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Maintaining a safe environment reflects a level of compassion and vigilance for patient welfare that is as important as any other aspect of competent ...
Patient safety in the hospital setting
Leading cause of death around the world
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Seminar Essay: Medical Mistakes According to the Journal of Patient Safety, between 210,000 and 440,000 patients die each year of hospital errors. “Medical mistakes are the third leading cause of death in the United States” (Medical Health Leaders). Three changes that would reduce the number of mistakes are: exposure of the mistakes, checkups before surgeries, and communication with doctors. If the errors are exposed to the hospitals, the deaths caused by medical errors would decrease. When people speak up about an issue, attention is brought to it; therefore, causing the problems to diminish. An article from The Wall Street Journal called “How to Stop Hospitals from Killing Us” says “If anyone knows whether a hospital
The Institute of Medicine (IOM) reported in 1999 that between 44,000 and 98,000 people die each year in the United States due to a preventable medical error. A report written by the National Quality Forum (NQF) found that over a decade after the IOM report the prevalence of medical errors remains very high (2010). In fact a study done by the Hearst Corporation found that the number of deaths due to medical error and post surgical infections has increased since the IOM first highlighted the problem and recommended actions to reduce the number of events (Dyess, 2009).
Hospitals are busy places, and with so much going on it is hard to believe that mistakes are not made. However, there are some accidents that should never happen. Such events have been termed ‘never events’ because they are never supposed to happen. This term was first introduced by Ken Kizer, MD, in 2001 (US, 2012). The Joint Commission has classified never events as sentinel events and asks that hospitals report them. A sentinel event is defined as, “an unexpected occurrence involving death or serious physiological or psychological injury, or the risk thereof” (US, 2012). Never events are termed sentinel events because in the past 12 years 71% of the events reported were fatal (US, 2012). Because these events are never supposed to happen, many insurance companies will not reimburse the hospitals when they occur. A study in 2006, showed that the average hospital could experience a case of wrong-site surgery, one example of a never event, only once every 5 to 10 years (US, 2012). This study illustrates how rare a never event is. Hospitals do not want these never events to happen any more than a patient does. To help prevent these errors, hospitals have created policies that, if followed, will minimize the possibility of a mistake. The consequences of never events are devastating and because of this the goal is to make sure that they are eradicated from hospitals and medical facilities.
I have been aware of medical errors for some time now. While in nursing school I have heard many stories from classmates and instructors of instances where people they knew, or loved ones had been either harmed or died because of a medical error. I have had experiences with medical errors. When I was in the hospital for the birth of my first child, the nurse that came to change out my IV bag did not check the
Surgical errors are seen in every hospital; however, hospitals are not required to report such incidents. Unintended retained foreign objects, often abbreviated as URFOs, are among those events that are often not reported.
Over the past several years extended work shifts and overtime has increased among nurses in the hospital setting due to the shortage of nurses. Errors significantly increase and patient safety can be compromised when nurses work past a twelve hour shift or more than 40 hours a week. Hazardous conditions are created when the patient acuity is high, combined with nurse shortages, and a rapid rate of admissions and discharges. Many nurses today are not able to take regularly scheduled breaks due to the patient work load. On units where nurses are allowed to self-schedule, sixteen and twenty-four hour shifts are becoming more common, which does not allow for time to recover between shifts. Currently there are no state or federal regulations that restrict nurses from working excessive hours or mandatory overtime to cover vacancies. This practice by nurses is controversial and potentially dangerous to patients (Rogers, Hwang, Scott, Aiken, & Dinges, 2004). Burnout, job dissatisfaction, and stress could be alleviated if the proper staffing levels are in place with regards to patient care. Studies indicate that the higher the nurse-patient ratio, the worse the outcome will be. Nurse Manager’s need to be aware of the adverse reactions that can occur from nurses working overtime and limits should be established (Ford, 2013).
Hospital medical errors can involve medicines (e.g., wrong drug, wrong dose, bad combination), an inaccurate or incomplete diagnosis, equipment malfunction, surgical mistakes, or laboratory errors. High medical error rates with serious consequences occurs in intensive care units, operating rooms, and emergency departments; but, serious errors that harmed patients may have prevented or minimized. Understand the nature of the error
Today, medical error has become a major and important challenge to health care systems across the globe. This is because medical errors often lead to harm that may also be non-repairable (Valiani et al. 540; Denham “Chasing Zero”). In 1999, the Institute of Medicine published a report that indicated that medical error in hospitals accounts for between 48,000 and 98,000 deaths annually (Swift et al. 78; Barger et al. 2441). As such, reducing the occurrence of medical errors has become an international concern. Poorolajal defines a medical error as “an act of omission or commission in planning or execution that contributes or could contribute to an unintended result.” (Poorolajal, et al. para 5 -10). In this case, it’s very important to acknowledge
A few documented cases can be found in the literature that directly looks at the complex issue of medical error reporting. For example, Cleary & Duke, (2017) research demonstrates the nexus of ethical issues present in the case of Bundaberg Base Hospital (BBH) in Australia. In 2004, BBH which is a 136-bed hospital that provides emergency medicine, general medicine, general, to a population of 87,933 in Bundaberg, Queensland, Australia. Director of Surgery, Dr. Jayant Patel, was employed at BBH April 2003 and April 2005, in which time saw 1457 patients, performed approximately 1000 operations, and 400 endoscopic procedures. From May 2003 until April 2005, nurses from several hospital departments reported and raised concerns about Patel's competence. Sighting evidence of post-operative complications, lack of infection control measures, and general decision-making process to perform complex surgeries instead of transferring patients to a more equipped hospitals and specialists. Nurses perused ever possible option available to them for reporting the errors in this situation continually from May 2003 through April 2005 (Cleary & Duke, 2017). The case represents nurses using verbal and written complaints, incident
As humans when we are faced with any psychological or emotional problems, our initial thought is to turn to a therapist, doctor or any other health practitioners. Our initial thought when we are faced with problems regarding our health is to turn to a health professional because for ages that’s how it has been. When it comes to our health, health professionals nowadays do more harm than help. Many might disagree, but often patients are misdiagnosed with mental illnesses they do not have. Misdiagnosis occurs when a therapist or other health practitioners decide that a patient is suffering from a condition that he or she may not be suffering with. When misdiagnosed, patients are given unnecessary treatment, which could potentially
The goal of patient safety is to prevent harm to patients Mitchell (n.d.). Patient safety in any health system is critical not only for the credibility of the system, but for patient trust and satisfaction as well. Adverse outcomes are defined as any injury or harm resulting from medical care (Watcher, 2008). Adverse outcomes can result in death and disability and cost the health system dearly. Bernard and Encinosa (2004) reported that in the U.S. it costs twice as much to care for patients that experienced adverse outcomes. The Institute of Medicine (IOM) (2000) reported that adverse outcomes cost the U.S. more than 16 billion dollars or 6% of total inpatient costs. Therefore, adverse events are costly both in terms of human life and fiscal resources.
“When Doctors Make Mistakes” narrates an event where the author Atul Gawande, a doctor, made a mistake that cost a women her life. He relates that it is hard to talk about the mistakes that occurred with the patient's family lest it be brought up in court. In that instance the family and doctor are either wrong or right, there is no middle ground in a “black-and-white mortality case”(658). Even the most educated doctors make simple mistakes that hold immense consequences but can only speak about them with fellow doctors during a Morbidity and Mortality Conference.
MacDonald, Ilene. "Hospital Medical Errors Now the Third Leading Cause of Death in the U.S." FierceHealthcare. N.p., 20 Sept. 2013. Web. 25 Mar. 2014.
Keeping patients safe is essential in today’s health care system, but patient safety events that violate that safety are increasing each year. It was only recently, that the focus on patient safety was reinforced by a report prepared by Institute of medicine (IOM) entitled ” To err is human, building a safer health system”(Wakefield & Iliffe,2002).This report found that approx-imately 44,000 to 98,000 deaths occur each year due to medical errors and that the majority was preventable. Deaths due to medical errors exceed deaths due to many other causes such as like HIV infections, breast cancer and even traffic accidents (Wakefield & Iliffe, 2002). After this IOM reports, President Clinton established quality interagency coordination task force with the help of government agencies. These government agencies are responsible for making health pol-icies regarding patient safety to which every HCO must follow (Schulman & Kim, 2000).
The health care is extremely important to society because without health care it would not be possible for individuals to remain healthy. The health care administers care, treats, and diagnoses millions of individual’s everyday from newborn to fatal illness patients. The health care consists of hospitals, outpatient care, doctors, employees, and nurses. Within the health care there are always changes occurring because of advance technology and without advance technology the health care would not be as successful as it is today. Technology has played a big role in the health care and will continue in the coming years with new methods and procedures of diagnosis and treatment to help safe lives of the American people. However, with plenty of advance technology the health care still manages to make an excessive amount of medical errors. Health care organizations face many issues and these issues have a negative impact on the health care system. There are different ways medical errors can occur within the health care. Medical errors are mistakes that are made by health care providers with no intention of harming patients. These errors rang from communication error, surgical error, manufacture error, diagnostic error, and wrong medication error. There are hundreds of thousands of patients that die every year due to medical error. With medical errors on the rise it has caused the United States to be the third leading cause of death. (Allen.M, 2013) Throughout the United States there are many issues the he...
It is shocking to know that every year 98000 patients die from medical errors that can be prevented(Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.), 2000). Medical errors are not a new issue in our healthcare system; these have been around for a long time. Hospitals have been trying to improve quality care and patients safety by implementing different strategies to prevent and reduce medical errors for past thirty years. Medical errors are the third leading cause of death after heart disease and cancer in America (Allen, 2013). In addition medical errors are costing our healthcare system an estimated $735 billion to $980 billion (Andel, Davidow, Hollander, & Moreno, 2012).