of samples or change of specimens in laboratory, drawing blood specimens from the wrong patient, transfusion of wrong blood to the patient, interchange of files of patients etc.
- ERRORS DUE TO EQUIPMENT FAILURE: Empty oxygen cylinders, Burn injuries of new borns in phototherapy unit, dislodgement of valves of intravenous pumps giving high drug doses, Defibrillators with dead batteries etc.
- PREVENTIVE ERRORS: There can be failure to provide prophylactic treatment.
- OTHER ERRORS: In this era of globalisation and medical tourism, language can be a barrier and also a cause of error. In India itself 1652 languages are spoken. Long work hour shifts and lack of sleep of the doctors can cause errors and harm the patients. Some of the other causes are understaffing of nurses, failure of communication among health professionals, Insufficient time spent by Doctors with the patients, Poor handwriting of health care professionals, lack of computerised medical records and Complexity of medical care.
DISCLOSURE OF MEDICAL ERROR: Whatever be the reason of medical error, it is a sensitive topic for the Doctors, Institutions/ organisations as well as for the patients. Disclosure of medical errors to patients is the best ethical, clinical and legal course. Every Patient has a fundamental right to know regarding their health. In absence of disclosure there is a higher chance of suing of the physician by the patient if he comes to know about it through some other sources and the physician will be more liable in such cases. Physicians should start with an apology and explain the complete situation clearly. They should try to address all the concerns and issues raised by the patient and his relatives. Patients expect their physicians to be honest in revealing what went wrong and what was done to ameliorate that harm.
BARRIERS TO DISCLOSURE OF ERRORS: Fear of legal action, guilt feeling, shame, loss of respect, loss of reputation of hospitals are some of the reasons preventing truthful disclosures by individual doctors and hospitals.
METHODS TO PREVENT AND REDUCE ERRORS: Patient safety is very important. There is a need to understand the cause of errors and the methods to prevent it.
- Certain standardised protocols should be made by each hospital to prevent errors.
- Feasible prototype systems and tools should be developed for safety in key processes in both managerial and clinical support system for ICU, Operation rooms, Emergency depts, medication systems, Neonatal ICU, geriatrics and Diagnostics dept.
- Tools and methods for educating doctors should be developed.
- Periodic evaluation of error reporting system should be conducted.
- There are more than 20,000 registered pharmaceutical companies in India with a flood of brand names. Many of these brand names sound alike, look alike and pronounce alike. Precaution must be taken to avoid such brand names in hospitals.
- Information technology must be used as much as possible to avoid hand -written notes which is one of the major cause of error.
- Electronic prescriptions should be encouraged which reduce the errors due to illegible handwriting. Safe prescription means writing down age/weight/ allergies of the patient; drug name/ exact weight/concentration/ drug form; avoiding abbreviations; writing generic names; avoiding Latin directions for use.
- All medical records of the patients should be completed on time and not by memory.
- All “high alert drugs” ( intravenous adrenergic agonists and antagonists, chemotherapy agents, anticoagulants and anti thrombotic agents, concentrated parenteral electrolytes, general anaesthetics, neuromuscular blockers, insulin and oral hypoglycaemics, narcotics and opiates)should be well identified
- Overworking of the staff can play an important role in rise of errors. Staff duties must be distributed accordingly. When a new technology is introduced in the hospital, it might take some time to get accustomed to it. Till the staff has got well acknowledged with the new technology it should not be applied.
- Infrastructure of the hospitals should be such that it will prevent injuries, falls, slips of the patients.
- Good communication should be obtained with the patients.
- Healthy physician- patient relationship should be developed.
- Ask patients to be actively involved in all of their health care decisions and processes. They should not hide any of their medical history from their physicians. They should be able to communicate openly and be able to raise concerns regarding their problems with the health care givers.
No one should be harmed in health care and yet, every day, thousands of patients suffer avoidable harm while receiving care. The objective of World patient safety day is to raise global awareness about patient safety and encourage global solidarity and action.
About the author: Dr. Rupali Patil is a Medico-Legal Consultant of CHD Group and is also a practicing ENT surgeon and Allergy specialist.
Disclaimer: The views expressed are the author’s own and not of CHD Group.