A medical error is a preventable adverse effect of medical care, whether or not it is evident or harmful to the patient. Among the problems that commonly occur during providing health care are adverse drug events and improper transfusions, misdiagnosis, under and over treatment, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities. High error rates with serious consequences are most likely to occur in intensive care units, operating rooms, and emergency departments. Medical errors are also associated with extremes of age, new procedures, urgency, and the severity of the medical condition being treated.
The Institute of Medicine’s (IOM) legendary report in 1999, "To Err is Human," estimated 98,000 iatrogenic deaths making it the sixth leading cause of death in the U.S. A later study in 2010 yielded almost twice that many deaths, at 180,000. The most recent study in 2013 suggested the numbers range from 210,000 to 440,000 deaths per year. The latter number would make it the third leading cause of death after heart disease and cancer. However, these numbers can only be estimated because medical records are often inaccurate and providers might be reluctant to disclose mistakes.
One of the 1999 IOM report’s main conclusions is that the majority of medical errors do not result from individual recklessness or the actions of a particular group. More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. For example, stocking patient-care units in hospitals with certain full-strength drugs, even though they are toxic unless diluted, has resulted in deadly mistakes. Thus, mistakes can best be prevented by designing the health system at all levels to make it safer--to make it harder for people to do something wrong and easier for them to do it right. Of course, individuals should be still held accountable when an error can be attributed to them. As an example, anchoring bias (persistence with an initial diagnostic impression despite evidence of another diagnosis) is a major source of diagnostic error. When an error occurs, however, blaming an individual does little to make the system safer and prevent someone else from committing the same error.
The nine most common medical errors in the United States in 2014, by occurrence are: adverse drug events, catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), injury from falls and immobility, obstetrical adverse events, pressure ulcers, surgical site infections (SSI), venous thrombosis (blood clots), and ventilator-associated pneumonia (VAP).
The November 2016 issue of Risk Management Monthly (Volume 10, Number 11) extracted highlights from The Emergency Medicine Closed Claims Study from The Doctors Company that analyzed 332 closed claims in emergency medicine in 2007-2013. The major findings were:
A study by Sklar, D.P., et al., addressing unanticipated deaths occurring within seven days after emergency department discharge made several observations. There were 30 deaths per 100,000 discharges, half of which were unexpected but related to the ED visit and 60% of which involved a possible error. There were four recurring themes:
The article Medical Malpractice Liability in the Age of Electronic Health Records cites three phases of malpractice risk associated with EHR systems:
Medical errors continue to occur, albeit at a much lower rate than in the past. It is imperative that all healthcare workers on the interprofessional team, including the pharmacist, nurse, and physician be aware that medical errors not only subject patients to harm but also lead to medical malpractice litigation. Clinicians need to verify their orders before submission. The pharmacist will perform an interaction check, and verify dose and agent selection. Finally, the nurse serves as the final backstop before administering a drug, checking the right dose, right drug, and right patient. There are many causes of medical errors and most hospitals have introduced rules and regulations to minimize these errors with a system of checks. In the end, constant awareness by every member of the interprofessional team is the only way to reduce medical errors.
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