Don't Become a Medical Blunder

[NRSKarenRN, BSN, RN]

consumer action

by stacey l. bradford

january 31, 2002

http://aol.smartmoney.com/consumer/index.cfm?story=20020131

ilene corina is still mourning the death of her three-year-old son. back in 1990, she took him to syosset hospital in new york for a routine tonsillectomy. a couple of days after the surgery corina noticed blood in her son's mouth. concerned, corina brought him to that hospital's emergency room. the doctor cauterized his throat to stop the bleeding and said there was nothing to worry about. a couple of days later corina noticed more blood, and that her son had welts on his buttocks and groin. back in the emergency room, another doctor gave him a cursory exam and sent him home. one week after the surgery, corina brought her son in for a checkup with the surgeon. he confirmed that her son was healing properly. the next day he died. corina, who now runs a national patient-safety group called pulse of new york, was later told that her son died because he was hemorrhaging from the sutures and swallowing blood, which caused a fatal infection evidenced by his welts. a standard test would have diagnosed the problem immediately. "i was failed by a whole system that let a three-year-old child slip through the cracks," says corina, who received a settlement from the hospital and doctors.

corina's story is heartbreaking. but what's worse is that tragic events like this aren't all that rare. according to a 1999 report from the institute of medicine, as many as 98,000 people die each year in hospitals from medical errors. while that report drew a lot of attention, systematic changes that will significantly improve safety for hospital patients are still at least a few years away, says nancy foster, coordinator for quality activity at the agency for healthcare research and quality, a division of the department of health and human services. in the meantime, you don't have to be a victim. there are precautions you can take to help prevent some of the more common medical errors. it will require monitoring your own care and quizzing doctors and nurses closely, even in high-pressure situations like the operating room. if you have a tendency to get intimidated by doctors, find someone who'll act on your behalf. here are some common medical errors, and what you do to make it less likely they'll happen to you. we don't mean to scare you, but it could be a matter of life and death.

medication errors

last december, a 25-year-old florida woman went into cardiac arrest after an allergy medicine, epinephrine, was incorrectly injected into her vein instead of her muscle at the martin memorial medical center. the hospital publicly admitted its mistake and the patient recovered. but many others like her aren't so lucky. each year at least 1.3 million people are injured by medication errors ranging from adverse drug interactions to dispensing blunders, according to the food and drug administration. and at least 7,000 patients die annually, says the institute of medicine report. the medical community is actively trying to address this problem. the best proposed solution, a computerized physician order-entry system that would do everything from calculating appropriate dosages to checking for adverse drug interactions, is unfortunately very costly, running around $2 million. since most hospitals don't have that kind of extra cash in their budgets, it's up to the patient to act as the last barrier to error.

here's what you can do.

if you get a prescription during a visit to the doctor, make sure you can read the handwriting. read the prescription back to your doctor and ask what it's for. at the pharmacy, make sure you're given the exact drug your doctor ordered. check the dosage. it isn't uncommon for a decimal point to be misread. and if you're getting a refill, it should look identical to the previous prescription. during a hospital stay, you must be even more vigilant. with so many people involved in your care, the chances for error increase exponentially especially in an environment in which practitioners are often tired and overworked. a simple room change, for example, might go unnoted, and a nurse on the next shift could administer a previous occupant's medication, warns dr. paul gluck, a florida based obstetrician-gynecologist and board member of the national patient safety foundation. so ask every nurse or aide the name of the medicine he or she is giving you and what it's for. be particularly vigilant about medicines with similar names. the fda even posts a list on its web site of medications that are commonly confused, and it unfortunately isn't all that unusual for a nurse or pharmacist to grab the wrong bottle. for example, there are numerous reports of mix-ups involving celebrex, an arthritis drug; cerebyx, a seizure medication; and celexa, an antidepressant. finally, present your physician with a complete list of all the medications you're now taking. this will help him or her avoid prescribing a new medicine that will interact adversely with another drug you're already on. this is especially important for the elderly, who tend to take several different medicines, warns gluck.

hospital-acquired infections

hospitals are crawling with bacteria that cause infection. in fact, two million people each year come down with hospital-acquired infections. and for all our antibacterial cleansers, the situation is only growing worse. that's because hospital patients are generally getting sicker. healthier people are electing to have minor surgery performed in outpatient surgical centers. and cost-squeezed hospitals are increasingly pushing all but the sickest patients out their doors as quickly as possible. this leaves hospitals looking more like large intensive-care wards, experts say. infections are often passed from one patient to another by hospital workers' hands as they rush between cases.

"unfortunately, hand-washing compliance is less than desirable," says hhs's foster. as awkward as it may be, you should ask everyone who might touch you to wash his or hands. even foster feels uneasy asking, but says she has never been rebuffed when she has done so in a friendly manner. it isn't just dirty hands that can make you sick. dirty medical devices can cause infections, too. nationwide, 200,000 people are infected by intravascular catheters each year and nearly a million people suffer urinary-tract infections from urinary catheters.

at the university of michigan, dr. sanjay saint, the director of patient safety enhancement program, and his colleagues set out to reduce the incidence of such infections. what saint discovered is that catheters serve no purpose for one-third to one-half of the time they're in place because they're often inserted and forgotten. "initially it may have been required, but once the patient is treated it was never taken out," he says. saint adds that doctors are unaware that a urinary catheter is in place in a patient 40% of the time. the problem with leaving catheters in longer than necessary is that each additional day of use increases the risk of infection. what can you do? ask your doctor if it's absolutely necessary that you have a catheter. if the answer is yes, ask when it can be taken out. many hospitals will simply change catheters to prevent infection. but saint says available data don't support this practice. instead, he recommends that you request an antiseptic-coated intravascular catheter at all times. and if you will be needing a urinary catheter for more than two days, ask for one made of silver alloy.

wrong-site surgery

since 1996, the joint commission on accreditation of healthcare organizations has received at least 150 reports of surgeries being performed on the wrong limb or organ or even the wrong person. rhode island hospital recently made headlines when it admitted that one of its surgeons operated on the wrong side of a patient's brain after the ct scan was inserted backwards in the viewing box. a year ago a similar incident occurred at long island college hospital in brooklyn, n.y. even though the j.c.a.h.o. has issued a couple of alerts about the problem, the rate of incidence remains steady. to ensure you aren't the next victim, make sure you and your surgeon are in complete agreement on the surgery before you enter the operating room. the j.c.a.h.o. also recommends that you discuss with your surgeon what steps are being taken to identify the right site for the procedure and participate in them. for knee surgery, for example, the physician and the patient should together mark the appropriate knee with a "yes" and the healthy one with a "no" using a special surgical pen that will not wash off when the area is sterilized. a simple "x" could be confusing, warns the national patient safety foundation's gluck.

once you're in the operating room, confirm that everyone on the surgical team knows who you are and what procedure has been scheduled. you also need to ask if they're looking at your medical records. and if you have any questions, don't be shy. these simple precautions can avoid some tragic outcomes. as you might imagine, there are times when you'll simply be unable to take a role in preventing medical errors. if you're sedated, or rushed to the emergency room, for example, you may not be conscious or able to speak with your doctor. but the rest of the time, you should approach medical treatment with your eyes wide open and your mouth ready to ask many questions. the more engaged you are, the less likely it is that anything will go wrong.

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