The one element most of these errors have in common is that they are usually inflicted when hospital staff are in a hurry, either because they are behind schedule or there is an emergency situation. A surgical team starting a routine procedure one hour late may try and rush through all of the pre-operative steps in order to get done for the day on time. This can be problematic if one of those steps that was glossed over was which kidney was supposed to be removed. To paraphrase comedian Tom Shllue, "So you're telling me that one of my kidneys is bad... and now you have the good one!?"
Unfortunately, saying oops isn't usually enough in healthcare.
How bad is the problem?
Unfortunately, medical errors are a humongous problem in the United States. Medical errors of all sorts kill approximately 43,000 Americans a year according to the CDC. Medication errors alone kill 7,000 or so and inflict grievous harm on many more. As medical technology improves it has allowed many patients to be saved but it also means that healthcare workers need constant reeducation on how to perform those new skills, handle that new equipment, and the risks and dangers of new medications and treatments. When that constant flow of new information is combined with a hectic hospital environment where each staff member has to treat multiple people each day, it can easily lead to serious problems.
For an example of how easy it is to make an error, most hospitalized patients are on at least five different medications. Some of these may be pills taken orally, other drugs go through IVs, some are injected into the skin, and some are pushed through J or G tubes-devices that enter the stomach or small intestine. So with a typical 3-4 patient caseload for a nurse, that's twenty or so different medications for different patients, some with different routes of administration, some of which may have to be given multiple times each day. Combine that amount of information to remember with the exhaustion brought on by 12 hour or longer shifts that some healthcare workers perform and you have a recipe for disaster.
How a hospital looks after 16 hours of working there. Medication labels don't look any sharper unfortunately.
When a sleep deprived person tries to deal with information that has multiple steps, like what medication is supposed to go to who, or which patient is getting what surgery on which body part, it's easy for screw-ups to occur. So how do we fix this problem? Fortunately there are a couple methods to stop the easily preventable mistakes that keep occurring in healthcare-medications errors and wrong-site or incorrect surgery.
Medication Barcoding
Barcoding medications works like it does with UPCs in a supermarket. Every patient room is equipped with a computer and a barcode reader. All the medications in the hospital are labeled with a barcode that can then be scanned, verifying what the medication is, its dose, and other important information about it. This is compared with the patient's medication profile in the hospital's computer system to make sure that everything is correct-this is the right medication and dose for this patient.
Aricept tablets with barcode on the side.
The scanner is then used to scan the patient's wristband. Every patient in hospitals has these wristbands nowadays to ensure that they can be identified easily. If the medications that were scanned don't match up with the wristband that is scanned, the barcode system will deliver an error message and the person giving the medications will know that something is wrong and take a look at the problem.
Unfortunately, you can't just call for a price check to figure out the problem like you can at Wal Mart.
If used properly, this system prevents the vast majority of medication errors. Any staff member will get a warning that they're doing something wrong if they brought the wrong patient's medications into a room, have the wrong dose, or some other problem.
The main problem with the system is that it takes a bit more time than older methods of medication administration. Barcodes can also be torn, difficult to scan, or non-functional for other reasons. This necessitates a manual override being available for the system, but many staff members misuse this to give a lot of medications in a hurry when they're busy or behind in their shift. It's important for this inappropriate use of manual overrides to be unacceptable in a hospital organization for the system to work. Fortunately, it only takes one error being caught to make staff members get on board with the system.
Surgical Checklists
Airlines and other complex high risk industries have been using checklists in their normal course of operations for decades. They make sure that pilots and other staff don't forget any important details when they are preparing to do their job.
Killer shades? Check!
Most surgeries, particularly routine surgeries, still have a number of steps that have to be taken before each procedure to make sure that everything is correct. The patient is usually under anesthesia when they are brought into the operating room, so they are unable to verify any of this information. The patient must be identified, the surgical site and surgical procedure confirmed, the use of pre-incision antibiotics discussed, and any potential complications brought up as well. For instance, if the patient had a blood clotting problem that might be a special concern to bring up, as blood would need to be available in the event of an unanticipated severe bleed.
To resolve this problem, many hospitals now use a timeout before a surgery begins that discusses all of these problems. Look at this video to see an example of a good timeout.
Of course, there are plenty of surgeons and other staff who don't see the point of taking a few minutes at the start of every procedure to do this. Here's a couple examples of poor timeouts.
Conclusion
Medical errors continue to occur at unacceptable rates. Barcoding medications and surgery timeouts are too ways to prevent some of the worst errors-inappropriate medication administration and wrong site or wrong procedure surgery. However, they are only effective when they are taken seriously by staff. It may take a few minutes of time, but it's well worth it when it prevents a lifetime of disability to the patient.
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