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.

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.

Potential Medical Errors Prevented

This is a true story.

An 80-year-old female patient of mine with high blood pressure,chronic irregular heart beats(chronic atrial fibrillation) and moderate narrowing of the internal carotid artery in the neck,was sent to an orthopedic surgeon for consultation for carpal tunnel syndrome(pinching of the median nerve at the tunnel called carpal tunnel at the wrist)

She was treated with a wrist splint but her symptom of pain was not getting any better. The pain in her right hand was getting worse and she is right-handed. She was frustated and ask if any thing else can be done besides taking pain killer.

Without sending a consultation report to me,the orthopedist mentioned-above scheduled a surgical procedure to release the pinched median nerve within about a week or 10 days after he saw her. He did not call me. The patient called me to inform me about the date of the proposed surgery.

The patient was advised to come in to dicuss about the proposed procedure. She was advised to call the orthopedist to postpone the surgery. She did so but very reluctantly because she was afraid that she might make him mad. This prompted a call from the orthopedist asking me for the reason to postpone the procedure. I told him the reasons which were explained to the patientlater.

Even though the surgery will be done under local and or regional anesthesia,I explained to the patient that sometimes it will have to be converted to general anesthesia which will put a burden to her heart. Therefore she should be ready for that. The patient was also at high risk of developing a stroke due to atrial fibrillation and blockade of the internal carotid arteries.

The patient was sent to a cardiologist who cleared her for surgery,provided that the ventricular rate(heart rate) was under controlled. At that time her ventricular rate was a little fast and it was finally controlled by adjusting one of her medication. She was also on a blood thinner called coumadin.

A radiological procedure called CTA(CT Angiography of the carotid arteries) was done to more accurately assess the severity of the blockage of the internal carotid arteries. It turned out that the stenosis was not critical enough to require carotid endarterectomy(removal of the atherosclerotic plaque from the internal carotid aretry)

All these time,the patient was wearing the wrist splint faithfully.

On an office visit after the above work-up,the patient's symptoms of pain of the carpal tunnel compression was dramatically relieved. She did not have any more pain in the three middle fingers in the right hand. I told the patient that she should consider to postpone the surgery indefinitely because the carpal tunnel release will not accomplish any more symptom improvement. Again the patient felt so intimidated that she asked me to call the orthopedist to cancel the operation for her.

After explaining to her the concept of patient's autonomy,she began to understand that it was her right to decide whether to undergo a surgical procedure or not. A day later I received a call from her. She cancelled the surgery indefinitely.

Recommendations:

1. Always inform your primary care physician about any proposed procedure recommended by the specialist consultant.
2. You have the right and autonomy to decide whether to undergo anr kind of surgery after the surgeon gives you the informed consent.
3. Always ask the following questions:What is going to be done? What will happen to you if you don't want to have the procedure done? What is the usual result for the particular procedure? Will there be any complication? Will the condition come back? When will it be done? Why any rush to do it?,etc. There are no stupid questions. If the surgeon answer all your questions to to your satisfaction,and you have made a decision. This is called an informed decision and if you sign a consent to have the procedure done,the consent is called an informed consent.
4. If you have multiple medical problems,and the procudure is not urgent,it is always wise to have your primary care physician perform proper preoperative assessment to prepare you to be in the optmimal condition for the surgery to prevent or minimize potential complications.

Lessons learned in this case: An elective surgical procedure is postponed indefinitely. If the diagnosis is in doubt or the pain comes back,a repeat EMG(Electromyography) can always be done.

Reduce Medical Errors

This weblog is created to try my best to inform any patient to play a central role in reducing medical errors. If my fellow physicians happen to read this blog and found it useful,feel free to use it. There are many,many areas of potential medical errors that can be prevented,if the patients are more educated and not intimidated to ask their health-care providers any kind of questions before undergoing any medical treatment.

I will use real medical histories to illustrate or highlight the error or potential error. The sources of the stories can be from my experiences or those of my medical colleagues. The patient will be identified by gender and his or her approximate age only. If the story resembles any reader's real medical story,it is coincidental. Only rarely that I will create a story to illustrate the potential medical errors. In this situation,i will tell the readers that it is a created story.

The only intent of this blog is to alert,inform,and guide patients to prevent potential medical errors that can happen to them,by working with their health-care providers.

I am a board certified general surgeon,with formal training in peripheral vascular surgery,who also practicing primary care for more than 25 years.

At one time or another,I was involved in administrative functions of the medical staff of a couple of hospitals which belong to a major Health System in Southeastern Michigan.

I was chairman of surgical care evaluation committee,chairman of department of surgery and president of medical staff.

With the experiences mentioned above,I hope that I can accomplish my goal and intent.