Dangerous medical mistakes

They can happen at any level of the health care system, from your local clinic and pharmacy to hospitals and long-term care facilities. Medical mistakes or “preventable adverse events” can lead to injury, permanent disability and even death — and some experts argue there’s more we should be doing to stop them.

How common is the problem? Exact numbers are hard to pin down: it depends on who is doing the reporting (patients versus staff, for instance) and how an adverse event is defined (for example, not all mistakes are considered to be preventable). Different institutions have different reporting structures, and researchers often focus on a particular institution like a hospital or long-term care facility rather than the problem as a whole.

However, to give you a sense of the scope of this issue, a recent study published in the Journal of the American Medical Association found that around 15 per cent of patients report errors each year. The World Health Organization (WHO) says there is a 1 in 3 chance a patient will experience harm somewhere in the healthcare system — though some smaller studies peg this number as high as 50 per cent. Roughly 1 in 10 patients in developed countries suffers harm while receiving hospital care.

How many people die from mistakes that could have been avoided? According to the Canadian Patient Safety Institute (SPSI), between 9,000-24,000 Canadians die from preventable adverse events each year. In the U.S., that number reaches an estimated 180,000 people. Unofficially, medical errors are a top cause of death in industrialized countries despite all the advantages we have like sanitary conditions and skilled staff.

And here’s another scary thought: a recent study out of the U.S. suggest that numbers still aren’t going down. A six year study examining 10 North Carolina hospitals published in the Nov. 25 issue of the New England Journal of Medicine showed that error rates didn’t decline despite new policies and educational campaigns. (However, critics argue that all new measures take time to show progress.)

In fact, medical errors could be increasing. According to an editorial in the Canadian Medical Association Journal, the complexity of care we’re now seeing plus a breakdown in communications may be leading to more mistakes. Furthermore, overworked doctors and staff are increasingly suffering from burnout, and doctor-patient relationships are suffering. (Read the full editorial here.)


Top mistakes

Unusual occurrences make the headlines and TV dramas, but what are we really up against? Here’s a look at some of the top issues that worry experts:

Hospital-acquired infections. According the WHO, at any given time there are 1.4 million people suffering from an infection they picked up in the hospital. One of the top sources? Germy hands. It’s no surprise that international educational campaigns are focussing on getting everyone — including staff, visitors and patients — to wash their hands. (See Head off hospital bugs.)

Compounding the problem is the fact many infections aren’t caught soon enough. Delays in diagnosis and treatment can have deadly results.

Prescription mistakes. Medication errors affect about one million Canadians each year, resulting in about 700 preventable deaths. Mistakes can happen at the pharmacy — like getting the wrong dose or wrong medication when you fill your prescription — as well as at home. In a hospitals, medication mix-ups are possible and even if you get the right one, the dose could be too much or too little. In some countries, 1 in 10 hospital admissions is due to an adverse drug event.

Patients can be their own worst enemy too. It isn’t always clear how to measure medication, when to take it and what to do if you miss a dose. Patients aren’t always upfront about what medications and supplements they’re already taking, which could lead to dangerous interactions.

These mistakes are especially risky for baby boomers and seniors who are more likely to be taking multiple prescriptions. Almost half of the fatal medication errors occurred in people over 60, according to the Federal Drug Administration (FDA). (For more information, see Deadly Cocktails.)

Medical procedures errors. We’re warned that every surgery has a risk of complications, but many of them can be prevented. Horror stories like getting the wrong procedure (or in the wrong place) and instruments like sponges and clamps being left inside the patient happen more often than we’d like to believe. Problems with anaesthetic, poor communication and lack of briefing on risks and allergies can also put patients at risk.

Worse yet, according to the WHO, problems with surgical safety account for half of all deaths due to preventable adverse events. In the past two years, there’s been a major push to adopt a “Safer Surgery Checklist” to help avoid these common problems. (For more information, see Safer surgery: what you need to know.)

Misdiagnosis. True, some illnesses can be hard to diagnose — a lack of expertise and faulty lab test results can also be to blame. With a misdiagnosis, patients are doubly at risk. Not only are they getting treatment they may not need — including surgery and radiation therapy — they are also not getting the treatment they do need. In the meantime, the untreated health problem can get worse. For example, when Celiac disease is misdiagnosed as irritable bowel syndrome, continuing to eat gluten can cause further damage to the small intestine.

Falls. All too often they get passed off as accidents, but falls can be caused by dangerous conditions (like a wet floor) or a lack of supervision or assistance. Falls can be especially devastating to older adults, leading to permanent disability and a loss of independence. As many as half of residents in long-term care facilities are injured in a fall each year.

Equipment failure. We expect technology to work perfectly, but that isn’t the case. The machines we rely on when we’re most vulnerable can sometimes break down — sometimes in the middle of surgery. Proper maintenance, repairs and safety checks can go a long way to minimize these risks.

Lack of communication. Your family doctor knows something your specialist doesn’t — or vice versa. We’d like to think that everyone is working together, but often the people responsible for a patient’s care aren’t sharing what they know. A lack of communication and poor organizational culture play a role in an estimated 70 per cent of adverse events — including many of the errors listed above. The WHO has identified this issue as one of the top priorities for future investigation.

What you can do to avoid errors

Unfortunately, there’s a lot we have to leave in the hands of governing bodies and administrations — like implementing new safety practices, improving reporting and transparency and breaking down communication barriers. However, there are some simple steps we can do to help protect ourselves, including:

Be informed. Arm yourself with information by doing some research of your own about your condition and treatment options. These days there’s a wealth of information out there in books and online, and doctors are increasingly relying on patient input in the decision making process. (Just be careful to use reliable sources — see Beyond Dr. Google for tips on where to look and how to evaluate information.)

Be honest. It’s hard to own up to things we’re doing wrong — like not exercising enough or smoking — but this information can be crucial for making health decisions. (See 10 secrets not to keep from your doctor for more information.)

Understand and follow instructions. Not sure how to take your medication or what to do when you go home from the hospital? Make sure you understand all instructions — and get them in writing. Talk to your doctor, read through the information you’re given and consult with your pharmacist.

Another tip: make sure you’ve got the right medication and the right dose before you leave.

Ask questions. Don’t be shy if there’s something you don’t understand. You have a right to ask questions about your tests and treatment options — and to seek a second opinion.

Take along backup. Sometimes it helps to have the support of a friend or family member — not to mention an additional person to ask questions and listen to instructions. Take along someone who isn’t afraid to speak up on your behalf.

Speak up. Ultimately, the best thing we can do is to speak up if we have questions or concerns — whether it’s your health or someone else’s at stake. It’s okay to ask staff to wash their hands before they touch you, or to double check medication before it’s administered. Make sure every expert you see has all your crucial information like your medical history.

In short, if something doesn’t seem right, go with your gut and seek confirmation or clarification.

For more information about patient safety, visit:
Canadian Patient Safety Institute
U.S. Agency for Healthcare Research and Quality

In addition, Health Canada has a list of Links on Patient Safety which includes provincial and international organizations.

Additional sources: BusinessWeek.com, Ontario Ministry of Health and Long-term Care website, USAToday.com, WebMD.com, the World Health Organization’s report on Patient Safety Research