A medical error is defined by the Institute of Medicine (IOM) as “the failure of a planned action to be completed as intended, or the use of a wrong plan to achieve an aim.” A rather benign definition for what is a leading cause of death in the United States; with numbers far greater than fatalities attributed to automobile accidents (43,458), breast cancer (42,497) and AIDS (15,516). The term “medical error” has become an umbrella to cover a multitude of mistakes in the health care system including mishandled surgeries, diagnostic errors, equipment failure and medication errors.
A report from the IOM in 1999 has been the standard of statistics for medical errors for over ten years, with many quoting their estimate of 95,000 American deaths per year. The United Kingdom has reported a substantially lower number of 40,000, Canadians are lower still with 24,000, but Australia reports the lowest with just 18,000 per year.
The IOM’s report estimated that medical errors cost somewhere between $17 and $29 billion dollars. It called for sweeping improvements in patient safety and went on the record as stating that it would be “irresponsible to expect anything less than a 50% reduction in errors over five years.” This report resulted in seven high-profile hearings in Congress and the introduction of five medical error bills; but none were adopted and eventually the flurry died down.
A study performed in 2004 by HealthGrades found that the numbers hadn’t dropped by 50% but were in fact twice what was reported by the IOM. Using Medicare hospital records from 2000 to 2002 they determined that the actual number of deaths attributed to medical errors averaged 195,000 per year.
Dr. Samantha Collier, HealthGrades’ vice president of medical affairs, likens this to 390 jumbo jets full of people crashing each year, making it one of the leading causes of death in the United States; and these are “preventable, in-hospital medical errors”.
“If the Center for Disease Control’s annual list of leading causes of death included medical, it would show up as number six, ahead of diabetes pneumonia, Alzheimer’s disease and renal disease,” stated Dr. Collier.
Non-Fatal Medical Errors
A new study by the IOM in 2006 reported that not all medical errors are fatal, but that a sobering 1.5 million people are injured each year. Studies indicate that 400,000 preventable drug-related injuries occur each year in hospitals. In long-term care settings that number is 800,000, and the number is 500,000 among Medicare recipients in outpatient clinics. Of course, they also admitted that these numbers are “likely underestimates”.
More sobering still is that the costs related to treating “drug-related” injuries occurring in hospitals was conservatively estimated to be $3.5 billion a year; and this didn’t take into account lost wages and productivity.
The Most Common Medical Errors
The term “medical errors” covers a wide variety of mistakes among the medical professions and these include but are not limited to the following categories:
• Type of health care given (medication, surgery, diagnostic imaging, etc.)
• Severity of the injury (minor discomfort, serious injury, death, etc.)
• Legal definitions (negligence, medical malpractice, etc.)
• Setting (hospital, emergency room, intensive care unit, nursing home, etc.)
• Persons involved (physician, nurse, pharmacist, patient, etc.)
The causes of medical errors are as various as the types, and can include errors in prescriptions due to illegible handwriting and diagnostic errors that have lead to improper prescriptions, mistreatment and even unnecessary medical procedures. Steps need to be taken to ensure that there are checks and balances better than the status quo.
Publicized Medical Errors
When considering “medical errors” many may recall the widely publicized case from 1994 involving the death of a Boston newspaper columnist from an overdose of chemotherapy for breast cancer. Due to a misinterpretation of the doctor’s prescription the patient was given four times the correct daily dose. The doctor intended for the dosage of medication to be administered over a four-day period.
Unfortunately, this isn’t an uncommon problem. According to the Medication Error Reporting Program operated cooperatively by U.S. Pharmacopeia and the Institute for Safe Medication Practices, confusion caused by similar drug names accounts for up to 25% of all errors reported. In addition, labeling and packaging issues were cited as the cause of 33% of errors, including 30% of fatalities.
A common medical error with infants involves the blood thinner, Hep-lock. When using an IV there is a risk of blood clots and so a blood thinner is used to flush out the IV lines and prevent this problem. Infants are supposed to receive the equivalent of 10 units, but can instead be given the adult version Heparin, which is a 1,000 times stronger.
This error happens when the pharmacist provides the wrong bottle, the floor nurse doesn’t catch it and the administering nurse misses it, too. When this error occurs it is ultimately blamed on poor packaging and labeling of the two drugs: their color is so similar as to be almost indistinguishable and the writing on the label is crammed with text as to be almost illegible.
In 2006 at Methodist Hospital in Indianapolis, six infants were given multiple adult doses of Heparin instead of Hep-lock resulting in three deaths. Due to this tragedy Baxter International (the manufacturer), fully aware that confusion over the labeling of these two drugs had lead to these fatal errors, changed the labeling, however, they didn’t recall the old, poorly labeled stock sitting in hospitals around the country.
As a result many other infants were put at risk as doctors, nurses and pharmacists continued to struggle with poor packaging and labeling.
Steps to Prevent Errors
We expect a lot of the medical profession, when we put our lives in their hands it’s easy to be intimidated. Don’t be. Ask questions and take an active part in the healthcare decisions for both you and your family.
Steps you can take to prevent medical errors:
• Don’t be afraid to ask questions
• Make a list of all medications and their dosage being prescribed to you, as well as how often you should take it; never rely on the label provided by the pharmacist
• Request all results of tests or procedures and discuss what they mean with your doctor
• If your doctor recommends a surgical procedure be sure to discuss the options, the reason for it and what will be done
Consider your choices – advocacy groups are available that give hospitals a “score” and, when options are available, pick the best hospital for the procedure or treatment in your community
* Information from The Wellness Newsletter, Peter Pan Potential.