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The Institute of Medicine
which is a very sophisticated scientific medical
group, made up of some of the leading physicians in
this country, dropped a major bombshell when it
reported that thousands of hospital patients die or
are harmed by errors made by caregivers. The
caregivers are doctors, nurses, pharmacists and
countless other unseen people like technologists and
secretaries in laboratories, whose work it is to help
people not harm them. I have worked in my practice
exclusively in a hospital for over thirty years and
know that errors are made. Most errors do not result
in adverse patient care, the majority are caught
before the patient is ever exposed to the potential
consequences. Nevertheless, the Institute of Medicine
is correct in identifying unintentional mistakes which
do and have caused problems. The exact number can be
argued and the remedy to this will be argued even
more. This certainly is grist for the politicians'
mill.
What is Done to
Prevent Mistakes
Patients need to know
that there are a series of systems in place to protect
patients from human error. Nobody reasons that there
is an "acceptable" mistake rate that we can tolerate.
All steps in patient care have built-in redundancies
and methods to prevents errors. For example, the
administration of blood requires two people to check
the patient's name, hospital number, blood type and
other information before the blood can be given.
Syringes and bags that have medicine on them must
carry a label with the medicine and concentration of
medicine, which must be read before administered and
verified as an appropriate medical order. All
hospitals have a variety of committees charged with
the oversight of patient care and the identification
of problems. One example is the infection committee
which looks at infection rates and tries to identify
practice patters that contribute to increases in
hospital infections. In fact there are literally
hundreds if not thousands of safeguards to "prevent"
errors.
Who Governs
the Safety
Physicians and nurses
must be licensed to practice: they are licensed by the
state. There are hospital committees which are
charged with the responsibility of granting privileges
to physicians. Increasingly these committees are
voluntarily requiring proof that the physician allowed
to practice in a hospital has the experience or
training to do the procedures or diagnostic tests
applied for and that results are within national
norms. Pharmacy and nursing monitor the performance
of their personnel and all hospitals have quality
improvement programs designed to improve care and to
monitor the quality of care. The Joint Commission on
Hospital Accreditation inspects hospitals and is
especially focused on procedures and systems known to
be at risk for human error. Hospitals must report
safety violations when they occur, and if they occur
with an unacceptable frequency the hospital will lose
its accreditation. Finally, the U.S. has a legal
system which permits malpractice and other litigation,
and this has long been a major deterrent in the fight
to eliminate medical errors.
What Next
Seabrookers and all
other Americans need to have confidence in their
hospitals. The aim of all hospitals should be zero
tolerance for mistakes. My recommendation is that
systems be created within hospitals, if they do not
already exist, that report all errors so that
accidents and mistakes are tracked and individual
hospital specific solutions found where recurrent
problems lie. It has been my experience that when
problems are identified and supported with data that
they can be solved. Those who argue against reporting
of errors might have better ways in mind of improving
care, but I think good information helps us in the
performance of our duties. How much information
should be made public is a whole other issue, but
patients must know that their doctors, nurses and
hospitals are doing everything possible to eliminate
errors. |
