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PubMed2006

[Consequences of medical errors in intensive and semi-intensive care units].

This report was aimed at characterizing medication errors and evaluating their consequences for the patients' conditions and for the nursing workload in the Intensive Care Units (ICU) and Semi-Intensive Care Units (SICU) of two hospitals in the city of São Paulo. The sample was 50 patients, and data was gathered in record logs. The severity of the conditions and the nursing workload were assessed before and after the occurrence. Out of a total of 52 medication errors, 12 (23.80%), were non-administration of dosage, 11 (21.15%) were wrong medication, and 9 (17.31%) excessive dosage. There were no changes in patient conditions (p=0.316), but the nursing workload increased (p=0.009). As for the medication group, i.e, potentially dangerous or non-dangerous, there were no statistically significant differences either in the severity of the patients (p=0.456) or in the nursing workload (p=0.264) after the occurrence.

Adolescent↗
PubMedDate not supplied

Addressing medical errors: the key to a safer health care system.

A recent report on patient safety by the Institute of Medicine's Committee on Quality of Health Care in America noted that there are at least 44,000 patient deaths from medical errors each year, placing them as the eighth leading cause of death in the United States. They occur in every aspect of the practice of medicine. Some result in adverse events that harm patients. Can an organized effort to reduce medical errors be effective? Other complex industries have been successful in reducing errors and improving quality. The IOM report argues that the medical community must do the same to ensure a higher quality of care. Both the Clinton administration and Congress have expressed concerns about the frequency of medical errors, as has organized medicine. These findings raise significant policy questions for physician executives' charges with ensuring patient safety.

Delivery of Health Care↗
PubMed2003

The role of information technology in reducing medical errors.

This Article summarizes the discussion at a breakout session held at the American Health Lawyers Association's (Health Lawyers') 2003 Public Interest Colloquium,' Minimizing Medical Errors: Legal Issues in the Debate on Improving Patient Safety, held February 28-March 1, 2003, in Washington, DC. The authors developed a series of core questions identifying relevant legal and policy issues relating to the use of information technology in reducing medical errors, and facilitated the breakout discussion.

Humans↗
PubMedDate not supplied

Intravenous medication safety system averts high-risk medication errors and provides actionable data.

A major responsibility of nursing leaders is to implement systems and policies to improve patient and staff safety, avoid medication errors, and most importantly safeguard patients against harm. In the medication use process, the nurse at the bedside is the most vulnerable, and intravenous (i.v.) drug administration often results in the most serious medication error outcomes. At a 675-bed, tertiary-care "Magnet Hospital System," nurses played a key role in a multidisciplinary process that led to successful implementation of a computerized i.v. medication safety system. Software customization, staff training and product set-up were completed in approximately 2 months; 685 devices were installed in 3 hospitals within 12 hours. Nursing acceptance is excellent, and implementation of the system is thought to enhance nursing retention and recruitment. Preliminary data indicate an estimated 849 programming changes ("near misses") annually, ie, potential infusion errors averted by the i.v. medication safety system. A chronogram created from safety data demonstrates that most infusion error warnings occurred between 3:00 PM and 9:00 PM, with an unexpected peak at 6:00 PM. Implementation of the i.v. medication safety system has prevented potentially serious infusion errors and has provided previously unavailable, actionable continuous quality improvement data for best practice improvements.

Automation↗
PubMed2006

Causes and outcome of medication errors in hospitalized patients.

OBJECTIVE: To develop better understanding of Medication Errors (MEs) in the health care sector, and to improve the error prevention services in the hospital. METHODS: We conducted a retrospective study at the Hera General Hospital, Makkah, Saudi Arabia. The medical records were reviewed for adult hospitalized patients from June 1, 2000 to June 30, 2002. Patients demographic data, types, and causes of MEs, were recorded. The contributing factors, frequency and patient's outcome were also analyzed. RESULTS: A total of 2627 patient files were analyzed, 3963 errors were studied as follows: 1559 files contain one error, 800 files with 2 errors, and 268 with >3 errors. The most common type of error found was wrong strength (concentration) in 914 patients (34.79%), 807 patients (30.7%) had wrong route of administration, and 788 (30%) had wrong dosage form. On the other hand, the most common cause identified for MEs, was human factor, which accounted in 1223 patients (46.49%). Miscommunication was the most common second cause in 920 patients (35.02%), and the third common cause was name confusion [484, (18.43%)]. Medication Errors were classified from a regulatory prospective into actual in 735 patient files (28%), potential in 1866 (71%) and serious in 26 (0.98%). CONCLUSION: The study showed that wrong strength was the most common ME found and human factors were the most common cause contributing MEs. Therefore, focusing on these factors will definitely minimize MEs in hospitalized patients.

Adolescent↗
PubMed1991

Preventing medication prescribing errors.

Medication errors may arise in the manufacture, preparation, distribution, and administration of drugs. Physician prescribing errors are of particular importance as such errors have been associated with significant adverse patient outcomes. The pharmacist plays an important role in preventing such errors from reaching the patient. The purpose of this article is to define and illustrate the various error types and the mental attitudes that cause individuals to prescribe errant orders. Through better understanding of the cause of prescribing errors, pharmacists may be able to improve the error prevention services they provide. Based on the error types discussed and their causes, recommendations are proposed to decrease the frequency of such errors and thereby improve the quality of patient care.

Drug Prescriptions↗
PubMed2002

Using standard desk-top tools to monitor medical error rates.

Many experts believe it is time to do something about the high number of medical errors and adverse events highlighted in the recent IOM report. This article examines how front line managers can use a valuable quality improvement/assurance tool--the statistical process control chart--to track and analyze medical error rates. It includes a step-by-step guide to the creation and interpretation of a demonstration chart, discusses potential barriers to the use of statistical process control charts, and suggests ways to overcome those barriers.

Data Collection↗
PubMed2006

[Attitudes to medical errors and patient injury among doctors and medical students].

BACKGROUND: As health care providers most of us will experience that patients are harmed by medical treatment. Our attitudes and reactions to this part of the medical reality are therefore important. MATERIAL AND METHODS: 103 medical students and 156 hospital doctors (surgeons and anaesthetists) at a university hospital were asked to answer a questionnaire anonymously. RESULTS: 81 students (80 %) and 69 hospital doctors (44 %) responded. Students were more worried about the possibility of harming patients, and 78 % of the students had considered dropping out because of this. 88 % of the doctors answered that they had done mistakes that could have had consequences and 71 % answered that they had done mistakes that had consequences. If an error does not cause harm, both students and doctors were reluctant to share the event with others. Doctors were less interested in placing guilt than students. When the error had caused harm, the students were less willing than the doctors to inform others, including the patient. The doctors are sure that they themselves will support and help a colleague who tells them about an error, but they did not think that their department had a system to handle situations like that. INTERPRETATION: To be able to learn from errors, it is important to consider all adverse events, also those that do not cause patient injury. It is important that health care workers understand why they should report, that the actual reporting is perceived as a positive experience and that it feels safe to do so. Supporting health care workers after errors and patient harm is vital to keep the caregivers in work. There are still areas for improvement before a just culture combined with sound error management is achieved. Medical students need more knowledge about patient safety.

Attitude of Health Personnel↗
PubMed2006

Medication errors: immunisation.

Case histories are based on actual medical negligence claims or medicolegal referrals, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. This article outlines a medication error involving childhood immunisation and examines the underlying causes of the incident. Advice about how to deal with a patient and their family when things go wrong is provided.

Australia↗
PubMed2006

Evaluation of stigmatizing language and medical errors in neurology coverage by US newspapers.

OBJECTIVES: To analyze US newspaper coverage of neurologic diseases to determine whether stigmatizing language is used in describing patients and examine its sources where found and to examine stories for medical errors. METHODS: A content analysis of newspaper articles was performed for 2003 using the Lexis-Nexis database. Keyword searches for 11 common neurologic conditions were performed for The New York Times and 8 regional newspapers with circulation greater than 200,000. RESULTS: A total of 1203 stories focusing on 11 neurologic conditions were recovered. Newspaper coverage did not reflect disease prevalence (rank correlation, p=-0.009; P=.98). The topics most covered were Alzheimer disease and other dementias (400 stories, 33% of total), which were eventually combined Into 1 category for purposes of data analysis. Conditions with the highest prevalence were among the least covered topics, including migraine (34 stories, 3% of total) and head trauma (19 stories, 2% of total). Stigmatizing language was found in 15% of all stories. Excluding wire stories, the average among locally produced newspaper stories was higher (21%). Stories on epilepsy (30%) and migraine (29%) contained the highest frequency of stigmatizing language. Sources of stigma within a story included reporters (55%), patients (26%), family (17%), and physicians (16%). In an accuracy analysis, 20% of sampled stories contained medical errors or exaggerations, with half of these concerning neurodegenerative conditions. CONCLUSION: A total of 21% of all stories (excluding wire stories) contained language judged stigmatizing, with reporters as the most common source of the stigmatizing language. A total of 20% of analyzed stories had medical errors or exaggerations, the latter most often overstating treatment effectiveness.

Attitude to Health↗
PubMed2005

Medical errors.

Following the 2000 report of the Institute of Medicine, To Err Is Human, which documented that as many as 98,000 people in this country die of medical errors every year, medical, hospital, and governmental agencies began to consider changes in hospital systems. The report had found that errors were much more likely to result from systemic problems than from inept health care providers. Progress in reinventing hospital systems has been very slow, although some institutions have made great gains."Medical errors" may be of several types. Some lead to malpractice claims, many do not. Many people who have been severely injured by errors never file claims. Making a medical mistake is not necessarily "malpractice." There are six elements a patient must prove in order to win a malpractice case: a physician-patient relationship must exist, the care provider must owe the patient a duty of care, evidence (usually expert testimony) must be presented that there was a failure in some part of the duty of care, there must proof that the lack of care was the proximate cause of harm, and proof of evidence that harm occurred. The patient must also prove his or her assessment of damages. Solutions to the problem of patient injuries are suggested.

Delivery of Health Care↗
PubMed1992

Developing control charts to review and monitor medication errors.

There is a need to monitor reported medication errors in a hospital setting. Because the quantity of errors vary due to external reporting, quantifying the data is extremely difficult. Typically, these errors are reviewed using classification systems that often have wide variations in the numbers per class per month. The authors recommend the use of control charts to review historical data and to monitor future data. The procedure they have adopted is a modification of schemes using absolute (i.e., positive) values of successive differences to estimate the standard deviation when only single incidence values are available in time rather than sample averages, and when many successive differences may be zero.

Data Collection↗
PubMed2001

Setting up a database of medical error in general practice: conceptual and methodological considerations.

Though common and the cause of much morbidity and health cost, medical error has until recently attracted little attention from primary care workers. A database that logs medical error, operating within the context of clinical governance initiatives at the level of Primary Care Groups, could provide an appropriate framework within which to scrutinise and identify systematic organisational features associated with risk of serious adverse events. This paper discusses some of the key conceptual and methodological issues that need to be resolved before such a database can be implemented in general practice and considers these deliberations in the light of the Chief Medical Officer for England's recent report, An organisation with a memory.

Clinical Competence↗
PubMed2005

Disclosure of medical errors to patients.

The literature review presented here explores the feelings of patients and health care providers regarding the disclosure of medical errors. Findings from these studies illuminate patients' desires for information about medical errors and what they are likely to do with the information once they are informed.

Age Factors↗
PubMed2006

Medical errors: understanding the parent's perspective.

Health care practitioners who advocate for full and open disclosure of medical errors often are met with opposition from legal advisors, insurance providers, hospital leadership, and colleagues. Although some progress has been made, a culture of fear around blame and retribution persists and continues to stymie the progression toward open discussion and disclosure of adverse events. The following case discussion addresses some common obstacles to disclosure of medical errors and reversals the potential for positive outcomes for patients and their families, hospital staff, and the health care system when those challenges are overcome.

Child↗
PubMed2004

Medication errors in family practice, in hospitals and after discharge from the hospital: an ethical analysis.

Thousands of medical errors are occurring daily in physician's offices, in hospitals, and even upon discharge from the hospital, leading to unnecessary injury and death and costing billions of dollars. We have a systems approach that has been proven to be tried and true in aviation, nuclear energy and many other industrial settings. Being honest when medical mistakes occur, reporting them to national clearing house, objectively searching for root causes, avoiding the fixing of arbitrary blame, and then, where possible, implementing safeguards to minimize the occurrence of future mistakes, is the best way to enhance patient safety. But until the medical establishment takes medical errors and patient safety more seriously, and until the general public rises up in protest, it is up to the state and federal governments to take the lead in protecting the lives of innocent Americans by creating a public policy.

Aftercare↗
PubMed1999

Medication errors in a pediatric emergency department.

OBJECTIVE: To initiate investigation into the medication errors that occur in a pediatric emergency department. These errors have the potential for significant morbidity and mortality, as well as costly litigation. METHODS: We conducted a retrospective chart review of all medication and intravenous fluid errors identified in a pediatric emergency department through incident reports filed over a 5-year period. An attempt was made to determine who was involved with the errors and what caused the errors. The patient outcomes were noted and classified according to clinical significance using previously published criteria. RESULTS: Thirty-three incident reports involving medication or intravenous fluid errors were analyzed. Most errors occurred on the evening and night shifts. Nurses were involved in 39% of reported errors; the nurse and emergency physician were jointly involved in 36%. The most common error was an incorrect dose of medication (35%) or incorrect medication given (30%). In one third of the cases, the family was not made aware of the error. In 12%, patients required additional treatment, and one was admitted to the hospital because of the error. There were no deaths. CONCLUSION: Incorrect recording of patient weights leading to an incorrect medication dose and failure to note drug allergy are common causes for medication errors in the pediatric emergency department. Incorrect drugs and i.v. fluids are given because of similar names and packaging. Many of the errors in the ED seem to be preventable.

Adolescent↗