Medical errors the 3rd leading cause of death??

Wellworth, BSN · May 5, 2016

One of my jobs over the past 10 years was to review incident reports. While there were many errors, mostly medication and procedural ones, it was difficult to tell which were "preventable" without doing a thorough investigation, which takes time and trained individuals. What I got out of the CNN news was that people need to be more involved in their care, speak up if something does not seem right, actively look out for themselves, and be aware that hospitals can be dangerously complex places.

Guest219794 · May 5, 2016

I think the number is impossible to even guestimate.

How many errors did you make this week? How would you know?

I recently nearly gave an insulin overdose. It was a form I am not familiar with, and the dose looked wrong. I questioned it to the very good and experienced ER doc. She said it came from the hospitalist, also an excellent doctor. I spoke with him directly. Luckily I was questioned by a family member. As I was repeating the explanation, I realized I actually was still skeptical. Needle was unsheashed, site prepped when I questioned the order a 3rd time, with the pharmacist. He told me not to give the dose, as it was double what was indicated. (Tujeo).

Shortly after, completely unrelated, the woman developed serious cardiac problems with lengthy pauses requiring emergent transport for a pacemaker.

Had I given the med as ordered, she would have had a crashing blood sugar during this emergency. It would have thrown a huge wrench into the works, and would likely have not been caught during a cardiac emergency.

Easily could have killed her, and would never have been attributed to the medical error.

NotAllWhoWandeRN, ASN, RN · May 5, 2016

It would be nice if people stopped kvetching about giving their name and date of birth with meds/procedures. Or visibly sneering every time I ask for it. Some really truly believe that we ought to have their names and faces and birthdays memorized by the end of the shift, or that the risk of error isn't really there.

Susie2310 · May 5, 2016

One of my jobs over the past 10 years was to review incident reports. While there were many errors, mostly medication and procedural ones, it was difficult to tell which were "preventable" without doing a thorough investigation, which takes time and trained individuals. What I got out of the CNN news was that people need to be more involved in their care, speak up if something does not seem right, actively look out for themselves, and be aware that hospitals can be dangerously complex places.

It is wise for people to involve themselves in their care, speak up if something doesn't seem right, actively look out for themselves, and be aware that hospitals can be dangerous places, but the practical limitation is that patients are often very sick and/or elderly and often have multiple co-morbidities when they are hospitalized and are unable to engage in scrutiny of their care even if they would like to. And even if they do speak up there is a very realistic likelihood that their concerns will be dismissed/disregarded by the health care team. Even when I have stayed by my family members' bedsides 24/7, which I usually do, and both my family member and I have advocated together in regard to aspect/s of their care, we have on occasion met with opposition from various members of the nursing staff. On one occasion I managed to catch the hospitalist involved in my family member's care before they were sent for a risky, invasive procedure, and was able to discuss medications to be given during the procedure, which resulted in the hospitalist paging the specialist and the plan of care being altered. There is no way my family member, acutely ill with no medical/nursing training could have advocated for themself in this way.

My family members, like many members of the public, have no medical/nursing training, and place their trust completely in the doctors and nurses providing their care in all situations where they receive care. Even when errors have been made in their care they are reluctant to politely discuss these errors (and have dissuaded me from doing so) with either the doctors/hospitalists or hospitals involved in their care after they are discharged because they fear retaliation and because they do not have the energy to engage in this way. I imagine there are many other patients who feel similarly.

jdub6 · May 5, 2016

I think the number is impossible to even guestimate.
How many errors did you make this week? How would you know?
I recently nearly gave an insulin overdose. It was a form I am not familiar with, and the dose looked wrong. I questioned it to the very good and experienced ER doc. She said it came from the hospitalist, also an excellent doctor. I spoke with him directly. Luckily I was questioned by a family member. As I was repeating the explanation, I realized I actually was still skeptical. Needle was unsheashed, site prepped when I questioned the order a 3rd time, with the pharmacist. He told me not to give the dose, as it was double what was indicated. (Tujeo).
Shortly after, completely unrelated, the woman developed serious cardiac problems with lengthy pauses requiring emergent transport for a pacemaker.
Had I given the med as ordered, she would have had a crashing blood sugar during this emergency. It would have thrown a huge wrench into the works, and would likely have not been caught during a cardiac emergency.
Easily could have killed her, and would never have been attributed to the medical error.

But, on the other hand, the overdose could have had minimal or no effect, or the effects easily treated, but the error blamed for her cardiac event when really it would have happened anyway. It is very hard to prove causation rather than affiliation with these things.

It reminds me of the WA nurse who killed herself several years ago after being fired after a medical error on a baby in the PCICU. The baby had been in icu for a long time and was on a Berlin pump with serious heart problems. The nurse gave a major overdose of calcium chloride. She immediatly reported it to the MD and management and then the family. The baby died I think two days later. After the nurse died there was extensive national media coverage. Out of all the articles I read only one quoted one of the baby's doctors who said something along the lines of "the overdose certainly wasn't good for the baby, but this was a critically ill patient who very well may have died anyway and it is unclear whether the overdose made a difference in the ultimate outcome. " the rest of the coverage made it sound like the overdose killed the baby who would have definitely made a full recovery otherwise. Causation vs correlation is a major issue in all statistics and research.

Susie2310 · May 6, 2016

But, on the other hand, the overdose could have had minimal or no effect, or the effects easily treated, but the error blamed for her cardiac event when really it would have happened anyway. It is very hard to prove causation rather than affiliation with these things.

If the patient's blood sugar crashed during a code due to the patient receiving too high a dose of insulin a short time before their arrhythmia and the code being called, if the dose, time of onset and effect of the insulin would ordinarily result in a patient's blood sugar significantly decreasing during the period from the time of administration to the time they experienced an arrhythmia, then the insulin would have been the cause of the blood sugar crashing. In hherrn's post the patient had an arrhythmia but fortunately did not receive the wrong dose of insulin - having one's blood sugar crash while the code was underway would certainly have harmed one's prospects for survival even if someone had checked their blood sugar and tried to correct it during the code. If the patient had received too high a dose of insulin, while the heart attack may have killed them, having their blood sugar crash would have been a cause of death also (and could have contributed to the arrhythmia).

**NickiLaughs, ADN, BSN, RN** · May 6, 2016

Believable. I caught my own almost lethal med error that would have ended my career right when it started. The pharmacy had put a neuromuscular blockade in the Pyxis where the Levo should have been. Same size containers and another nurse had double checked with me. A quick glance was a double check in this ICU. Then I look at the name more closely (I forget which one now but is started with an N) and realize my mistake.

Terrible. I was devastated because I knew what could have happened and it made me want to quit.

since then I've made errors, thankfully nothing lethal. i always double check my meds. I'm grateful I had the near miss early in my career. I've gone with my gut many times. I've questioned docs to find meds ordered on wrong patients frequently. We do the best we can. Theres always room for improvement.

NursesRmofun, ASN, RN · May 6, 2016

I always triple check and quadruple check meds. Do I think the numbers of errors resulting in death are that high? Well, if you count the kinds of things they are in the article(s), maybe then....That including procedure's adverse effects, etc. Otherwise, no...I don't think it's that high.

offlabel · May 6, 2016

This is horsesh.. agitation propaganda ahead of some agenda fueled policy push. There was a paper that came out in 2003 that named American physicians as the 3rd (funny coincidence, huh?) leading cause of death in the US because of shoddy care.

If you look at the definition of "error" in the BMJ paper, you'll find that it is so broad it even includes therapies that weren't wrong, but just did not benefit the patient. It also includes therapy that was given after a change of plan that even may have benefited the patient. In other words, even when nothing went wrong other than the plan changed, that was counted as an error.

This is BS sensationalism meant to inflame passions so that some socialist power grabbers can advance their agenda...don't fall for it.

James W. · May 6, 2016

Were the hospital mortality stats porificed for those patients

who were morbidity rated as having a very poor likelihood

of a positive outcome to medical Tx, anyhow?

I worked night charge in a private hospital which had a contract

with a major local hospital to take those patients for which the nil

medical prospect of a live future - was deemed a statistical/rep' liability.

A defacto hospice, really.. 'not that there's anything wrong with that'..

It was a positive practice experience for me,

- to consolidate caring nursing provision of terminal cares skills.

But on the other hand..

..as an emergency ortho-patient.. in a shocker of a

public hospital, I was given a surgical/post recovery drink of orange juice..

..which oddly, hurt my teeth.. so I had look at my anaesthetic record..

& saw that I'd stopped breathing.. on the basic (cheap) mask set-up,

thus I was the recipient of a rough-as metal laryngoscope application..

to ram some airway tubes down.. which knocked the enamel off my front teeth..

I asked - when I was to be officially informed of this, only to be told that..

"Nurses make the worst patients, you shouldn't even be reading that chart!"..

I sheet you not..

djh123 · May 6, 2016

Yeah, I've seen some of these articles lately too. In school (just a few years ago for me) we were told it was 100,000, so it's quite a jump from that to 250,000, but it could be possible. I've heard of 2 atrocious mistakes in my area, both of which resulted in *immediate* death. And of course there are many more less-lethal mistakes, but which still may result in a death.

I thought it was smart, though, in school, that we didn't just have to pass the 'dosages and calculations' class (which was part of the pharmacology class), but we had to pass a test on it at the beginning of each subsequent semester. But of course, many mistakes are made which don't involve dosages & calculations.

macawake, MSN · May 6, 2016

This is horsesh.. agitation propaganda ahead of some agenda fueled policy push.
This is BS sensationalism meant to inflame passions so that some socialist power grabbers can advance their agenda...don't fall for it.

Funny how you present your opinion as fact. Please do elaborate. Exactly which hidden agenda is it that you believe the authors of the BMJ article are promoting?

If you look at the definition of "error" in the BMJ paper, you'll find that it is so broad it even includes therapies that weren't wrong, but just did not benefit the patient. It also includes therapy that was given after a change of plan that even may have benefited the patient. In other words, even when nothing went wrong other than the plan changed, that was counted as an error.

Isn't it true that the BMJ article lists several existing definitions of the term "medical error"?

Medical errorâ€”the third leading cause of death in the US | The BMJ

Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome ,3

the failure of a planned action to be completed as intended(an error of execution), the use of a wrong plan to a chieve an aim (an error of planning),4

or a deviation from the process of care that may or may not cause harm to the patient.5

and they conclude by stating:

Patient harm from medical error can occur at the individual or system level. The taxonomy of errors is expanding to better categorize preventable factors and events.6 We focus on preventable lethal events to highlight the scale of potential for improvement.

The BMJ article is an analysis of some of the previously conducted research in the area of medical errors. In order to see which exact definition of the term "medical error" was used in the respective studies referenced, one would have to look at them individually.

Here's one from the BMJ article's reference list:

â€˜Global Trigger Tool' Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured

This article looks at adverse events in the following categories; medication-related, procedure-related(excluding infection), nosocomial infection, pulmonary/VTE, pressure ulcers, device failure, patient falls and other.

As I understand the BMJ article, one of the major challenges when attempting to ascertain the number of patients who die as a direct result from a preventable medical error or when a medical error in some part may have contributed to or accelerated the patient's demise is that:

However, a major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death.1 As a result, causes of death not associated with an ICD code, such as human and system factors, are not captured.

And they identify the following potential obstacle to learning from the mistakes of others in order to minimize future errors which may result in harm to patients.

Currently, deaths caused by errors are unmeasured and discussions about prevention occur in limited and confidential forums, such as a hospital's internal root cause analysis committee or a department's morbidity and mortality conference. These forums review only a fraction of detected adverse events and the lessons learnt are not disseminated beyond the institution or department.

In my personal opinion, only a fool would argue that medical errors don't in some instances cause temporary harm, permanent harm or even death to patients. Identifying the exact number of deaths caused is of course extremely difficult, and the numbers will likely be extrapolated from various studies. There will always be a margin of error/uncertainty.

Factors like communications breakdown, inadequate staff-patient ratios, stress, inadequate skill and procedural mistakes all have the potential to result in patient harm and/or death. The question is, what can we as individual healthcare professionals do to minimize the risk of adverse events occurring? What can be done on an organizational/systems level?

Does it really matter if medical errors is the third leading cause of deaths or "only" the fifth or sixth? I'm certain that there is room for improvement in either case.