Preventing Medical Errors
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Prevention is Key
To prevent medical errors, think defensively. Mistakes can occur anywhere—at the doctor’s office, the pharmacy, or the hospital. Errors may result in a wrong diagnosis, medication, or surgery, or an infection or serious complication.

Avoiding Medication Mistakes
Medication errors are one of the most common medical errors. You can help avoid them if you understand the medications you are supposed to be taking and how you should take them.

Keep these tips in mind when you are prescribed medication:

  • If the color, shape, or size of a medication you have been taking changes, be sure to ask about this before taking the new medication and be sure you receive an explanation that you trust.
  • Take all your medications (including supplements and herbal therapies) with you to all appointments and discuss any questions you have about any new prescriptions you may need.
  • If you have medication allergies be sure that anyone giving you a new medication is aware of that allergy. Ask whether this medication might be something a person with your allergy should not take. For example, you may have an allergy to sulfa drugs (a kind of antibiotic). This may mean that you are also allergic to some diuretics (“water pills”), as well as some medications to treat diabetes.
  • Have your doctor or pharmacist explain how to use the medication correctly and if there are other foods, medications, or activities you should avoid while using it.
  • Ask your doctor or pharmacist about possible side effects to expect and which ones are serious.
  • If your doctor writes a prescription for you, make sure you can read it. If not, your pharmacist might not be able to either.
Avoiding Diagnostic Mistakes
Problems with diagnosis are another kind of error that you can help your doctors avoid. Even experienced doctors can forget to think of a diagnosis under some circumstances. If you think you know what might be wrong with you, insist that the doctor clearly explains what evidence they have that makes that diagnosis unlikely.

One of the most common kind of medical errors is called “premature closure.” This occurs when doctors come to a firm conclusion before they have considered all of the alternatives—even when one of these alternatives is the correct diagnosis.

Even the best and most experienced doctors are at risk for premature closure, and experience with human nature tells us that it can be very difficult for someone who has made his mind up firmly to change it easily. If the doctor offers a diagnosis that seems unlikely to you, you can help prevent error by asking the doctor:

  • What other alternative diagnoses were considered
  • What tests or other evidence helped you choose among them
  • Whether further testing should be done
  • Write down what you discussed and answers to any questions you have
A uniquely avoidable error is when doctors or nurses misidentify you as a different person and try to give you the treatment intended for that person. Be sure you know what treatments or tests you are expected to receive. If you think something unexpected is being done to you, be sure to confirm that this is what your doctor intended for you. Many care facilities will verify your name and birthdate when they approach you.

Be Prepared
Decreasing your risk of a hospital error begins before you need care. Learn about your condition so you can make informed decisions. Share your medical information with all healthcare team members. Ask questions.

The Magnet Nursing Services Recognition Program for Excellence in Nursing Services was developed to recognize facilities that provide outstanding nursing care. Ask if the hospital you are considering has this status.

Despite nurses’ importance, hospitals may be understaffed. Therefore, it is vital to understand nurse staffing levels and overtime policies. A tired nurse is more likely to make a mistake. Does the hospital rely on temporary nurses? Unfamiliarity with the unit or care needed increases error risk.

Find out how many procedures like yours the hospital does. For certain procedures, such as coronary artery bypass surgery, hospitals with more experience have better results. The US Department of Health and Human Services offers a website where you can compare hospitals all over the country. Many national magazines review this information every year.

While in the Hospital
Enlist a friend or family member as an advocate, prepared to politely inquire if anything seems amiss. Raising questions puts the brakes on possible mistakes and gives the healthcare team time to think.

While you are in the hospital, make sure your healthcare team member washes their hands before they touch you. Handwashing can prevent the spread of infections in hospitals.

People preparing for surgery should also talk with the surgeon, anesthesiologist, and nurse so that everyone agrees on what is going to happen.

Before you leave the hospital, be sure to ask your doctor to explain the treatment plan you will follow at home. This includes new medications, follow-up apppointments, and when you can resume normal activities.

Take an Active Role in Your Healthcare Team
Medical miracles happen regularly in surgical suites and modern hospitals, but so do mistakes. Investing time and effort in your own care helps ensure positive outcomes. Welcome to the most important team you will ever join.




RESOURCES:
Hospital Compare
US Department of Health and Human Services

The Joint Commission

CANADIAN RESOURCES:
Canadian Patient Safety Institute

Canadian Institute for Health Information

References:
20 tips to help prevent medical errors. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/patients-consumers/care-planning/errors/20tips/index.html. Updated September 2011. Accessed October 9, 2014.

Check your medicines: Tips for using medicines safely. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/checkmeds/index.html. Updated September 2010. Accessed October 9, 2014.

Graber M. Diagnostic errors in medicine: a case of neglect. Jt Comm J Qual patient saf. 2005;31(2):106-113.

Medical errors: Tips to help prevent them. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/healthcare-management/self-care/medical-errors-tips-to-help-prevent-them.html. Updated May 2014. Accessed October 9, 2014.

Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002;346:1715-1722.

Nurse staffing and postsurgical adverse events: an analysis of administrative data from a sample of US hospitals, 1990-1996. Health Serv Res. June 2002.

Patient safety. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.org/topic.cfm?topic=A00684. Updated December 2013. Accessed October 9, 2014.

Redelmeier DA. Improving patient care. The cognitive psychology of missed diagnoses. Ann Intern Med. 2005 Jan 18;142(2):115-20.

Last Reviewed September 2014



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