Medical errors the 3rd leading cause of death??

RNperdiem, RN · May 6, 2016

Med errors.. Would that include patient med errors too?. I remember one woman who totally misread the pharmacy bottle for taking coumadin and though 5mg meant to take five pills three times a day. Would misuse and overdose of a prescribed drug count too?For all that meds are given by nurses, the majority of drugs are taken at home.

allnurses Guide · May 6, 2016

The BMJ article is based off the Landrigan study which essentially found a 0.3% mortality rate associated with tertiary medical treatment. If we compare that to the mortality rate from established routine interventional procedures (like cardiac caths, hip and knee replacements, cholecystectomies, etc) it's about the same. It is a bit of a sobering number, however, for every 3 out of 1000 people that die from medical error, there are how many that survive because of it?

I do have a bit of a visceral reaction to the article because, for me, I think about how a morbidly obese diabetic with full metabolic syndrome who is non-compliant with medication and lifestyle interventions that I have prescribed ends up having a massive MI, I admit him, start him on a heparin drip, and he develops HIT and dies, that death would be secondary to a medical treatment rather than his underlying pathology.

ixchel · May 6, 2016

Hey Pangea,
I am not getting may be from what I have been reading, but is. Although, the number might be higher, since it looks like they are only talking about acute care hospitals, and not including surgery centers, LTC's, LTAC's, clinics, etc. Here is the original article they have all been referring to in The BMJ
Medical errorâ€”the third leading cause of death in the US | The BMJ
The following is an example taken from the article above:
Case history: role of medical error in patient death
A young woman recovered well after a successful transplant operation. However, she was readmitted for non-specific complaints that were evaluated with extensive tests, some of which were unnecessary, including a pericardiocentesis. She was discharged but came back to the hospital days later with intra-abdominal hemorrhage and cardiopulmonary arrest. An autopsy revealed that the needle inserted during the pericardiocentesis grazed the liver causing a pseudoaneurysm that resulted in subsequent rupture and death. The death certificate listed the cause of death as cardiovascular."
I do see where they are shedding light on this, and maybe death certificates should be altered to better study this.

Maybe I'm thinking about this incorrectly, but how do you graze the liver while aiming for the pericardium? what is sad story, surviving to get an Organ and then dying anyway.

Libby1987 · May 6, 2016

The BMJ article is based off the Landrigan study which essentially found a 0.3% mortality rate associated with tertiary medical treatment. If we compare that to the mortality rate from established routine interventional procedures (like cardiac caths, hip and knee replacements, cholecystectomies, etc) it's about the same. It is a bit of a sobering number, however, for every 3 out of 1000 people that die from medical error, there are how many that survive because of it?
I do have a bit of a visceral reaction to the article because, for me, I think about how a morbidly obese diabetic with full metabolic syndrome who is non-compliant with medication and lifestyle interventions that I have prescribed ends up having a massive MI, I admit him, start him on a heparin drip, and he develops HIT and dies, that death would be secondary to a medical treatment rather than his underlying pathology.

I can see reasonable defensiveness in cases like the one you've described where a sick person dies from a SOP treatment. However the types of errors I catch, mostly medication and often they're omissions made at dicharge that are picked up upon a glance, are just plain mistakes. The personal situation I posted about, which I would love to share the details because they're so mind boggling, occurred to a healthy person and were ordered and committed by multiple people, one of those DON'T DO THIS EVER type errors performed repeatedly where you can't even blame staffing or anything else other than no one paying attention to a basic precaution.

allnurses Guide · May 6, 2016

There is no doubt that errors are made at every step in care, probably on a daily basis, in in-patient and out-patient care. I have seen some egregious ones. I am sure I have made some along the way too, as everyone here has.

My disagreement with the statistics in the study is that medical errors that are "preventable" aren't always preventable. Everyone has different anatomy and even in the most diligent practice there will still be adverse effects and the only way to truly prevent them would be to not intervene at all.

macawake, MSN · May 6, 2016

Maybe I'm thinking about this incorrectly, but how do you graze the liver while aiming for the pericardium? what is sad story, surviving to get an Organ and then dying anyway.

It is quite sad. I think that the risk of liver injury has to do with the chosen approach. With a pericardiocentesis procedure there are as far as I know three possible approaches; parasternal, apical and subxiphoid. The subxiphoid approach has a lower risk of causing a pneumothorax but the highest risk of causing liver injury. With echocardiography-guided pericardiocentesis the risk of liver injury (as well as injury to the myocardium) is of course much lower than it was when the subxiphoid approach was done "blindly". But it is still a possible, if rare, complication.

Here's one example:

Emergency pericardiocentesis: a word of caution! Accidental transhepatic intracardiac placement of a pericardial catheter

My disagreement with the statistics in the study is that medical errors that are "preventable" aren't always preventable. Everyone has different anatomy and even in the most diligent practice there will still be adverse effects and the only way to truly prevent them would be to not intervene at all.

@BostonFNP, I absolutely agree.

I don't share the opinion of those who think that all harm to patients or all deaths are preventable. Patients are in the hospital for a reason. They are sick. The question you asked earlier about how many would die without medical intervention is a valid one. Sometimes the correct treatment of a patient's condition will lead to their death due to complications associated with that treatment or the patient's weakened health. If the chance of success outweighed the potential risk of doing nothing at all (and the patient consented), I would not consider such a death a medical error.

But there are mistakes made by all level of healthcare providers that could have been prevented. I think it's important to identify what they are and implement strategies that will strive to minimize the impact of the mistakes that individual human beings will no doubt make during the course of their career.

Chisca, RN · May 6, 2016

Maybe I'm thinking about this incorrectly, but how do you graze the liver while aiming for the pericardium?

Rule #6 House of God.

"There is no body cavity that cannot be reached by a 14g needle and a good strong arm"

ShaneTeam · May 6, 2016

@BostonFNP, I absolutely agree.
I don't share the opinion of those who think that all harm to patients or all deaths are preventable. Patients are in the hospital for a reason. They are sick. The question you asked earlier about how many would die without medical intervention is a valid one. Sometimes the correct treatment of a patient's condition will lead to their death due to complications associated with that treatment or the patient's weakened health. If the chance of success outweighed the potential risk of doing nothing at all (and the patient consented), I would not consider such a death a medical error.
But there are mistakes made by all level of healthcare providers that could have been prevented. I think it's important to identify what they are and implement strategies that will strive to minimize the impact of the mistakes that individual human beings will no doubt make during the course of their career.

Quite agree Macawake. There is not a procedure that is done that is 100% safe. I also applaud what the researchers are trying to do, and still feel the system needs to have some way to look at the errors, so that best practices can be changed, if they need to.

I can also see what would make the administration tremble, since such a system would be a risk management nightmare.

Cultmember · May 6, 2016

A 55 year old woman came into hospital for a routine hip replacement. Post-op, she complained of pain and was given 3x the prescribed amount of injectable Dilaudid because the nurses who had given her the painkiller failed to document.

The patient then went into respiratory duress, a classic case of having been overdosed. The doctor doing his rounds found his patient blue and barely breathing, a Code was called. The assigned nurse claimed that the reason she had not checked in with her patient for a prolonged period was because she was "helping an LPN on the unit". [When in doubt, blame the LPN].

The patient did not revive but did not die after CPR/intervention was administered. She remained in a coma and was transferred to the palliative unit where she subsequently died the next day.

The nurse given the responsibility of calling the patient's 20 year old son to inform him that his mother had died after coming into hospital for something as simple and as routine as a hip replacement went home that day and drank an entire bottle of wine and could not get out of bed for 2 days.

Yes, medication errors happen a lot because men and women are becoming nurses due to their love of money rather genuine concern for the patients under their care. The health authority here has implemented an hourly rounding schedule which is suppose to make nurses check their patients every hour on the hour.. Why is this even needed? I'll tell you why---again--- because nurses are there for the money and sometimes the prestige rather than genuine concern for people who find themselves in the midst of a health crisis.

Another nurse I know accidentally gave 50 mg of Loxapine rather than 50 mg of Gravol subcut, causing the patient to spend 24 hours in ICU. Luckily, the patient did not die but her resps needed to be monitored. Was the nurse reprimanded? No, she wasn't even called into a meeting.

On the other hand, another nurse, who I would say is genuine and caring, gave a SCHEDULED DOSE of Dilaudid subcut on a palliative ward; and, 30 mins later, the patient passed away. The nurse was held responsible and the union barely backed her up because the family said that the nurse had killed their mother! The nurse was then suspended without pay for 1 year.

The joys of nursing.

NOADLS · May 6, 2016

Without reading, I can tell you that this is the media playing the stats manipulation game.

ixchel · May 7, 2016

It is quite sad. I think that the risk of liver injury has to do with the chosen approach. With a pericardiocentesis procedure there are as far as I know three possible approaches; parasternal, apical and subxiphoid. The subxiphoid approach has a lower risk of causing a pneumothorax but the highest risk of causing liver injury. With echocardiography-guided pericardiocentesis the risk of liver injury (as well as injury to the myocardium) is of course much lower than it was when the subxiphoid approach was done "blindly". But it is still a possible, if rare, complication.
Here's one example:
Emergency pericardiocentesis: a word of caution! Accidental transhepatic intracardiac placement of a pericardial catheter

Thank you for breaking this down. I was thinking subxiphoid might explain how the liver could be in the way, but it seems strange to me to even take that approach. You would likely go through the diaphragm, right? That seems more complicated in my mind than parasternal or apical. For apical, do you mean a little bit lateral or medial to the apex? Just curious.

dream'n, BSN, RN · May 7, 2016

US healthcare has lost sight of its true mission. I've been around a long time and administration rarely monitors the quality of the care provided, but is more interested in the customer service aspect. Nurses are reprimanded not for lacking critical thinking skills, but for not filling out a form, not writing on the 'white board', or not smiling and giving the warm blanket quick enough.