Medicine is a sphere that ideally is to be infallible. But more frequently than not it kills people because in healthcare professionals make mistakes. Every drug prescription, every visit to a doctor or performed surgery can become fatal to a patient. Medical system indeed kills people and alarming statistics only proves this fact. In this paper we will discuss medical errors, their costs, frequency and strategies of reduction. We will also discover the key issues in risk management and predict the future of issues on this topic.
Key Issues in Risk Management
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Risk management in health care is understood as organized attempt to find, assess and eliminate or diminish the risk to patients and other people working in the hospital. It is to guarantee health care services provision to all the people, as it is indicated in the law, at more or less cost-effective level, and diminish the possibility of unfavorable consequences for the patients and other people employed at the hospital (Kavaler & Spiegel, 2003). Among the most frequent risk factors in this respect are: age of the patient, number of treatments received, nature of intervention, staff fatigue, stress and workloads, staff inexperience and characteristics of the hospital.
An important issue of risk management is medical documentation handling. It is extremely important for it to be complete, high quality and legible. One of the most general mistakes of medical professionals is to ask patient something, but not to write it down into the medical history. The important thing while dealing with any medical condition is to document it properly. The key components of medical record that are always to be included are the following: illness history, demographic data about a person, clinical observation, test results, informed consent and conclusion written by the doctor with recommendations concerning the date of discharge. All these things need to be documented as soon as possible in order not to lose any data. Documentation filled in before performing medical procedures is to include type of procedure, prescribed drugs and drug allergies. Procedures that include sedation need special attention. General procedure note is to include date, patient’s ID, instruments and medications used, physiologic monitoring and indications, anatomic extent of examination and findings, records of tissues and fluids sampled, complications and recommendations, documentation of photographs and videotaping, disposition and follow up. Complications need to be documented carefully and objectively. There needs to be a clear description of a certain complication, how it was managed by the doctor, and if there was any communication with patient’s family members, it should be indicated in a medical record. During post-procedure period monitoring of patient’s functioning is to be performed and documented. When a patient is ready for discharge, there are several rules to be dictated to him. Among them are the following: not to miss appointments with a doctor, use prescribed medications, not to participate in any dangerous activities if a patient uses sedation. The patient is also to be informed about situations that may force him to call doctor. Correction of medical records is a process of crossing out entry and placing a new entry instead of it together with a date and initials of a person making corrections. The doctor owns a medical record but only a patient has a right to access the information within it (Kavaler & Spiegel, 2003).
Informed consent is an important risk management technique. It helps patient to learn all potential risks, benefits and alternatives to certain procedure or type of treatment. Patient is to understand information connected to procedures and treatment to the full or he has a right to have an appointed person who will act on his or her behalf. The most important components of informed consent are: information about type of procedure, reasons to perform these particular procedures, its’ possible benefits and risks, information provided about possible alternative procedures, and all the possible complications. Informed refusal is an alternative to informed consent. In this case a patient refused to undergo any kind of procedure after receiving information about all the possible benefits and risks. Informed refusal also needs to be documented in a proper way with indication of possible negative impacts of the procedure in question. Nevertheless, there are several cases when informed consent is not needed. These are: 1) emergency situations when there is a threat to patient’s life and immediate intervention is of importance; 2) incompetence of a patient, in which case informed consent is filled in by a guardian or a parent; 3) therapeutic privilege, in which case informed consent is viewed as something detrimental to the patient’s medical state; 4) waiver, when the patient declines the right to the information regarding the procedure; 5) legal mandate, when judicial order substitutes patient’s right to informed consent (Kavaler & Spiegel, 2003).
Failure to perform risk management successfully may result in medical malpractice or medical negligence, as it is frequently called. It occurs when health professionals fail to treat patient’s medical condition properly and it results in aggravating injury to the patient. Medical malpractice can be viewed as inappropriate treatment, as a failure to provide treatment, or as a delayed care. It is a part of tort law and is viewed as something civil wrong procedure. Medical malpractice includes several components, among which are: duty, breach of duty, causation and damages. Duty is understood as doctor’s responsibility to take care of the patient. It starts from a consultation or hospital visit, but it also may occur after a patient schedules an appointment with a doctor. By a breach of duty is meant a deviation of doctors’ obligations to patient, which is generally based on the standard of care. It is doctors’ obligation to update a patient about any changes in standard care. This information must be carefully documented in medical record with an informed consent. Causation is connecting breach of duty to damages done to the patient. Damages are viewed as any kind of losses suffered by a patient because of medical treatment. General damages include pain and suffering. There are also special damages like medical expenses, money loss, as well as funeral expenses. Punitive damages occur because of gross negligence, which presupposes reckless disregard of patient (Kavaler & Spiegel, 2003).
There are different types of medical negligence and each of them can cause certain unfavorable consequences for the patients. Among the most common medical malpractices is failure to diagnose a disease or condition. In this case medical professional just incorrectly diagnoses the patient and, as a result of this fact, the disease progresses without any treatment. Another medical negligence may be caused by failure to monitor patient properly in the course of a disease or an illness. One more medical malpractice which is often observed is connected to the fact that patient does not notify care providers about changes in his condition. This results in failure of medical professionals to provide proper treatment in a timely manner because signs of deterioration were registered at a wrong time (Rasansky, 2010).
Medical Errors Statistics: Frequency and Costs
Medical errors’ statistics is indeed alarming and improvement is not expected any time soon. According to data collected, 22 percent of medical errors are made because of lack of knowledge or information. This may be understood as lack of knowledge about patient, rule violations and memory lapses. It is estimated that 8 million people have already died because of conventional medicine during the previous decade. Approximately 7000 patient die because of illegible doctors’ or nurses’ handwriting. 7.5 million unnecessary procedures or operations are performed annually. It was estimated that 50 percent of American citizens were forced to overcome unnecessary procedures. 42 percent of population were affected by medical error, procedure or prescribed drug in a direct way. Prescription of wrong medications is deemed to be the third leading cause of death. Drug related errors include the wrong dose, wrong route, wrong choice, wrong drug technique, wrong frequency, drug-drug interaction, drug allergies. Thousands of people die every year because they have adverse reaction on drugs. 1.5 million patients are annually affected by preventative medical services. Number of medical errors is doubled sufficiently when medical interns keep themselves awake for more than 24 hours. According to the recent data, approximately 160.000 misidentification errors in laboratories during the last year also caused some fatal consequences (“Medical error statistics”).
It is estimated that approximately one American citizen out of five states that he or member of his family has fallen victim of medical errors. From 44.000 to 98.000 deaths are caused by medical negligence annually. Medical error is 8th leading cause of death in the USA. The quantity of fatal outcomes because of this reason exceeds even the death rate because of car accidents, breast cancer occurrences and cases of AIDS. From 5 to 10 patients admitted to the hospital acquire some kinds of infections there (“Patient safety: current statistics”).
Medical errors not only cost people their lives, they are also costly for the economy and for overall health care budget. Preventable patient injury resulting from medical mistakes costs economy from 17 to 29 billion dollars annually. Adding to this, antibiotic-resistant hospital acquired infections can cost 30.000 dollars per case (Rasansky, 2010). Adverse outcomes which occur as a result of drug treatment have different undesirable consequences for the average citizens. They entail approximately 116 million extra visits annually, as well as 76 million additional prescriptions, 17 million emergency department visits, 8 million admissions to hospitals, 3 million admissions to long-term care facilities, and 199.000 additional deaths. Total cost may amount to 70 billion dollars. The cost of medication errors involving failures of treatment due to non-prescribing can also be very high. Despite patients experiencing serious adverse effects caused by medical negligence, only 2 percent or even less made claim for compensation.
Strategies of Medical Errors’ Reduction
What can possibly be done to reduce the alarming tendency of frequent medical errors? Is it possible to eliminate them totally or at least diminish their quantity and fatal outcomes? These questions are difficult to answer at this point, but there several reduction strategies which if applied may change the situation for the better.
The first strategy that may prove to be helpful is reduction of reliance on memory among medical professionals. Very often failure of memory to reproduce essential information concerning treatment can be the reason of medical complications or even death. Work in a hospital is to minimize the need for human tasks that can be accomplished with mistakes. Computerized decision aids and protocols – these are some of the tools to be incorporated into health care process to reduce mistakes. Another strategy that may be applied is improvement of information access. It presupposes that information is more readily available for caregivers about patient’s whole history of diseases and complications, minor health problems and organism peculiarities (Spath, 2011).
One more useful strategy may be securing mistake-proof processes and procedures in the hospital. It presupposes that critical tasks to be structured so that errors cannot be made. For example, a computerized system in the hospital may be designed in such a way that it will prevent entry of an order for a lethal drug. Another strategy that may help to eliminate medical errors is standardization of tasks. It is obvious that if task is done in the same way every time – there is less chance for mistake. The strategy that presupposes reduction in number of hand-offs may also prove to be useful. It goes without saying that many errors come from slips in transfer of materials, information, instructions, and supplies. If medical processes are performed with fewer hand-offs the chances of mistakes will be reduced sufficiently (Spath, 2011).
The future of such a complex issue cannot be determined for sure, as, actually any other issue. The thing is human beings make mistakes and this is inevitable. They are not Gods, they are not perfect creatures and cannot predict all possible consequences of their actions. Human beings will continue making medical errors. And it does not matter whether they are well educated or not, or whether they double check or even triple-check. That is the sad reality of our life. After the statistics about death rate connected to medical errors was revealed, a lot of hospitals started working successfully on reduction of mistakes rates. But absolute elimination of medical errors seems to be something from the sphere of fantasy.
To conclude with, health care professionals are entrusted with peoples’ lives and when they make mistakes someone may suffer indeterminate harm or death. The reason to this is the fact that their profession is not infallible. Patient safety improvements will only come about when every person understands that errors are inevitable accompaniment of human condition, even if medical professionals are conscientious. Medical errors can be eliminated, but not overnight and not without considerable efforts. They can disappear only with the help of system’s redesign and improved teamwork, as well with the help of sheer willpower of people committed to making it happen.
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