Medical Error Reduction and Prevention

Excerpt

Medical errors have more recently been recognized as a serious public health problem, reported as the third leading cause of death in the US. However, because medical errors are comprised of different types of failures (eg, diagnostic or medication errors) that can result in various outcomes (eg, near-miss, injury, or no harm), estimates of the incidence of medical errors vary widely in studies. One study reported that approximately 400,000 hospitalized patients experience some preventable harm each year, while another estimated that >200,000 patient deaths annually were due to preventable medical errors. Moreover, the reported cost of medical errors is wide-ranging, with some experts estimating $20 billion each year and others approximating healthcare costs of $35.7 to $45 billion annually for hospital-acquired infections alone.

The definition of a medical error varies, making analysis via uniform objectives difficult. Furthermore, a lack of standardized terminology has hindered data assessment, synthesis, and evaluation. The Institute of Medicine (IOM) Committee on Quality of Health Care in the US, which performed the first large study on medical errors, defined a medical error as "the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim." Another definition identifies medical errors as a failure in care that may or may not result in patient harm. Regardless of the definition, medical errors are associated with high morbidity, mortality, and economic burden. Moreover, they can negatively impact the patient, their family, involved clinicians and support staff, the healthcare facility, and the community. Healthcare professionals may experience profound psychological effects (eg, anger, guilt, inadequacy, depression, and suicidal ideation) due to actual or perceived errors, which the threat of impending legal action may compound. Clinicians can also equate errors with failure, a breach of public trust, and patient injury despite their mandate to do no harm, which may lead to decreased clinical confidence.

Some experts believe the term error is excessively antagonistic and perpetuates a blame culture. Due to the negative connotation, limited use of the term is prudent when documenting patient records; some experts suggest the term not be used at all. However, adverse events secondary to medical errors occur; therefore, simply discontinuing the word's usage will not prevent or reduce these errors. Uncovering the cause of these errors, as well as providing viable solutions to avoid these errors from occurring, is challenging. Healthcare professionals should be familiar with the different types of medical errors to understand better the adverse events that may be caused.

Common types of medical errors include surgical errors, diagnostic errors, medication errors, equipment failures, patient falls, hospital-acquired infections, and communication failures. By identifying the deficiencies, failures, and risk factors that lead to an adverse event, corrective measures can be developed to prevent similar errors. Encouraging individuals involved in every aspect of healthcare to report medical errors is essential to this process. Confidential reporting options are necessary to identify deficiencies or failures a system may contain. Changing workplace culture and developing protocols for addressing medical errors can encourage medical error reporting. Institutions that adopt a patient safety culture and implement corrective interventions can make healthcare safer for patients and healthcare workers. Working together, healthcare professionals can improve patient safety by identifying the contributing factors and events that result in medical errors, developing multifaceted prevention protocols, and implementing these strategies at various healthcare levels.