Preventing Medical Errors & Infection

What are Medical Errors?

Medical errors are one of the nation's leading causes of death and injury. A 1999 report by the Institute of Medicine estimates that as many as 44,000 to 98,000 people die in U.S. hospitals each year as the result of medical errors. This means that more people die from medical errors than from motor vehicle accidents, breast cancer, or AIDS.

Medical errors can occur anywhere in the healthcare system:

  • Hospitals
  • Clinics
  • Outpatient Surgery Centers
  • Doctors' Offices
  • Nursing Homes
  • Pharmacies
  • Patients' Homes

Errors can involve:

  • Medicines
  • Surgery
  • Diagnosis
  • Equipment
  • Lab Reports

They can happen during even the most routine tasks, such as when a hospital patient on a salt-free diet is given a high-salt meal.

Most errors result from problems created by today's complex healthcare system. But errors also happen when doctors and their patients have problems communicating. For example, a recent study supported by the Agency for Healthcare Research and Quality (AHRQ) found that doctors often do not do enough to help their patients make informed decisions. Uninvolved and uninformed patients are less likely to accept the doctor's choice of treatment and less likely to do what they need to do to make the treatment work.

What Can You Do? Be Involved in Your Healthcare.

The single most important way you can help to prevent errors is to be an active member of your healthcare team.

That means taking part in every decision about your healthcare. Research shows that patients who are more involved with their care tend to get better results. Some specific tips, based on the latest scientific evidence about what works best, follow.

Medicines

Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.

At least once a year, take all of your medicines and supplements with you to your doctor. It can also help your doctor keep your records up to date, which can help you get better quality care. One of the most effective things you can go is keep an up-to-date list of all your medications. Click here for a wallet card to help you track your medications.

Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.

This can help you avoid getting a medicine that can harm you.

When your doctor writes you a prescription, make sure you can read it.
Ask the doctor to use block letters to print the name of the drug.

Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.

  • What is the medicine for?
  • How am I supposed to take it, and for how long?
  • What side effects are likely? What do I do if they occur?
  • Is this medicine safe to take with other medicines or dietary supplements I am taking?
  • What food, drink, or activities should I avoid while taking this medicine?

When you pick up your medicine from the pharmacy ask: Is this the medicine that my doctor prescribed?

A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.

If you have any questions about the directions on your medicine labels, ask.

Medicine labels can be hard to understand. For example, ask if "four doses daily" means taking a dose every six hours around the clock or just during regular waking hours.

Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you're not sure how to use it.

Research shows that many people do not understand the right way to measure liquid medicines. For example, many use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people to measure the right dose. Being told how to use the devices helps even more.

Ask for written information about the side effects your medicine could cause.

If you know what might happen, you will be better prepared if it does—or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.

Antibiotic overuse.

Antibiotics have been used since the 1940’s and represent one of the greatest healthcare discoveries of the last 100 years. But taking antibiotics when you don’t need them can lead to the development of antibiotic resistant germs, sometimes called “super bugs”. The flu, most colds, and many sore throats are caused by viruses against which antibiotics have no effect. If you develop any of these conditions, consult your physician for appropriate treatment.

Hospital Stays

If you have a choice, choose a hospital at which many patients have the procedure or surgery you need.

Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.

If you are in a hospital, do not hesitate to ask all healthcare workers who have direct contact with you whether they have washed their hands.

Hand washing is an important way to prevent the spread of infections in hospitals. In spite of hospitals’ best efforts, sometimes hand washing is not done regularly or thoroughly enough. A recent study found that when patients checked whether healthcare workers washed their hands, the workers washed their hands more often and used more soap.

When you are being discharged from the hospital, ask your doctors or other caregivers to explain the treatment plan you will use at home.

This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors and caregivers think their patients understand more than they really do about what they should or should not do when they return home.

Surgery

When having surgery, ask questions and make sure there is complete agreement on what is being done to guard against errors.  Your safety during surgery is of the highest priority, and all hospitals have guidelines in place to ensure that your surgery is error-free. By taking an active role in your pre-operative planning, you can help to eliminate the possibility of an error occurring during your operation.

Hospital protocols are in place to make sure your surgery is safe and is performed according to plan. Before your operation, the surgical team will involve you in clearly marking the operative site with an indelible pen or marker. The team will also make a checklist using your records, imaging studies, and informed-consent form. They will verify that they know who you are by asking your name and/or checking your hospital identification bracelet. And they will confirm that all of your allergies to medication and your medical history are well known among the members of the surgical team. While in the operating room (OR), your surgical team should verbally verify among themselves the correct site of the operation. And your records and imaging studies (X rays, and so on) should be in the OR at the time of your operation.

In making sure your surgery is performed correctly, communication is the key. Discuss with your surgeon exactly what will be done before, during, and after your operation. And do not hesitate to ask the following questions:

  • What is the name of the operation that will be done?
  • Where or on what body part will you be operating?
  • Are there any alternatives to this operation?
  • What are the risks of this procedure?
  • What is likely to happen if I don’t have the operation?
  • Who is in charge of the surgical team?
  • About how long will it take to recover after the operation?
  • Will the correct part of my body be marked before the operation begins?

And don’t stop there. Keep asking questions about anything you or your family want to know until you fully understand everything that has been planned. Next, ask team members what role they will play in the operation and in your care. And what will they do to ensure your safety? You should also carefully review your informed consent form and verify the information on your patient identity bracelet.

Remember, you will be asked the same questions over and over again before your surgery – this is for your safety and protection. The open and frequent exchange of information will enhance your experience at the hospital and help ensure a safe and successful procedure.

For more information about safety in the operating room, click here

For more information about preparing for surgery, click here.

Other Steps You Can Take

Speak up if you have questions or concerns.

You have a right to question anyone who is involved with your care.

Make sure that all health professionals involved in your care have important health information about you.

It’s important to share all aspects of your health history with those health professionals responsible for your care and treatment. This includes all medications you are taking, allergies, including medications to which you are allergic, your current health status, prior health conditions and surgeries, and anything else that may be important for the provider to know. Never just assume that the health professional knows everything about you – it’s your job to educate them about your health history.

Consider asking a family member or friend to be there with you.

It may provide peace of mind to have a family member or friend accompany you to the hospital on the day of surgery. For same-day or out-patient surgery, you may need them to provide a ride home. This person can also be there to help you understand information you may receive, take notes about the procedure or care, or participate in healthcare decisions while you are hospitalized. Speak with your clinician to see what level of family or friend involvement may be needed.

Know that "more" is not always better.

It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.

If you have a test, ask when the results will be available.

If you don’t hear from the clinician or the lab, call to ask about the test results.

Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.
For example, treatment recommendations based on the latest scientific evidence are available from the National Guideline Clearinghouse™ at http://www.guideline.gov. Ask your doctor if your treatment is based on the latest evidence.

How Can You Prevent Infection?

Thorough hand washing is an important way to reduce the spread of infections anywhere, at home, at work, in the community, and in healthcare facilities. For information on the best techniques for hand washing, as well as a list of situations in which you should always wash your hands, click here for the federal Centers for Disease Control's Clean Hands Campaign information.

Always wash your hands before touching a hospital patient who you are visiting and don't visit anyone in the hospital while you are ill.

If you are a hospital patient and have a family member or friend who is ill, ask that person not to visit you in the hospital until they are well.

Many hospitals have sinks or hand washing gel dispensers outside of patient rooms so you may not always see your healthcare personnel clean their hands. If you have not seen your doctor, nurse, or other healthcare worker wash their hands, do not hesitate to ask them if they have washed their hands before allowing them to touch you.

Before you leave the hospital, if you have any breaks in your skin, such as from an injury or where you had surgery, make sure you understand how you are supposed to care for the area once you get home. Your doctor or nurse will give you specific instructions about when you can get the area wet, whether you should keep it covered, and how to keep it clean. If you have not received these instructions, ask before you leave the hospital. It is very important that you follow these instructions carefully because it is easy for bacteria that cause infections to get into your body through a break in your skin.

Patient Guides on Healthcare-Associated Infections

Developed by the SHEA Patient Safety and Quality Improvement Committee in collaboration with the Centers for Disease Control and Prevention (CDC) (All guides are in PDF format.)