How to avoid medical errors

Health care professionals dedicate their lives to keeping patients healthy and safe. But medical errors can happen despite the best intentions.

The startling fact is that “Medical errors are a serious public health problem and a leading cause of death in the United States” and other countries too.

Rachel Ann Elliott and colleagues write in BMJ Quality & Safety:

We estimated that 237 million medication errors occur at some point in the medication process in England annually, 38.4% occurring in primary care; 72% have little/no potential for harm and 66 million are potentially clinically significant.

In the UK

More than one in six (15%) of people in England now take five or more medicines a day, increasing the risk of adverse effects, the review found. One in 14 (7%) are on eight drugs or more.

About one in five hospital admissions in over-65s, and 6.5% of all hospital admissions, are caused by the adverse effects of medicines. The more pills a person takes, the higher the risk that one or more of these medicines will have an unwanted or harmful effect. Some medicines, such as those to reduce blood pressure, can also raise the risk of falls among the frail and elderly.

Types of medical errors

There are two major types of errors:

1. Errors of omission occur as a result of actions not taken.  Examples are not strapping a patient into a wheelchair or not stabilizing a gurney prior to patient transfer.
2. Errors of the commission occur as a result of the wrong action taken.  Examples include administering a medication to which a patient has a known allergy or not labeling a laboratory specimen that is subsequently ascribed to the wrong patient.

They can occur anywhere in the health care system—-hospitals, clinics, outpatient surgery centers, doctors’ offices, nursing homes, pharmacies, and in your own home. Errors can involve medicine, operations, tests, diagnosis, equipment, and laboratory reports. They can happen during the most routine tasks, such as when a hospitalised patient on a salt-free diet is given a high-salt meal or when home medications are not taken correctly.

Of course, we need medical professionals to be alert to this problem. We need errors to be investigated and lessons learned. We also need to be aware and alert as patients to the possibility of errors and not just assume the medical person knows best.

General tips to help protect yourself from medical errors

1. Speak up if you have questions or concerns. You have a right to ask questions of anyone who is involved in your care.
2. Make sure that all health professionals involved in your care have the important health information about you. Do not assume that everyone knows everything about you. You and your primary care provider may have been partners in your health care for many years, but another physician or nurse might be seeing you for the first time.
3. If you have a test done, don’t assume that no news is good news. Ask about the results, including what the results mean and if you need additional follow-up care.
4. Clearly identify yourself to your providers. If you are issued an identification band, keep it on. If you have difficulty hearing, tell the person that you have difficulty hearing and double-check that it is your name being called. If you have a common name, ask to have the birth date checked in the record to reduce the chance of mistaken identity.

How to avoid drug errors

It’s important to be vigilant to prevent medication errors.

Tell your doctor, pharmacist and nurse about everything you take. This includes prescription medicines, over-the-counter medicines, and dietary supplements such as vitamins, herbs or other alternative therapies.

At least once a year, bring all of your medicines and supplements with you to your doctor, nurse or pharmacist and ask them to evaluate them. Have them list all of this in your records.

Tell your doctor and pharmacist when you start or stop taking any new medications, vitamins, herbs or other therapies so they can check for drug interactions.

Tell your doctor, pharmacist or nurse about any allergies or adverse reactions you have had to medicines, herbs, chemicals or foods.

Take a list of everything you are taking, when you have a medical visit.

Ask for information about your medicines in terms you can understand. You have a right to know. Here are some possible questions:

•     What is this medicine for?
•     How am I supposed to take it and for how long?
•     Is this medicine safe to take with other medicines, herbs or dietary supplements?
•     What food, drink, or activities should I avoid while taking this medicine?
•     What side effects are likely?
•     What do I do if they occur?

Instead of relying on your memory, ask for printed information about the side effects and drug interactions that your medicine could cause, as well as printed directions for taking the medicines.

When you pick up your medicine from the pharmacy, make sure it is the medicine your doctor prescribed. If the medicine is one that you have been taking and it looks different, ask the pharmacist to double-check before taking the medicine.

Be sure you understand the directions on your medicine label. For example, ask if “four doses daily” means taking a dose every 6 hours around the clock or just during regular waking hours.

Ask your pharmacist for the best device to measure liquid medicine. Household teaspoons often do not hold a true teaspoon of liquid, so use specially marked syringes or marked measuring spoons to measure the right dose.

If the medicine requires a special device (for example, an inhaler), be sure you understand how to use it correctly. Practice in front of your care provider to demonstrate that you are using the device properly.

You are likely to forget up to 80% of what your doctor tells you!

You may feel that what I have already recommended is over the top, but there was a study published in the Journal of the Royal Society of Medicine that found that most patients forget as much as 80 percent of what their doctor tells them as soon as they leave the clinic. The study was published in 2003, but the results are unlikely to have changed.

Study author Dr. Roy Kessels explains why patients forget crucial medical information:

• Old age. As you age, your ability to remember episodic and unstructured information, including medical advice and test results, worsens.
• Preconceptions. Patients are likely to forget or misinterpret medical information if it doesn’t agree with their personal theories about illness. It’s easier to remember entirely new information than it is to remember something that challenges existing ideas.
• Stress. Anxiety causes what’s called attentional narrowing, a state where the brain can focus only on the most frightening statements. So, when a doctor tells a patient he or she has cancer, that person is unlikely to remember much else from that conversation.
• Structure and importance. Patients are more likely to remember the first statements they hear and are able to recall specific information better than general information. Structured, logical information will help patients remember better as long as doctors state first what the structure will be.
• Spoken words. The more information given by a doctor, the less the patient will remember, especially if it’s spoken information, rather than written information. Some hospitals have found that patients given spoken instructions remember only 14 percent correctly while those given information in the form of pictographs remember 80 percent correctly.

The medical community need to do its best to avoid medical errors, but we also need to do our bit as well.