How to protect yourself from medical errors

A surgeon left a gauze inside the stomach cavity following abdominal surgery.  A mother suffered a cardiorespiratory arrest during a normal delivery.  A set of X-ray films with a diagnosis of cancer was given to the wrong patient.  These mistakes may often appear as “simple slip-ups,” and always human, but the incidents mentioned above have all happened at our local top-tier hospitals sometime ago.  But medical errors are not just local problems.  Even in developed countries like the US, medical errors are one of the leading causes of death and injury.  A recent report by the Institute of Medicine estimates that as many as 44,000 to 98,000 people die in American hospitals each year as a result of medical errors.  This means that at least in the US, more people die from medical errors than from motor vehicle accidents, breast cancer, or AIDS, combined.

So, what is a patient to do?  Should we all be afraid to go to the hospital?  It’s not quite that bad, say experts in medical quality and error prevention; hospitals these days are being held to higher standards.  But, they add, there’s a long way to go on patient safety efforts.  And patients themselves also have a role to play in keeping themselves safe — asking questions, gaining a better understanding of how the healthcare system works, and more.

“There’s an assumption that health care providers have all the information and you should just take at face value whatever the provider tells you,” says Dr. Peter Angsood, chief patient safety officer of the Joint Commission, a US national organization that accredits hospitals and other healthcare facilities.  (Internationally, the accreditation is done by the Joint Commission International or JCI.)  “One of the biggest things we can do in healthcare is to help patients understand that they need to be better consumers  — it’s good to question, to ask for clarification, and solicit second opinions as needed.”

Here are some tips from organizations such as the Joint Commission and the Agency for Healthcare Research and Quality, which is charged with improving the quality and safety of healthcare, on how to reduce the risk that you or a loved one will experience a medical error.

In the hospital

• Ask questions.  The best way to help your physician and other health professionals avoid mistakes is to talk to them.  Many medical errors are related to medications — getting the wrong drug or the wrong dose.  A 2006 report by the US Institute of Medicine on medical errors calculated that a hospital patient is subject to one medication error per day, on average.  Medications most likely to be associated with errors, the report found, were insulin, morphine, potassium chloride, heparin, and warfarin.  If you are in the hospital and being given a new drug or dose, ask the nurse what it is or why the dosage has been changed.  If you don’t know why you are getting a medication, ask why.

•  Vigilance is easier if you have someone else with you, particularly if you’re having surgery or are too sick to keep track of your own care.  “People need to watch out for their family members,” says Maribeth Shannon of the California HealthCare Foundation.  “Often, errors are caught because a family member says, ‘that doesn’t make sense to me.’ ”

•  Keep close track of your medicines, including herbal remedies, supplements, and over-the-counter drugs such as aspirin.  And tell your doctors what you’re taking.  Some of these substances can interact with one another — ginseng, for example, interferes with the blood-thinner warfarin; chondroitin may cause excessive bleeding during surgery.  A study assessing data from 21,000 US adults in 2002 found that more than two-thirds of people using a supplement and a prescription medication in the same year did not tell their doctor about the supplement.

You can bring your current medication with you in a bag and have the doctor or nurse, who visits your hospital room upon admission, go over them and ensure that information about them is included in your hospital record.  You’ll also want to be sure that a medical professional gives you advice about how to start taking any long-term medications again after hospitalization.

•  Ask everyone who comes into your hospital room to wash their hands or use antibacterial lotion.  Along with medication mistakes, one other complication most likely to occur from a hospital stay is getting an infection.  Hospitals are germ factories, and there are some nasty, antibiotic-resistant bugs you really don’t want to bring home with you.

Patients shouldn’t feel uncomfortable about requesting that people sanitize their hands — some hospitals, in fact, put up posters reminding them to do so.  In a study reported in 2001, 39 patients at a hospital in Oxford, England, agreed to ask all healthcare workers who were going to touch them to wash their hands.  The result: an average 50-percent increase in handwashing rates.

• If you’re having surgery, ask your surgeon what measures are in place at the hospital to prevent wrong-site surgery — for example, having the wrong limb operated on. One of the hospital mistakes that gets the most attention, it is relatively rare but still does happen despite a lot of bad publicity.  (The US Joint Commission has collected 615 reports of them from 1995 to 2008.) The good news is that wrong-site surgery can be totally prevented.  For example, the American Academy of Orthopedic Surgeons urges its members to sign their initials directly on the site to be operated on when they visit their patients the night before surgery.  This is now also standard practice in some of our local hospitals.

• Make sure your hospitalization is being overseen by one particular doctor, whether that’s your internist, specialist, surgeon or family physician.

At the doctor’s office

Although the big-ticket mistakes take place in the hospital, it’s also possible to have a mix-up at the doctor’s office.  In a 2004 study of 15 family physicians practicing in the Cincinnati area, the physicians identified errors in 24 percent of 351 outpatient visits they later reviewed.

The doctors concluded that harm (albeit minor) was done to 18 patients, and potential harm to an additional 53 — including physical discomfort, mild adverse drug reaction, moderate physical injury, progression of disease, and (most commonly) emotional distress and wasted time.

• Make sure the doctor takes the time to hear what your symptoms and concerns are so the best diagnosis can be made. 

• Ask questions and write down the answers. Have someone with you if it helps. Studies have shown that patients remember just a fraction of what their doctor says, particularly in cases of serious illness.

• Take a medication list to the doctor, especially if you have several physicians. There’s no guarantee they’ll talk with one another or even read your record carefully, so it’s prudent to be sure each doctor is aware of your other treatments.

• If you get a handwritten prescription, make sure you can read it.  If you can’t, the pharmacist may not be able to either. In a 1997 study at a hospital in Texas, six experienced nurses reviewed written medication orders by 36 doctors and found 20 percent to be illegible or legible only with effort.

Still far to go

Medical mistakes call attention to how far hospitals have to go in preventing medical errors and in learning from the mistakes of others, even though some Philippine hospitals have made actual progress in protecting patients within their own institutions in the past few years.  But the truth is, despite a decade and a half of rising public awareness of such mistakes and research into how to prevent them, our hospitals still have a long way to go to avoid medical errors.

And yet, even simple changes have been shown to make a difference.  One statewide hospital group in Michigan followed a plan devised by Dr. Peter Pronovost, a critical-care specialist at Johns Hopkins Hospital, that involved a simple checklist, fashioned after the kind of safety list pilots are required to check each takeoff and landing.  A landmark study published in the December 28, 2006 issue of the New England Journal of Medicine found that by using  the checklist unfailingly, common infections from medical tubings in 108 ICUs in Michigan  hospitals were reduced by two-thirds.  Wash hands with soap.  Check.  Clean patient’s skin with antiseptic.  Check.  Wear sterile mask, gown, glove.  Check.  Put sterile drapes over entire patient.  Check.  The improvements were sustained over the 18 months’ duration of the study.

The hospitals must also hold accountable any member of the health team who commits medical errors.  But while accountability is improving, hospitals still face increasingly complex technology.  And medical culture, built on individual excellence, not teamwork, is slow to change.

Patients need to remain vigilant to stay safe in an increasingly complex healthcare system. “I’m really reassured there’s so much attention now on patient safety,” Shannon says.  “We’re safer in hospitals today but not completely safe yet.”

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Where to learn more

Here are two resources patients can use to learn more about how to avoid medical errors:

• 20 Tips to Help Prevent Medical Errors, Agency for Healthcare Research and Quality, www.ahrq.gov/consumer/20 tips.htm; a list of general pointers.

• General Advice on Safe Medication Use, Institute for Safe Medication Practices, www.ismp.org/consumers/brochure.asp; advice on safely obtaining and using medications.