Medical error is an inaccurate or incomplete diagnosis Medical diagnosis refers both to the process of attempting to determine the identity of a possible disease or disorder and to the opinion reached by this process and/or treatment Therapy , or treatment, is the attempted remediation of a health problem, usually following a diagnosis. In the medical field, it is synonymous with the word "treatment". Among psychologists, the term may refer specifically to psychotherapy or "talk therapy" of a disease A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal disfunctions, such as autoimmune diseases. Ecologically, disease is defined as; injury Injury is damage or harm caused to the structure or function of the body caused by an outside agent or force, which may be physical or chemical, and is either unintentional (For e.g. accidents at work, sports injury) or intentional (For e.g. suicide, homicide). A severe and life-threatening injury is referred to as a physical trauma; syndrome In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms (reported by the patient), phenomena or characteristics that often occur together, so that the presence of one feature alerts the physician to the presence of the others. In recent decades, the term has been used outside medicine; behavior Behavior, or behaviour , refers to the actions of a system or organism , usually in relation to its environment, which includes the other systems or organisms around as well as the physical environment. It is the response of the system or organism to various stimuli or inputs, whether internal or external, conscious or subconscious, overt or; infection An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host's resources to multiply, usually at the expense of the host. The infecting organism, or pathogen, interferes with the normal functioning of the host and can lead to chronic wounds, gangrene, loss or other ailment.
However, medical error definitions are subject to debate, as there are many types of medical error from minor to major,[1] and causality is often poorly determined.[2] The Health Grades study statistics, based on AHRQ MedPAR data, were based on administrative records, not clinical records, and largely overlooked multi-causality of outcomes.[3]
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Impact
In the U.S., medical errors are estimated to result in 44,000 to 98,000 unnecessary deaths and 1,000,000 excess injuries each year.[4][5] Medical care is frequently compared adversely to aviation Many cultures have built devices that travel through the air, from the earliest projectiles such as stones and spears., the boomerang in Australia, the hot air Kongming lantern, and kites. There are early legends of human flight such as the story of Icarus, and Jamshid in Persian myth , and later, somewhat more credible claims of short-distance: while many of the factors which lead to errors in both fields are similar, aviation's error management protocols are regarded as much more effective.[6]
Risk factors
Medical errors are associated with inexperienced physicians and nurses, new procedures, extremes of age, complex care and urgent care.[7] Poor communication (whether in ones own language or, as may be the case for medical tourists Medical tourism is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care. It also refers pejoratively to the practice of healthcare providers travelling internationally to deliver healthcare, another language), improper documentation, illegible handwriting, inadequate nurse-to-patient ratios, and similarly named medications are also known to contribute to the problem. Patient actions may also contribute significantly to medical errors. Falls, for example, are often due to patients' own misjudgements.
Sleep deprivation Sleep deprivation is characterized by having too little sleep; it can be either chronic or acute. Long-term sleep deprivation causes death in lab animals. A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss or weight gain has also been cited as a contributing factor in medical errors. One study found that being awake for over 24 hours caused medical interns to double or triple the number of preventable medical errors, including those which resulted in injury or death.[8] The risk of car crash after these shifts increased by 168%, and the risk of near miss by 460%.[9] Interns admitted falling asleep during lectures, during rounds, and even during surgeries.[9]
In 2000, The Institute of Medicine released "To Err Is Human", which asserts that the problem in medical errors is not bad people in health care—it is that good people are working in bad systems that need to be made safer.[10]
Misdiagnosis of psychological disorders
Medical errors occur in the treatment of mental illness A mental disorder or mental illness is a psychological or behavioral pattern associated with distress or disability that occurs in an individual and is not a part of normal development or culture. The recognition and understanding of mental health conditions has changed over time and across cultures, and there are still variations in the.
Sufferers of dissociative identity disorder Dissociative identity disorder is a psychiatric diagnosis that describes a condition in which a person displays multiple distinct identities or personalities , each with its own pattern of perceiving and interacting with the environment. In the International Statistical Classification of Diseases and Related Health Problems the name for this usually have psychiatric histories A psychiatric history is the result of a medical process where a clinician working in the field of mental health systematically records the content of an interview with a patient. This is then combined with the mental status examination to produce a "psychiatric formulation" of the person being examined that contain three or more separate mental disorders A mental disorder or mental illness is a psychological or behavioral pattern associated with distress or disability that occurs in an individual and is not a part of normal development or culture. The recognition and understanding of mental health conditions has changed over time and across cultures, and there are still variations in the and previous treatment Therapy , or treatment, is the attempted remediation of a health problem, usually following a diagnosis. In the medical field, it is synonymous with the word "treatment". Among psychologists, the term may refer specifically to psychotherapy or "talk therapy" failures.[11] The disbelief of some doctors around the validity of dissociative identity disorder may also add to its misdiagnosis.[11]
Studies have found that bipolar disorder Bipolar disorder or manic–depressive disorder is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood and one or more depressive episodes. The elevated moods are clinically referred to as mania or, if milder, hypomania has often been misdiagnosed as major depression Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities. The term "major depressive disorder" was selected by the American Psychiatric Association to designate this symptom cluster as a mood disorder. Its early diagnosis necessitates that clinicians pay attention to the features of the patient's depression and also look for present or prior hypomanic Hypomania is a mood state characterized by persistent and pervasive elevated or irritable mood, as well as thoughts and behaviors that are consistent with such a mood state. Individuals in a hypomanic state also have a decreased need for sleep and rest, are extremely outgoing and competitive, and have a great deal of energy. However, unlike with or manic symptomatology.[12]
The misdiagnosis of schizophrenia Schizophrenia is a serious mental illness characterized by a disintegration of the process of thinking and of emotional responsiveness. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with significant social or occupational dysfunction. Onset of symptoms typically occurs in is also a common problem. There may be long delays of patients getting a correct diagnosis of this disorder.[13]
Approaches to error
Main article: Preventable medical errorsTraditionally, errors are attributed to mistakes made by individuals who may be penalized for these mistakes. The usual approach to correct the errors is to create new rules with additional checking steps in the system, aiming to prevent further errors. As an example, an error of free flow IV administration of heparin is approached by teaching staff how to use the IV systems and to use special care in setting the IV pump. While overall errors become less likely, the checks add to workload and may in themselves be a cause of additional errors.
A newer model for improvement in medical care takes its origin from the work of W. Edwards Deming William Edwards Deming was an American statistician, professor, author, lecturer, and consultant. Deming is widely credited with improving production in the United States during the Cold War, although he is perhaps best known for his work in Japan. There, from 1950 onward he taught top management how to improve design (and thus service), product in a model of Total Quality Management Total Quality Management is a management concept coined by W. Edwards Deming. The basis of TQM is to reduce the errors produced during the manufacturing or service process, increase customer satisfaction, streamline supply chain management, aim for modernization of equipment and ensure workers have the highest level of training. One of the. In this model, there is an attempt to identify the underlying system defect that allowed the opportunity for the error to occur. As an example, in such a system the error of free flow IV administration of Heparin is dealt with by not using IV heparin and substituting subcutaneous administration of heparin, obviating the entire problem. However, such an approach presupposes available research showing that subcutaneous heparin is as effective as IV. Thus, most systems use a combination of approaches to the problem.
The field of medicine that has taken the lead in systems approaches to safety is anaesthesiology.[14] Steps such as standardization of IV medications to 1 ml doses, national and international color coding standards, and development of improved airway support devices has made anesthesia care a model of systems improvement in care.
Pharmacy Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs. The word derives from the Greek φάρμακον , "drug, medicine" (the earliest form of the word is the Mycenaean Greek pa-ma-ko, attested in Linear B syllabic professionals have extensively studied the causes of errors in the prescribing, preparation, dispensing and administration of medications. As far back as the 1930’s, pharmacists worked with physicians to select, from amongst many options, the safest and most effective drugs available for use in hospitals.[15] The process is known as the Formulary System and the list of drugs is known as the Formulary. In the 1960’s, hospitals implemented unit dose packaging and unit dose drug distribution systems to reduce the risk of wrong drug and wrong dose errors in hospitalized patients;[16] centralized sterile admixture services were shown to decrease the risks of contaminated and infected intravenous medications;[17] pharmacy computers screened each patient’s medication list for drug-drug interactions;[18] and, pharmacists provided drug information and clinical decision support directly to physicians to improve the safe and effective use of medications.[19] Pharmacists are recognized experts in medication safety and have made many contributions that reduce error and improve patient care over the last 50 years. More recently, governments have attempted to address issues like patient-pharmacists communication and consumer knowledge through measures like the Australian Government The Commonwealth of Australia is a federal constitutional monarchy under a parliamentary democracy. The Commonwealth of Australia was formed in 1901 as a result of an agreement among six self-governing British colonies, which became the six states. The terms of this agreement are embodied in the Australian Constitution, which was drawn up at a's Quality Use of Medicines The term Quality use of medicines is used by the Australian government as part of their policies on effective and correct uses of medicine and access to appropriate medicines policy.
A 2005 study by Wendy Levinson of the University of Toronto The University of Toronto is a public research university in Toronto, Ontario, Canada, situated north of the city's Financial District on the grounds that surround Queen's Park. It was founded by Royal Charter in 1827 as King's College, the first institution of higher learning in the colony of Upper Canada. Originally controlled by the Church of showed surgeons discussing medical errors used the word "error" or "mistake" in only 57 per cent of disclosure conversations and offered a verbal apology only 47 per cent of the time.[20]
Patient disclosure is important in the medical error process. The current standard of practice at many hospitals is to disclose errors to patients when they occur. In the past, it was a common fear that disclosure to the patient would incite a malpractice lawsuit. Many physicians would not explain that an error had taken place, causing a lack of trust toward the healthcare community. In 2007, 34 states passed legislation that precludes any information from a physician’s apology for a medical error from being used in malpractice court (even a full admission of fault)[21]. This encourages physicians to acknowledge and explain mistakes to patients, and keeping an open line of communication.
Examples of errors
- Misdiagnosis Medical diagnosis refers both to the process of attempting to determine the identity of a possible disease or disorder and to the opinion reached by this process
- Giving the wrong drug A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease or (wrong patient, wrong chemical, wrong dose, wrong time, wrong route)
- Giving two or more drugs that interact unfavorably or cause poisonous metabolic Metabolism is the set of chemical reactions that happen in living organisms to maintain life. These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. Metabolism is usually divided into two categories. Catabolism breaks down organic matter, for example to harvest energy in cellular byproducts
- Wrong-site surgery Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, and sometimes for religious reasons. An act of performing surgery may be called a surgical procedure, operation, or simply, such as amputating the wrong limb
- Gossypiboma Gossypiboma is the technical term for a surgical sponge accidentally left inside a patient's body. It is derived from the Latin "gossypium" and the Swahili "boma" (place of concealment), a surgical sponge left behind inside the patient after surgery
- No diagnosis, due to physicians' lack of knowledge of rare or newly-described disorders
- Patients' implementation of drugs and treatments
- This list is incomplete; you can help by expanding it.
Methods to improve safety and reduce error
Main article: Patient safety Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often lead to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported staggering numbers of patients harmed and killed by- patient's informed consent Informed consent is a phrase often used in the law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the facts, implications, and future consequences of an policy
- patient's getting a second opinion from another independent practitioner with similar qualifications
- voluntary reporting of errors (to obtain valid data for cause analysis)
- root cause analysis Root cause analysis is a class of problem solving methods aimed at identifying the root causes of problems or events. The practice of RCA is predicated on the belief that problems are best solved by attempting to correct or eliminate root causes, as opposed to merely addressing the immediately obvious symptoms. By directing corrective measures at
- Electronic or paper reminders to help patients maintain medication adherence
- systems for ensuring review by experienced or specialist practitioners[22]
- hospital accreditation Hospital accreditation has been defined as “A self-assessment and external peer assessment process used by health care organisations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve”. Critically, accreditation is not just about standard-setting: there are
See also
- Adverse effect (medicine) In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect, and may result from an unsuitable or incorrect dosage or procedure, which could be due to medical
- Adverse drug reaction An adverse drug reaction is an expression that describes harm associated with the use of given medications at a normal dose. The meaning of this expression differs from the meaning of "side effect", as this last expression might also imply that the effects can be beneficial. The study of ADRs is the concern of the field known as
- Biosafety Biosafety: prevention of large-scale loss of biological integrity, focusing both on ecology and human health[citation needed]
- Complication (medicine) Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathological changes, become widespread throughout the body or affect other organ systems. A medical treatment, such as drugs or surgery may
- Fatal Care: Survive in the U.S. Health System (book)
- Iatrogenesis The terms iatrogenesis and iatrogenic artifact refer to inadvertent adverse effects or complications caused by or resulting from medical treatment or advice. In addition to harmful consequences of actions by physicians, iatrogenesis can also refer to actions by other healthcare professionals, such as psychologists, therapists, pharmacists, nurses,
- Medical malpractice Medical malpractice is professional negligence by act or omission by a health care provider in which care provided deviates from accepted standards of practice in the medical community and causes injury or death to the patient. Standards and regulations for medical malpractice vary by country and jurisdiction within countries. Medical
- Medical resident work hours
- Negligence Negligence is a legal concept in the common law legal systems mostly applied in tort cases to achieve monetary compensation (damages) for physical and mental injuries (not accidents)
- Patient Safety and Quality Improvement Act of 2005
- Quality Use of Medicines The term Quality use of medicines is used by the Australian government as part of their policies on effective and correct uses of medicine and access to appropriate medicines
- Swiss Cheese model Models of accident causation are models used for the risk analysis and risk management of human systems. Since the 1990s they have gained widespread acceptance and use in healthcare, in the aviation safety industry, and in emergency service organizations. It is sometimes called the cumulative act effect[citation needed]
- To Err is Human: Building a Safer Health System
Thu, 22 Jul 2010 23:29:32 GMT+00:00
InjuryBoard.com (blog) A medical error is often not only life-changing for a patient, but for a doctor as well. No doctor should trade a few hours of sleep for patient safety. ...
Orac
Wed, 27 Jan 2010 14:00:00 GM
And now for something completely different. I've been on a bit of a tear the last few days beating on Mike Adams, someone who arguably deserves the title of Woo--meister Supreme, but it's important to remember that defending ...
