Medical error

A medical error occurs when a healthcare provider fails to complete a planned action as intended or uses an incorrect plan to achieve a medical goal. This can include doing something that should not be done, failing to do something that should be done, or performing a task incorrectly. Medical errors happen, regardless of whether or not the errors lead to serious problems or adverse effects for the patient. A medical error can be either wholly accidental or the result of some deliberate or reckless act; most are unintentional and result from miscommunication, workflow problems, or lack of coordination. The focus in healthcare is shifting away from blaming individuals and toward improving systems to prevent mistakes.

Background

Medical errors can happen in different parts of the healthcare system. A staff member in a physician’s office, clinic, laboratory, nursing home, ambulatory care center, hospital, pharmacy, or other clinical setting can make an error in treating a patient. The complex nature of medical care and the number of people involved in treating a person for even a common illness make it relatively easy for errors to occur. There are four main types of medical errors: diagnostic errors, treatment errors, prevention errors, and other errors.

Errors can occur during diagnosis. A physician can order the wrong test or fail to order a necessary test. The test results can be interpreted incorrectly, or the physician can fail to follow up after receiving the results. This can lead to the patient receiving no treatment or the incorrect treatment.

Many errors can occur during a patient’s treatment. Such errors might include mistakes in prescribing or administering medications, errors in performing a procedure or failing to perform a necessary procedure, and ordering treatment not indicated for the condition. Caregivers can also err by not reading or interpreting a test result correctly, or by failing to order a drug or treatment that could help the patient improve. Errors can also occur with prescription drugs. Pharmacists can fill the prescription incorrectly or list the wrong instructions on the label. Home caregivers can give too much or not enough of the medication, or give it at the wrong time.

Some errors are related to preventing illnesses, such as failing to offer immunizations or neglecting to follow up on treatments. Errors in which medical professionals do not take necessary precautions against spreading diseases, such as failing to wash their hands or wear a mask when warranted, would also fall into this classification. Many hospital-acquired infections are the result of this type of error.

Errors can occur in numerous ways. Equipment might fail during a procedure due to poor maintenance or missed safety checks. There might also be communication errors among caregivers. For instance, two physicians may think the other is taking care of the patient when, in fact, no one is with the patient.

Medical errors can be attributed to simple human mistakes, system failures, professionals who disregard safety procedures, or clinical environments that create conditions that encourage or necessitate cutting corners. Regardless of the cause, thousands of people are affected by medical errors each year. These patients may undergo additional procedures, spend more time in the hospital, incur additional expenses, and suffer emotional and physical discomfort due to medical errors. Many also die as a result of incorrect or inadequate treatment.

Overview

It is difficult to determine just how many people are affected by medical errors each year because there is no standard way to report them. Researchers analyze data based on diagnosis codes for conditions known to be related to hospital error. Each illness or condition for which a person is treated has an assigned numeric code known as an International Classification of Diseases (ICD). However, there is no code specifically for medical errors, so researchers have to either analyze thousands of patient charts or examine smaller samples and estimate how many errors would occur in a larger population.

Researchers from Johns Hopkins University published a 2016 study in The British Medical Journal (BMJ), estimating that as many as a quarter of a million Americans might die each year due to medical errors. This figure suggested that medical error was the third leading cause of death, after heart disease and cancer. Many have disputed these numbers, however. Critics argued that the researchers used the usual flawed system of combining and averaging numbers for medical errors without determining whether the error truly played a role in the patient’s death. Consider the following example: Surgery is indicated for a patient’s condition. The physician delays scheduling surgery, and the patient dies before surgery can take place. Was the death due to the delay in surgery, or was it likely the patient would have died anyway? Research indicated a much lower prevalence. A study published in 2019 by The BMJ found that preventable patient harm occurred in 6 percent of patients across various medical settings, while the World Health Organization estimates that approximately one in ten patients worldwide experiences harm during healthcare, much of which is preventable. The most common type of error was prescription dose errors.

Medical professionals at all levels work to minimize errors, which are costly to all concerned, cause patients and families to lose faith in the medical industry, and demoralize practitioners. Additional safety procedures, increased monitoring, automation (e.g., automated medication dispensing systems), and increased education for medical professionals can help. Patients can also help minimize the possibility of medical error by taking some steps when receiving care.

Sharing information about any medications—including over-the-counter drugs, supplements, and herbal treatments—with every physician is important to avoid duplication and drug interactions. It is also important to understand what a drug is for and how it should be taken, especially when starting a new medication. During inpatient care, ensuring that all staff follow proper handwashing rules can help limit infections, and discussing care with the physician can help identify potential errors. If a patient is too ill to do this, another caregiver or family member can assist. Following up to get the test results is essential; having one physician coordinate care can help reduce the chance of medical error.

Bibliography

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