What are the most common medical errors and how can you protect yourself?
There is a patient safety epidemic in Canada, but the public knows almost nothing about it.
Preventable harm in our healthcare system is the third leading cause of death in the country. In 2018, Ipsos Public Affairs surveyed Canadians about their awareness of patient harm in our healthcare system. 67% of Canadians surveyed did not consider patient safety to be a top 3 healthcare priority, while just 10% believed the rate of preventable deaths caused by patient safety incidents reported by the Canadian Patient Safety Institute.[1]
In this blog post, we will identify some of the most common adverse events resulting from medical management and categorize the different types of medical errors to help you recognize situations that may involve medical mismanagement. We will conclude with tips and resources to help protect you and your loved ones from medical error.
Common Adverse Events from Medical Management
The most common adverse events resulting from medical management include:[2]
Adverse drug events;
Catheter associated urinary tract infection;
Central line associated bloodstream infections;
Injury from falls or immobility;
Obstetrical adverse events;
Pressure ulcers (bed sores);
Surgical site infections;
Blood clots;
Ventilator associated pneumonia;
Wrong site/wrong surgery; and
Failure to diagnose or misdiagnosis of the following conditions:
a. Cancer related issues;
b. Neurological related issues;
c. Cardiac related issues;
d. Complications during surgery and post-surgery; and
e. Urological related issues.
Classification of Medical Errors
The specific types of medical errors have been categorized to include performance errors, failure to take preventative measures, diagnostic errors, improper drug treatment, and systemic errors.[3]
The most common form of physician error has been found to involve errors in the performance of a procedure or operation. The second and third most common types of physician errors were found to be failure to take preventative measures and diagnostic errors, respectively.
i. Performance Errors
The forms of performance errors include inadequate preparation of patient for procedure, technical error, inadequate monitoring of patient after procedure, use of inappropriate or outdated therapy, avoidable delay in treatment, and physicians or other healthcare professionals practicing outside their area of expertise.
The most common incidence of performance error has been found to be technical errors, which accounted for 76% of such errors. However, there remains a significant proportion of surgical errors involving mismanagement prior to or following the surgical procedure.
The causes of surgical errors may include lack of adequate surgeon training or education, absence of standardized rules and regulation, gap in communication between surgeon, anesthesiologist, and other ancillary staff, gap in communication between surgeon and patient, or time restraints.
ii. Preventative Errors
The preventative errors involve failure to take precautions to prevent accidental injury, failure to use indicated tests, failure to act on results of tests or findings, use of inappropriate or outdated diagnostic tests, avoidable delay in treatment, and physicians or other healthcare professionals acting outside their area of expertise.
The most common incidence of preventative error involves failure to take precautions to prevent accidental injury, which accounted for 45% of such errors.
In a healthcare setting, many factors may increase the risk of falling. These include blood loss, medication side-effects, decreased blood sugar, altered mental state, environmental change, urge to void or defecate, and decreased strength or balance.
iii. Diagnostic Errors
The diagnostic errors include failure to use indicated tests, failure to act on results of tests or findings, use of inappropriate or outdated diagnostic tests, avoidable delay in diagnosis, and physicians or other healthcare providers acting outside their area of expertise.
Inaccurate diagnosis may occur with clinicians, radiologists, and pathologists. Diagnostic errors are most common among primary care physicians in solo practice. A common cognitive error undermining the diagnostic process is closing the process prematurely, which can involve a benign or common diagnosis being given to a patient with an uncommon, serious disease.
Commonly missed diagnosis includes acute renal failure, acute renal failure, acute pyelonephritis, acute vascular occlusion, aneurysms, angina, appendicitis, arrhythmias, asthma exacerbation, cellulitis, decompensated heart failure, metastatic cancer, metabolic disorders like hypoglycemia, gout, osteomyelitis, pneumonia, spinal cord compression, symptomatic anemia, and urinary tract infection.[4]
The most common incidence of diagnostic error involves avoidable delay in diagnosis, which accounted for 55% of such errors. Inaccurate
iv. Drug Treatment Errors
Drug treatment errors include error in dose or method of use, failure to recognize possible antagonistic or complementary drug-drug interactions, inadequate follow-up of therapy, use of inappropriate drug, avoidable delay in drug treatment, and physicians or healthcare professionals practicing outside their area of expertise.
Error prone situations and medications include:
Antithrombotic agents (e.g., insufficient dosing leading to a thrombotic event like a stroke, excess dosing resulting in bleeding)
Cardioplegic solutions (e.g., errors in preparation, team breakdown, lack of technical competence, and poor monitoring of the patient)
Chemotherapeutic agents (e.g., administering the wrong dose, wrong drug, wrong number of days supplied, and missed doses). In addition, drug administration errors including wrong flow rate or failure to monitor the site of intravenous (IV) transfusion are often reported with chemotherapeutic drugs administered intravenously.
Dialysis solutions (e.g., administering the wrong medication, wrong dose, infection at the site, hyperkalemia, patient falls, and access-related errors)
Epidural or intrathecal medications (risks include erroneous infusions-administering an IV medication via the intrathecal route, giving wrong medication or wrong dose)
Hypertonic solutions (known to cause renal failure, edema, hyperchloremic metabolic acidosis, coagulation abnormalities)
Hypertonic sodium chloride for injection (associated with renal failure, confusion, coma, seizures)
Hypoglycemic agents (known to cause hypoglycemic episodes when the dose is unmonitored)
IV Adrenergic agonists such as epinephrine, norepinephrine, and phenylephrine (administered in a vein that infiltrates, can lead to severe vasoconstriction leading to ischemia and gangrene of the hand and digits)
Narcotics and opioids (prescribing and dispensing high doses of opiates to native opiate users resulting in respiratory depression, seizures, and even death)
The most common incidence of drug treatment errors is inadequate follow-up of therapy, accounting for 45% of such errors. The public can submit reports of medical errors at www.mederror.ca. This website was created by the Institute for Safe Medication Practices Canada to further understanding and prevention of medical errors.
v. Systemic Failures
Errors of systemic failure include defective equipment or supplies, equipment or supplies being unavailable, inadequate monitoring equipment, inadequate reporting or communication, inadequate training or supervision of physician or other personnel, delay in provision or scheduling of service, inadequate staffing, and inadequate functioning of hospital service.
The most common form of systemic failure is inadequate training of physician or other personnel, accounting for 31% of such errors.
How Can Canadians Protect Themselves from Medical Errors?
i. Ask These Five Questions About Your Medications
Drug treatment errors become more frequent when patients require multiple medication or transition between treatments. Understanding the right questions to ask about medication enables you to be an active partner in your health.
The Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacists Association, and the Canadian Society for Hospital Pharmacists collaborated to create a list of important questions to ask about medications.[5] Their list is reproduced below:
Have any medications been added, stopped, or changed? If so, why?
What medications do I need to keep taking, and why?
How do I take my medications, and for how long?
How will I know my medication is working, and what side effects should I watch for?
Do I need any tests and when do I book my next visit?
Understanding the answers to these questions can help you mitigate drug treatment errors.
ii. Understand Signs of Rapid Deterioration
Family and loved ones can be an important part of the healthcare team. They are often better positioned to perceive subtle but vital changes in condition. Shift to Safety provides a list of ten key warning signs of a rapidly deteriorating patient. Their list is reproduced below:
Body temperature is too high or too low;
Changes in heart rate or respiratory rate;
Blood pressure is outside the normal range;
Changes in mental state (confusion, delirium, or personality, memory, or alertness);
Changes in urine output or appearance;
The patient states something is wrong with them;
The patient does not look right;
Shortness of breath or chest tightness;
Acute pain, particularly in the abdomen; and
Very pale appearance or breaking out in cold sweats.
Research has identified warning signs occurring about 6.5 hours before almost all critical inpatient events. If you are concerned about a loved one’s condition, then you have the right to ask questions. To speak up or elevate your concerns, try the following phrases:
I am concerned about my loved one’s condition
I am uncomfortable with my loved one’s condition
I believe the safety of my loved one is at risk
For the complete guide and details of each sign of deterioration, visit Deteriorating Patient Condition (patientsafetyinstitute.ca). [6]
iii. Review the Shift to Safety Tools and Resources
Shift to Safety provides a breadth of tools and resources to help patients and their loved ones:
Speak up and ask questions;
Convey more relevant information about their illness or injury;
Make home care safe;
Navigate the healthcare system; and
Make wise healthcare choices.
All Canadians are encouraged to review the extensive listing of tools and resources made available through the Canadian Patient Safety Institute at Shift to Safety (patientsafetyinstitute.ca). [7]
References
[1] Canadian Patient Safety Institute. Awareness of the Patient Safety Crisis in Canada. Accessible at: Awareness of the Patient Safety Crisis in Canada (patientsafetyinstitute.ca)
[2] Agency for Healthcare Research and Quality, 2020
[3] Leape, LL, Brennan, TA, Laird, N, Lawthers, AG, Localio, AR, Barnes, BA, et al. The nature of adverse events in hospitalized patients. N Engl J Med 1991; 324:377–84. Brennan TA, Leape LL, Laird NM et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. 1991. Qual Saf Health Care2004;13:145–51, discussion 51–
[4] Rodziewicz TL, Houseman B, Hipskind JE. Medical Error Reduction and Prevention. [Updated 2022 Jan 4]. Accessible from: https://www.ncbi.nlm.nih.gov/books/NBK499956
[5] Canadian Patient Safety Institute. Ask the Right Questions About Your Medications. Accessible at: Five Questions to Ask about your Medications (patientsafetyinstitute.ca)
[6] Canadian Patient Safety Institute. Recognizing Deteriorating Patient Condition – What the public needs to know! Accessible at: Public : Deteriorating Patient Condition (patientsafetyinstitute.ca)
[7] Canadian Patient Safety Institute. Shift to Safety: Public. Accessible at: Public (patientsafetyinstitute.ca)
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