Saturday, August 26, 2006

Reduce Medical Errors | Patient Safety

Reduce Medical Errors and Enhance Patient Safety

The following five steps to safer health care are taken and modified from the Patient Fact Sheet from the Agency for Healthcare Research and Quality(AHRQ), Department of Health and Human Service.

1. Ask questions if you have doubts or concerns. There are no stupid questions. Make sure you understand the answers. The answers must be candid. Take a relative or a friend with you to help you ask questions and understand answers. Be careful not to bring some one who has a history of hostility toward the medical profession.

2.Keep and bring a list of ALL the medicines you take. The list should include non-prescription medicicines. Don't forget to tell your pharmacist and doctor about any herb or supplements that you are taking also because these can cause bad interaction with your prescription medicines.
Tell or remind them of your dru allergies.
Read the label on the bottle of the medicine before taking it.
Ask questions if the medicine looks different than the one you are taking or the dosage seems incorrect.
I go one step further. I always tell the patient to bring all the bottles of medicines in at each appointment. This way I can spot any discrepancy in the strength and dosage of each medicine and corrct it timely.

3.Get the results of any test or procedure. Ask when and how will you get the results of tests or procedures. Call your doctor for the results if you don't hear from him or her in a reasonable time. This way you will prevent a potential medical error by alerting your doctor to look for the results. Once in a while the doctor never receive the result of the test/procedure and does not have a good tracking system to make sure to receive all test results. A lot of this kind of error is due to human error,such as misfiing or machine down.

4.Talk to your doctor about which hospital is best for your health needs. In general,you would prefer to be cared for in a hospital where your doctor is on staff. The reason is that your doctor knows your condition better than any other member of your health care team while you are in the hospital.

5.Make sure you understand what wil happen if you need surgery. Make sure you,your doctor, and your surgeon all agree on exactly what will be done during the operation.
Ask your doctor,"who will manage my care when I am in the hospital?"
Ask your surgeon: What,Where,When,Why,How?

What exactly you will be doing?
What time of the day and what day of the week will the operation be done? Avoid late in the day or friday for major elective surgery.
How long the operation will usually take?
What will happen if "I refuses or delay the proposed surgery?"
How can I feel after surgery?
When will you(the surgeon) see me after surgery? Avoid an elective operation if your surgeon will leave town the next day and leave the postoprative care to another surgeon? Your operating surgeon will be in the best position to reoperate on you due to unforeseeable complication.

In conclusion,speak up,and you will be able to help reduce medical eror for yourself.

Friday, August 18, 2006

Medical Error: Test done on the wrong patient

This is a true story

It happened to one of my patients about 10 or more years ago in a local community hospital.

The mistake: A nuclear liver scan was done on my patient without my order.

I received a call from the radiologist informing me that a liver scan was mistakenly performed on my patient and we have to notify the nuclear regulatory commission of this mistake.

I also informed the patient of the error and explain that no harm was done. I also apologized to the patient for the inconvenience and some pain caused by the intravenous injection of the radioactive material. The pain was caused by the insertion of the intravenous needle. The patient was very understandable.

How did this error happened? The transporter took the wrong patient. He or she was supposed to check the patient's ID and signed the patient out at the nursing desk. Apparently this transporter did not do that.

The clerk in the Xrays department did not identtfy the patient correctly. The xrays technician and the radiologist also did the same mistake by not double checking the identity of the patient.

In this case,the ultimate responsibility lied on the radiologist. If he had opened the chart he would have found out that I did not order a liver scan on this patient.

The scenario mentioned above can happen again and again due to human error even in the setting of a well written policy and procedure of avoiding the error like this.

How can you as a patient prevent this kind of error from happenning? By being inquisitive or in other words: speaking up. Feel free to ask any health care personnel what kind of test is going to be done on you. If you don't get a clear cut answer,call or have the nurse page your doctor to verify. In case of patient who can not make his or her own decision,this responsiblity of speaking up will be upon the guardin or care giver.

The physician's role is also important. The attending physician should always inform the patient verbally about any test to be done. The radiologist must make sure that there is a wriiten order for the test and identify the patient according to the written protocol.