Medical errors continue to be a major issue in the public health industry and one of the major causes of death in the world. Every time a patient walks into a medical facility, the expectation is that they will get out healthy and able to perform their normal duties. However, this has not been the case. Available statistics indicate that “8,220 people die in hospitals every day and 250,000 to 440,000 die in the US every day” due to medical errors.
Many cases of medical errors go unreported every day due to several reasons. For instance, a healthcare practitioner might be afraid to lose his or her only career or even face jail time if the incident was reported. There is also a likelihood that this exposure could “lead to a loss of clinical confidence. Clinicians equate errors with failure, with a breach of public trust, and with harming patients despite their mandate to “first do no harm.” This “fear of punishment makes healthcare professionals reluctant to report errors. While they fear for patients’ safety, they also dread disciplinary action, including the fear of losing their jobs if they report an incident.” “Many healthcare institutions have rigid policies in place that also create an adversarial environment. This can cause staff to hesitate to report an error, minimize the problem, or even fail to document the issue. These actions or lack thereof can contribute to an evolving cycle of medical errors. When these errors come to light, they can tarnish the reputation of the healthcare institution and the workers.”
Organizational challenges Due to Medical Errors
1. Loss of confidence
The patient has high expectations of the healthcare provider thus intolerant to any issues occurring due to acts of omission or commission. Whenever this happens, the reputation of the healthcare professional together with the organization gets tarnished.
2. Fear of punishment
Most healthcare professionals live in constant fear of punitive measures including jail time and huge fines, loss of career, and license to practice. Because of this perceived fear, most medical errors go unreported thus causing regulatory issues regarding incident and safety reporting.
3. Poor reporting mechanism.
There is a lack of a confidential and anonymous error reporting mechanism that allows anyone to report an incident anonymously. Anonymous medical error reporting facilitates an open discussion about the error where lessons are learned, and future potential mistakes are avoided.
4. Poor patient relation skills
Patient – physician communication about patient care is a huge contributor to medical errors. Most patients get treatments without any knowledge about their care plan. Physicians rarely consult their patients, nor do they actively engage them before, during, and after their care. Most patients get treatments that they haven’t been informed about. As a result, if a misdiagnose happens, they would not be able to file a complaint.
5. Enforcing safety and compliance standards, and quality initiatives
The solution to avoiding these medical errors lies in healthcare practitioners observing guidelines that ensure a high standard of patient care and safety. “Healthcare organizations need to establish a culture of safety that focuses on system improvement by viewing medical errors as challenges that must be overcome.” For this goal to be achieved, everyone in the healthcare industry must actively participate in patient safety strategies and coordinate activities that reduce patient readmission.
The Joint Commission is an accredited national agency that monitors patient safety. One of its patient safety goals is “to assist institutions and healthcare practitioners in creating a safer practice environment for patients and providers.” The following list contains some of the guidelines that if strictly adhered to would contribute to a reduction in medical errors.
- Creating a checklist of things that must be done before the start of care. For instance, before the start of any procedure, “two independent healthcare professionals must confirm the patient’s identity, site of surgery, type of procedure, and review the consent form.” After the procedure, both, the surgeon, anesthesiologist, and nurse verbally count the number of instruments and sponges, confirm that the specimen is labeled, and take notes on the clinical status of the patient.
- Implementing a system that utilizes electronic medical records and barcoding systems. “Barcode administration and handheld personal digital assistants increase medication administration safety. Providing real-time patient information, medication profiles, laboratory values, drug information, and documentation reduces errors. Electronic medication administration helps identify incorrect and omitted medications and canceled or changed medication orders.”
- There should be a high level of collaboration across all medical facility departments for purposes of ensuring safe medication prescription, administration, and monitoring.
Improvement Initiative:
Quality Improvement Program
This program entails documenting all near misses of medications that look alike or sound alike utilizing enhanced medication management tools and use of high-alert medications; reducing the kinds and quantities of medications stored outside of the pharmacy, shortening the period of time from writing stat (ST) physician orders to medication administration and standardizing the rule associated with skin tests and contraindications concerning cross allergy” and has been proven to work in reducing medical errors in most medical facilities.
Healthcare facilities should establish Quality Administrative Boards that consist of highly qualified and competent nurses as members. This board will be responsible for onsite surveys and “inspections on medication management inwards by inpatient pharmacists every month (first level), self-evaluation by each nursing unit every half-year (second level), and auditing by the Quality Administrative Board every year (third level).” Medication safety meetings should also be held quarterly and attended by all staff including pharmacists.
Medical facilities should also develop an electronic medication tracing system that is embedded into pharmacy management information and electronic nursing record systems. This system enhances the management in handling physician orders because it allows the orders to be traceable through the time of prescription, transcription, prescription auditing, sterile admixing (for intravenous [IV] drugs), starting time of logistics delivery, the time of receiving medications by ward nursing staff, starting time of dosing, and end time of IV infusion. Every nursing unit should be equipped with an audio device that will “sound out the alarm “there are ST orders, please handle them immediately”. The alarm will sound again 1 minute later if the nursing staff does not respond. The ST orders alarm will also sound in the inpatient pharmacy.”
The organization should develop “an online query system of appearance (color, size, shape) of tablet or capsule” which helps in checking medication or identifying the corresponding medications that had been ordered but temporarily discontinued.
Medical institutions should develop web-based software for prescription screening and drug counseling that is embedded into the pharmacy management information system, the electronic medical record (EMR), and the electronic nursing record system. Through the software, nurses can look up key points of medication knowledge.
Medical treatment centers should develop a labeling unit that will ensure medication dispensed from the inpatient pharmacy is “accompanied with a unit dose label containing barcode, patient name, identification number, drug information (name, dose, route, frequency, time), and warnings (drip rate, stability, signs of high-alert medication identification, medications to be refrigerated, medications requiring light protection, medications requiring special types of infusion sets, and medications that increase fall risk.”
Medical centers should develop a sophisticated interface for the pharmacy management information system for prescription auditing that enables pharmacists to review physician orders based not only on information that is already available such as (patient name, identification number, age, diagnosis, medication name, dose, administration route, and dose frequency), but also other key information such as current medications information, allergy histories, body weight, body surface areas, nutrition statuses, and clinical laboratories tests results such as hepatic and renal function, international normalized ratio, blood routine examination, and serum drug levels.
Medical centers should also invest in information technology equipment for nursing care such as personal digital assistants (PDAs) and mobile nursing carts. The application of mobile nursing carts has been found to bring about great convenience to nursing staff, while medication labeling together with barcode scanning before dosing is believed to enhance medication administration safety.
On the aspect of staffing and safety management, the medical center should create two units of highly qualified nursing groups with a nurse leader designated for each group. This arrangement allows for an individual nurse to manage rooms in the same group for two consecutive weeks. According to this model, each nurse is allowed to have an occupational development file that is instrumental in self-management awareness and a personal management plan. Customized training should organize with nurses possessing different levels of experience.