Medical Errors in the U.S. & Internationally in the HealthCare

Industry

By: Stephanie Bauer, Sarah Martin, Victoria Johnstone & Katelyn Vanacore

Student ID’s: 54007601, 55007313, 24008352 and 17009014

PLA4522: OM1/OM2: Dr. Elliot’s Healthcare Law Class FALL 2013

Introduction

Are Medical Errors still prevalent in

today’s U.S. and International

Healthcare Industry?

*Issues with medical errors have constantly increased throughout the years * Medical errors can be very detrimental to patients* Many horror stories such as wrong dosages of medicine being given to patients all the way to operations going completely wrong!* These errors can lead to morbidity and mortality* An implementation of many new suggestions are needed in order for the healthcare field to decrease these medical errors that are occurring in order to sustain lives and implement patient safety in healthcare establishments* Errors are known to occur when procedures and processes do not happen the way they were intended to happen* Laws that involve medical errors are known to be called tort laws that include malpractice and negligence* States are trying to move away from tort laws that involve medical errors and treat cases such as these more like Worker’s Compensation.* Many factors that are implemented within a healthcare facility in order to reduce the amount of medical errors that occur so frequently today

Statistics on

Medical Errors

• Have known to be going on for years within the healthcare industry

• Year 1999: Agency of Healthcare Quality shared research that was known about medical errors how they were detrimental to society and healthcare agencies

• Made known about medical errors hoping that healthcare facilities would change these errors

• According to the Institute of Medicine report: “To Err Is Human: Building a Safer Health System”: concentrated on patient safety and errors in hospitals all over U.S. (Clark, 2004).

• From IOM report: Many as 44,000 to 98,000 patients die each year due to errors in U.S. hospitals.

• From IOM report: errors cost the nation roughly 37.6 billion each year and of that money $17 billion is linked to preventable errors!

• 8th leading cause of death in the country (Clark, 2004)

• Tend to increase a patient’s hospital stay by two to five days and medical bill is $6,000 more because of the errors

• A doctor, on average, makes five errors out of every 1,000 prescriptions that are written

Statistics Continued…• American Hospital Association: Five types of medical errors that occur the most:• Patient information that’s incomplete (patient’s allergies & up to date drug info not available)• Drug orders that are miscommunicated or mixed up due to names that sound alike or spelled

similar• Drugs that are labeled incorrectly• When physician is in an environment that is noisy, hot or badly lit

• In a first study that was setup in Iran in internal wards of a teaching hospital for a two month period patients were under care with many types of doctors. This study was based on amount of errors that occurred within timeframe. Out of 132 patients 262 errors occurred found by the clinical pharmacist overseeing facility. Most common errors were wrong frequency, wrong selection of drugs used, forgot to order more medication for patient. Wrong dosage amount of medication,, lack od monitoring patients and forgetting to discontinue medication ( Clinical pharmacist oversaw many errors and was able to fix many before they occurred) Study has found that clinical pharmacist is a benefit to a hospital facility and can help reduce many errors before they occur (Abbasinazari, Hajhossein, Eshraghi & Sahraei, 2013)

• It is possible errors stem from lack of education; the more a healthcare worker interacts in the field the less mistakes one makes and more comfortable one feels

• Errors leading from sleep deprivation of physicians and nurses are known to cause medical errors by 36% and equivalent to the behavior of an intoxicated person (Czeisler, 2009).

• IOM Recommended: physicians not work more than 16 hours without sleep and not be allowed to drive home after 16 hours of work- 20% become depressed, 74% - burnout, not safe for patients.

• Known that tens of thousands of patients and doctors are injured and thousands lose their lives (Czeisler, 2009).

Important Facts to Know about Medical Errors

• Malpractice Law: costing more money to buy defensive medicine, does not keep the cost down of healthcare.

• 75% of claims usually get compensated, Takes about 5 years for patients and 54% of compensation is spent on legal fees (Taylor, 2009).

• Average doctor is sued at least once every six years and spends $30,000 to $200,000 a year on insurance.

• Doctors lose malpractice lawsuits 30% of the time, and they then have their names slandered for an error that they most likely did not cause

• Not been any evidence that changing malpractice laws will help cost of healthcare- but defensive medicine estimation costs are 20 billion a yr and 8 % about of healthcare spending ( Taylor, 2009).

• Only people who benefit from malpractice system= Lawyers on either side of issue

• Best idea to resolve this situation: Have Malpractice lawsuits be sent to specialized healthcare court= quicker and definite compensation & less legal costs, would also protect doctors & help reduce cost of defensive medicine ( Harvard School of Public Health & Common Good both heading towards this public health court idea)

Types of Medical Errors

Lack of attentiveness - missed predictable complicationsIncomplete patient information - not knowing about patients allergies or medicines they are currently takingInappropriate judgment - failure to recognize implications of a patients signs and symptomsMedication errors - wrong drug or wrong amountLack of intervention on patient’s behalf - failure to follow up on signs of patientLack of prevention - failure to prevent threats to patient safety such as breaches of infection control or precautionsMissed or mistaken doctor or healthcare provider’s orders - carrying out inappropriate orders or mistaken ordersDocumentation errors - charting procedures or medications before completion or failure to chart observations (Alendar& Aktas, 2013 p.308)

Statistics on Types of Medical Errors

• Multiple studies found high rates of antiretroviral medication errors among infected patients with HIV (Kagan & Barnov, 2013).

• Errors occur almost daily• Study of pediatric cardiac surgery team found 90% of

respondents state that they had encountered medical errors 41% of errors reported them to happen daily

• A large study documenting errors in 10 medical practices over a two week period reported 397 errors per 1,000 appointments, of these 32% = prescription errors, 23% were communication errors, 12% were equipment errors, and 2% were clinical errors ( Sohn, 2011).

Prevention of Medical Errors

• Studies have shown equipment failures and technology are the causes for a large portion of all operating room errors that occur in healthcare facilities

• Prevention of Medical Errors Tools• Safety checklists or specific equipment checklists - could implement few errors

within operating room• Not blaming anyone for medical errors, concentrate on delivering proper of care to

patients• Incident reports, quality assurance committees and state databases are all used for

medical error prevention• Mandatory reporting to a national agency is a step to take to minimize mistakes as

well (Clinical digest, 2013).• Physicians are normally very scared of having a mandatory reporting system they

fear that they will be in more malpractice situations – if they do not want to go with this type of system they can go with a system that examines the facility and points out recommendations such as checklists that help organize a healthcare facility so errors are less likely to occur.

Prevention of Medical Errors Statistics Continued

• U.S. Senate Health, Education, Labor and Pensions Committee passed bill on July 23, 2003 which created a national voluntary medical system that providers of healthcare could disclose mistakes to private patient safety establishments. These establishments would then seek causes for different types of errors and report back to providers on giving advice how to avoid them in future.

• Reporting errors can make doctors learn from past mistakes and experiences and learn how to deal with those same experiences in the future (Clark, 2004).

• Department of Veteran Affairs implemented a bar code system which reduced many errors. This system required ID strips that are worn by nurses and patients and attached to certain medications - as for drug dosage amount and drug type. Before a patient is prescribed a drug the ID strip is scanned by the nurse and implements information from that ID strip into a computer system and verified that the drug will not cause interactions with other drugs and that the drug is being given correctly with dosage prescribed. This system keeps a record of the activity of the patient and the drug that is prescribed. If there is a potential problem there is a flash warning that goes off on the ID Strip and in the system.

• Many errors have come about and healthcare facilities are getting rid of potassium chloride and other drugs-dangerous and drugs have accidently overdosed patients (Clark, 2004).

• Physician order entry systems are also a way of prevention of medical errors- physicians’ handwriting not all of the time is legible . A system such as this implements prescriptions for patients into a computer system that does the prescriptions for patients and that implements them and known to have reduced medical errors 86%

• Nurse shortages lead to many medical errors. In order to hire more healthcare workers such as nurses, this would implement less medical errors for healthcare facilities.

Patient Safety Laws

• Has become a core value within the contemporary workplace ( Patient Safety)

• Each state has individual patient safety laws

• Some states require medical errors be made known to publicly to patients, some do not

• Other states have no fault laws- allow a physician to apologize to a patient without that conversation being used against one in a court case

• State and federal law do require certain errors to be reported to a state and federal agency

• On July 29, 2005 President George W. Bush signed the Patient Safety and Quality Improvement Act that established a national medical error reporting system and gave the federal government the right to view this data

• Patient Safety and Quality Improvement Act gave protection to physicians so they would voluntarily report safety issues in an attempt to make changes to medical systems that would help reduce medical errors and included incentives to participating physicians.

• Reporting systems would determine why errors were occurring and attempt to improve the system in order to improve patient safety ( Howard, Iacovelli, Levy & Mareniss, 2010).

Malpractice Reform & Apology Laws

• Several initiatives around the country with purpose of reforming medical malpractice

• One- to create apology laws which allow physicians to disclose errors and apologize without fear that this information will be used against them in court such as a malpractice case. The hope is that disclosing mistakes will lead to positive changes that will improve patient safety ( Dresser, 2008).

• Another way states are looking to reform the issue of malpractice is to treat medical errors more like no-fault Worker’s Compensation. Patients then can make a claim against their provider that would go before a patient injury board. The board includes physicians, patient advocates and attorneys and they would review all the fact of the claim and decide if compensation is warranted. Payment would come from general fund that is supported by premiums paid by physicians - just like no-fault coverage of Worker’s Compensation injuries) Idea with this reform: to stop physicians from having to practice defensive medicine and help patients get compensated for amounts that are to small to go through court system and much quicker for the patient (Latner, 2013). This system would improve quality and efficiency and decrease medical errors.

Malpractice Reform & Apology Laws Continued

• No-fault Worker’s Compensation advantages include no need to prove fault, ongoing care provision means care continues even during compensation review & savings in legal fees (Symon, 2011).

• Malpractice is defined as medical errors in health services

• Medical errors are accepted as the action and situation that happens as a result of the health personnel which does not conduct the standard procedure intentionally, by mistake or ignorance.

Protecting Patients and Doctors from Lawsuits• In order to protect patients and doctors

from lawsuits. Tort laws for malpractice and negligence were put into place

• Malpractice can include: professional misconduct or demonstration of unreasonable lack of skill resulting in injury, loss or damage to the patient

• Negligence is an intentional act that occurs when someone performs or fails to perform an action that a reasonable professional would or would not have performed in a similar situation.

• Patients or their families who do not like the outcome of a procedure or visit will claim negligence against the physician, hospital and staff. The job of a jury is to decide the outcome of a negligence case (Fremgen, 2012).

Our Opinion on Medical Errors in the Healthcare Industry in General

• Healthcare industries must stay organized in order to prevent medical errors• Each healthcare worker needs to communicate with each other so no steps are

skipped• There are certain precautions to take in order to prevent medical errors from

occurring• Physicians need to communicate to their patients and the people they work

with in the healthcare facility so that everyone is on the same page when it comes to patient care

• Triple checking of each party member could most likely cut the occurrence of medical mistakes in half!

• Errors are not only caused by healthcare workers but also the patient. Patients when they do not report unusual affects or medications they are taking can also lead to medical errors.

• Order entry systems instead of paper based systems, health care workers that are not overworked and having effective communication with patients after being discharged are all great ways to prevent future medical errors

Continuation of Our Opinions

• We live in a litigious society and every time a doctor gives an incorrect diagnosis, or performs a test that does not give answers quickly enough, a patient or their family sues the doctor or a hospital because they feel the doctor or hospital should have done something better, faster, or sooner. The way the current laws are written, all a patient has to do is look hard enough and one can find a reason to sue a physician or a hospital. We think that no-fault compensation and apology laws give the physicians and hospitals back the confidence to do their jobs without the fear of litigation which is always hanging over their heads. These preventative methods will also help healthcare industries save money and will be able to contribute more profit into the organization instead of the organization losing money from these medical errors that are occurring.

ConclusionWith the statistics that have proven that many people die each year because of medical errors, in which some are preventable, there needs to be an implementation of factors towards reducing the number of medical errors that have been occurring in today’s healthcare society. Medical errors are known to be the 8th leading cause of death in the country and will continue to rise if something is not done to diminish these medical errors that are occurring in the healthcare industry today. Doing so, we as a nation, can save lives and can improve healthcare facilities to improve safeness, and quality of care to all patients. Using all of the preventative methods that we discussed in this PowerPoint presentation, we as a nation, can advance in healthcare facilities by using these methods and focus on patient quality and care rather than focusing on when the next medical error will occur. Over the years, medical errors have led to many state and federal laws designed to compensate patients and their families for injuries suffered as the result of negligence or malpractice. Under the current system, physicians spend great amounts of time and money practicing defensive medicine to avoid being held liable for malpractice or, even, situations that are beyond their control, but not beyond their blame. States are looking for ways to help patients get compensated, Doctors stay protected, and quality is improved, all at the same time. If one person takes the time out of his or her day to focus on one’s job and use these preventative methods, it could be saving patients’ lives.

The END • That is what the healthcare industry is all about; saving lives and improving the quality of care for patients is the primary goal. An organization’s future depends on the quality of care that is given!

Reference Page:

• Abbasinazzari, M., Talasaz, H., Eshraghi, A., & Sahraei, Z. (2013). Detection and management of medication errors in internal wards of a teaching hospital by clinical pharmacists. Acta Medica Iranica, 51(7), 482-486. Retrieved from http://db25.linccweb.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=89764615&site=ehost-live&scope=site

• Alendar, K., & Aktas, Y. (2013). Medical error types and causes made by nurses in turkey. TAF Preventive Medicine Bulletin, 12(3), 307-314. doi: 10.5455/pmb.1-1345816200

• Clark, P. (2004). Medication errors in family practice, in hospitals and after discharge from the hospital: An ethical analysis. Journal of Law, Medicine & Ethics, 32(2), 349-357. Retrieved from http://db25.linccweb.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=16288857&site=ehost-live&scope=site

• Czeisler, C. (2009, October 24). It's time to reform work hours for resident physicians. 176(9), 36-36. Retrieved from http://db25.linccweb.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=44745630&site=ehost-live&scope=site

• Dresser, R. (2008). The limits of apology laws. Hastings Center Report. 38(3), 6-7).

References…• Kagan, I., & Barnoy, S. (2013).

Organizational safety culture and medical error reporting by israeli nurses. Journal of Nursing Scholarship, 45(3), 273-280. doi: 10.111/jnu.12026

• Kaprielian, V., Ostbye, T., Warburton, S., Sanqvai, D., Michener, L. (2008). Volume 1: Assessment: A system to describe and reduce medical errors in primary care. In Advances in Patient Safety: New Directions and Alternative Approaches. Rockville, MD: Agency for Healthcare Research and Quality.

• Lancet. (2005). Technology can make patients safer. Brunel University, 366(9486), 608-608. doi: 10.1016/S0140-6736(05)67113-9

• Latner, A. W., (2013). Malpractice news. Renal & Urology News. 12(7). 28.

References continued:• MacCourt, D., & Bernstein, J. (2009). Medical error reduction and tort reform

through private, contractually- based quality medicine societies. American Journal of Law & Medicine, 34(4), 505-561. Retrieved from http://db25.linccweb.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=48307162&site=ehost-live&scope=site

• Mattox, E. (2012). Strategies for improving patient safety: Linking task type to error type. Critical Care Nurse, 32(1), 52-78. doi: 10.4037/ccn2012303

• McCarthy, M. (2011). U.S. to spend $1 billion on patient safety. National Journal Daily, 5-5. Retrieved from http://db25.linccweb.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=60012686&site=ehost-live&scope=site

• New sun tech software aims to reduce risk of clinical errors. (2013, September 11). Medical Device Daily, 17(175), 7-7. Retrieved from http://db25.linccweb.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=90255585&site=ehost-live&scope=site

• Nursing Standard. (2013, August 21). Clinical digest. Equipment-related failures account for a large proportion of all operating room errors. Retrieved from http://db25.linccweb.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=89918740&site=ehost-live&scope=site

References Last Page• Rolland, P. (2004). Occurrence of dispensing

errors and efforts to reduce medication errors at the central arkansas veteran;s healthcare system. Drug Safety, 27(4), 271-282. Retrieved from http://db25.linccweb.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=12754023&site=ehost-live&scope=site

• Symon, A. (2011). No-fault compensation: back on the legislative agenda. British Journal of Midwifery. 19(6). 400-401.

• Taylor, S. (2009). Wasting billions, doing injustice. National Journal, 3-3. Retrieved from http://db25.linccweb.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=44520852&site=ehost-live&scope=site

• Whiteley, M. (2011). Quality skills training. Nursing Standard, 25(34), 60-60. Retrieved from http://db25.linccweb.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=60405317&site=ehost-live&scope=site

Presentation By:Group 7 Healthcare Law Stephanie Bauer, Sarah Martin, Victoria Johnstone and Katelyn Vanacore Saturday, November 23,2013 at 11:00 a.m.