The Mölnlycke Health Care blog
Preventive steps in reducing medical errors
Prevention is a healthcare buzzword, most commonly associated with helping patients to prevent conditions before they develop. Prevention, though, has another important side to it: working toward preventing as many medical errors as possible in the hospital and other settings.
According to a new study in the British Journal of Medicine1, medical errors are the third biggest cause of death in the United States, killing more people than automobile accidents, disease outbreaks, breast cancer, AIDS or drug overdoses. The study estimates up to a quarter-million fatalities in 2013. This figure may even underestimate the number of fatalities because "medical error" is not listed on death certificates as a cause of death nor is it included in the official rankings on cause of death compiled by the US Centers for Disease Control (CDC).
As the study makes clear, the role of error is complex, and both minor and more serious errors can occur anywhere within the system. For the purposes of the study, the researchers defined medical error as follows:
"Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome2, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning)3, or a deviation from the process of care that may or may not cause harm to the patient4. Patient harm from medical error can occur at the individual or system level. The taxonomy of errors is expanding to better categorize preventable factors and events5. We focus on preventable lethal events to highlight the scale of potential for improvement."
Despite this complexity, prevention is possible with better reporting and information availability. With better statistics and information about how medical error fits into the equation, new processes and monitors can be devised to deliver what can be described as more careful care. This can include everything from double checking information, writing prescriptions more legibly, providing clearer instructions to patients6, to taking a systems approach to prevent errors in surgical environments, such as wrong-site, wrong-side or wrong-level surgery7.
"Human error is inevitable. Although we cannot eliminate human error, we can better measure the problem to design safer systems mitigating its frequency, visibility, and consequences. Strategies to reduce death from medical care should include three steps: making errors more visible when they occur so their effects can be intercepted; having remedies at hand to rescue patients8; and making errors less frequent by following principles that take human limitations into account. This multitier approach necessitates guidance from reliable data."
The strategy and approach is multitier and should be data-driven, with guidelines, processes and protocols forged from these insights.
Careful care: No better time for data-driven processes and bespoke, customized solutions
One way to potentially reduce human error is to further remove on-the-spot judgment calls or last-minute, unplanned needs in certain hospital settings. No method is going to prevent every error, but taking preventive steps within, for example, the perioperative environment, can contribute to mitigating the frequency or likelihood of errors. These methods can be both procedural (processes, protocols, checklists and lean principles) and material-related (implementing solutions that contribute to error reduction, such as customized, procedure-specific surgical trays; colour-coding systems for easier, correct identification).
The devil in the details
Medical errors are a pervasive, complex and rarely discussed problem within healthcare. The BMJ study aimed to shine a light on the magnitude of this underreported problem to prompt a 'systematic measurement' of it. Without fully understanding the scope of the problem, it is next to impossible to take as comprehensive a tack on prevention as is possible. In the meantime, vigilance and rigour in adherence to procedural and material guidelines are the most effective preventive tools we have to reduce the incidence of medical error.
- BMJ 2016;353:i2139
- Leape LL. Error in medicine. JAMA1994;272:1851-7. doi:10.1001/jama.1994.03520230061039 pmid:7503827
- Reason J. Human error.Cambridge University Press, 1990. doi:10.1017/CBO9781139062367.
- Reason JT. Understanding adverse events: the human factor. In: Vincent C, ed. Clinical risk management: enhancing patient safety.BMJ, 2001:9-30.
- Grober ED, Bohnen JM. Defining medical error. Can J Surg2005;48:39-44.pmid:15757035.
- Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in Medicare patients. Ann Surg2009;250:1029-34. doi:10.1097/SLA.0b013e3181bef697 pmid:19953723.