Distance Education -> Prevention of Medical Errors for the Massage Therapist -> Chapter: 03

Types of Medical Errors, and Approaches for Prevention

Types of Medical Errors that Occur in the Health Field, and Their Various Approaches for Prevention

Medical errors mainly involve six different types: Medicines, Hospital Stays & Surgery, Diagnosis, Equipment, Lab Reports, and System Failures. They can occur during the most routine of tasks involving any one or a combination of the six types, at any one or several of the locations mentioned in chapter 2.5

Medicines

Medical errors may start at the point when a doctor writes a prescription. When a doctor writes your prescription, you should make sure that it is legible. If you cannot read it, chances are the pharmacist might not be able to read it either. When you pick up your prescription, it is also good practice to inquire if this medicine is indeed the one the doctor prescribed. According to a study by the Massachusetts College of Pharmacy and Allied Health Sciences, eighty-eight percent of medicine errors involved the wrong dosage, or the wrong drug.

Another medical error that may involve medication is an allergic or adverse reaction to the medication prescribed. Be sure the prescribing physician is aware of all your known allergies to avoid getting medication that can harm you. Also, at least once a year it is important for the prescribing physician to know about all of your current prescriptions, vitamin, herbal, and other dietary supplements, as well as over-the-counter medicines. This is called “Brown bagging.” Place all of your medications in a brown paper bag and bringing them with you to your doctor’s appointment. Brown bagging will greatly help you and your prescribing doctor to better discuss your treatment, and improve the quality of your healthcare.

Another problem with prescribed medication is misinterpretation of the directions on the label. Some medication labels can be very difficult to understand. For example, does “four doses daily” mean taking a dose every six hours around the clock, or just during waking hours? Be sure to clarify your prescription with both your doctor and the pharmacist.

It is also very important to know how to measure your liquid medication. If the label says to use a “teaspoon,” be sure to purchase a special liquid medication-measuring container at the drugstore. Not all silverware is created equal. The teaspoon you measure sugar for your coffee with may not be the correct “teaspoon” amount for medication.

Hospital Stays and Surgery

If you are admitted to a hospital for medical care, regardless if the reason is surgical or non-surgical, it may be better to choose a hospital that has a great deal of experience with your condition. Patients tend to have better results when they are treated in hospitals that specialize in treating specific conditions.

The spread of infection is of great concern during a hospital stay. Hand washing is an easy and important way to prevent the spread of infection in health care environments. While in the hospital for medical care, consider inquiring of all the health care workers with whom you have direct contact, whether they have washed their hands prior to actual contact with you.

If you are admitted to the hospital for surgery, be sure to verify all that is expected to happen. For instance, be sure you understand the dynamics of the surgical procedure. Who are the doctors involved with the surgery? How long will the surgery take? What is the post-surgery procedure? How long will the recover time be? How can I expect to feel during recovery? Make sure the surgeon, anesthesiologist, and nurses know of any history of allergies or reactions to anesthesia. And finally, make sure you, your doctor, your surgeon, and the anesthesiologist all agree on exactly what will be done during the surgical procedure. This simple act of inquiry will cut down on the possibility of surgery being performed on the wrong site. (For example, operating on the left foot instead of the right.) Yes, medical errors like this do happen. It may be recommended to have a designated person, either a spouse, a family member, or a friend, to be present at all of the meetings with the doctor. It is also recommended they be with you during your hospital stay just to make sure that your care is being executed appropriately. This spokes-person would be able to speak on your behalf, if you are unable to speak for yourself. They would be able to follow-up with the nurses present to make sure your post-surgical care is being executed competently and correctly.

Upon discharge from the hospital, be sure to ask the doctor to explain the home treatment plan. The home treatment plan may include all information about medications sighted above, dietary concerns if any, and the time frame for return to your regular activities. 

Diagnosis

A wrong or misdiagnosis can lead to an incorrect choice of treatment. Usually specific diagnostic tests are indicated to confirm certain conditions. Failure to use an indicated diagnostic test may lead to an incorrect diagnosis, an incorrect choice of treatment, or more unnecessary testing. Failure to use the appropriate diagnostic test may lead to misinterpretation of a test result, and/or failure to act on abnormal results. Also, inexperience with performing a difficult diagnostic procedure, on the part of the healthcare worker, can affect the accuracy of the test results. Always make sure the diagnosis is confirmed either by a second more extensive test, or by a second opinion.

It is also good practice to receive direct confirmation of the results from any test or procedure. Make sure you talk with your doctor about how you will get the results for a procedure or a test. You may have to call and talk with them directly or set up a follow-up appointment. Do not assume the results are fine if you do not hear from your doctor after the test. Also ask what the results of the test will mean for you in terms of your health care. 

Equipment

Equipment failure can lead to failure to complete a medical plan of action, thus leading to a medical error. Dead batteries resulting in equipment failure is a possibility with defibrillators. Intravenous pumps, whose valves are accidentally dislodged or moved, causing a change in the dosage of medication over time, can have life-threatening results. Be sure to inquire about the equipment that is being used in your health care treatment plan.

Lab Reports and Diagnosis may go hand in hand. Usually it is the results of the lab work that tends to lead to a diagnosis. If the wrong lab work is ordered, and/or misinterpreted, this could often lead to a misdiagnosis, and a medical error.

Medical errors can be prevented through various means, the best of which is communication. You can protect yourself by taking the time to talk to your doctor, nurse, and/or any other health care worker; about the results of any lab test, the diagnosis, and the health care you are about to receive.

Medical errors can even result from the systematic organization of the health care. The organization of the health care includes the treatment plan, its systematic delivery to the patient, along with the resources that are provided to the delivery system. For example, a major study discovered that failures in the delivery system accounted for over three-fourths of adverse drug events.6 In other words, patients were either given the wrong dosage of a prescribed medication, or given the wrong medication in the first place. Another example of a system level problem is the correlation between staffing levels of nurses and the incidence of adverse events following major surgery, such as pneumonia, thrombosis, pulmonary compromise, and urinary tract infections.7 Understaffed post-surgical wards with nurses that are overworked and fatigued may result in numerous types of medical errors, including adverse drug events, equipment failures, or a breakdown in the delivery system of the treatment plan.

Constant monitoring of the system protocol, and making changes in system organization and design can decrease the adverse events of medical errors resulting from health care delivery system failures. These changes may include the reorganization of resources, the reorganization of decision-making upper level management, and /or retraining of all health care workers involved.

PRACTICE QUESTIONS FOR CHAPTERS 3.

Please complete the following questions:

1.    Misinterpretation of the directions on the label of a prescribed medication would constitute a medical error in which choice?

• a. Hospital Stay
• b. Diagnosis
• c. Equipment
• d. Medicines

2.    Incorrect choice of treatment may result from a medical error in which choice?

• a. Hospital Stay
• b. Diagnosis
• c. Equipment
• d. Medicines

3.    Dead batteries in a piece of medical equipment, such as an intravenous pump, can cause a medical error due to equipment                          failure. This could qualify as which medical error?

• a. Error in execution of the treatment plan
• b. Error in planning the treatment plan
• c. Both
• d. Neither

6   Internet Citation: Reducing Health Care. Translating Research Into Practice, April 2000. AHRQ Publication No. 00-PO58,             Agency for Healthcare Research and Quality, Rockville, MD. 

7   Internet Citation: Reducing Health Care. Translating Research Into Practice, April 2000. AHRQ Publication No. 00-PO58,             Agency for Healthcare Research  and Quality, Rockville, MD.