Research Paper On Preventing Medical Errors In EMS

Abstract

There is a need for an organization to use evidence-based practice when providing healthcare services. Evidence-based practice helps the healthcare organization to identify the best practice for their patients. There are different types of errors that include surgical errors, medication errors and even practice errors. There are a number of factors that increase such errors which include sickness, overworking, illness, lack of caution and many other factors. The population that is more vulnerable to this error includes the older patient, and the very young ones, the patients in the ICU are also more prevalent. It is important for the organization to know that there are various ways that it can use to reduce these problems. Patients also have an important role in reducing error in the hospitals.
Key words: evidence-based practice, healthcare, medical errors

Evidence-based practice

There are three major factors that can ensure that the patient get the best healthcare services. These are clinical experience, patient values and preferences and best research evidence. Looking at these three factors closely, one can agree that clinical experience means that the person providing the health services to the patients has the best type of knowledge that can promise the patient that their health will be better. On the other hand, best research evidence means that the patient is treated using techniques that are tested, and there is evidence to show the effectiveness of the particular practice. In this case, there is a continuous research to find and come up with the best techniques that can be used to enhance medical services. Patient values are quite important when providing health services to a patient. For instance, when a patient from the Jehovah Witness goes to a hospital, then the health care providers should understand their beliefs. In this case, the Jehovah witness believes that blood has a soul, and thus they cannot accept a blood transfusion. It is in such cases that the values of the patients are considered when providing services to them. The combination of these factors is called evidence-based practice.
A number of experts have delved into the research to define the concept of evidence-based practice, but the most often used definition is from David Sacket. According to his description , it is a conscientious, judicious and explicit use of the current best evidence when making decisions about a particular care of a particular patient (Sacket, 2000). This means that the provision of health to the patients takes into account the individual clinical expertise in combination with all the best experience available and the clinical evidence from available research.
It is quite a common thing for errors to occur in the provision of healthcare. But it is not unto the providers of medical services to start pointing fingers at one another on why the error occurred. Instead, it should be a good opportunity for the medical practitioners to look at the errors as a way to learn and to avoid the mistakes. There has been confusion about exactly what medical errors are. Initially, many people used to argue that these are errors that nurses, pharmacists and doctors commit while they are providing medications. Over the year’s research have sought to come up with an all-inclusive definition of medical errors. According to an IOM report of 1999, an error is the failure to use the correct procedure and equipment when trying to accomplish a particular task (Institute of Medicine, 2000).
There are four major categories of medical errors: medication errors, diagnostic inaccuracies, medical device errors, and equipment errors (Institute of Medicine, 2000). Surgical errors are thought to lead the list of medical errors. Ideally, surgical errors are the kind of errors that include wrong procedures, wrong sites, or wrong person surgery. A study that was done in Utah and Colorado showed that surgical errors accounted for two-thirds of all errors in the hospitals that lead to death. When surgical errors occur in the surgical room, then it is not the responsibility of the surgical doctors, but rather it is the responsibilities of all the medical personnel in the surgical rooms. Secondly, there are diagnostic inaccuracies and, in this case, the doctor might make an inaccurate diagnosis of the patient. For the medication to be effective, it is up to the doctor to make an accurate diagnosis. An inaccurate diagnosis can delay the treatment, lead to ineffective treatment and even prove invasive and costly. Medication errors are any cases that lead or may lead to the inappropriate use of medication or patient harm. These cases only apply when the medication is in the control of the patient, consumer or healthcare professional. Such errors are one of the major concerns of physicians and nurses that have the responsibility for administering medication to a patient. The most common types of these mistakes include omission errors, improper dose, and unauthorized drug errors. There are also other problems related to medical devices and equipment. In the provision of healthcare services, there are many devices and equipment. The people that use these devices have a great responsibility of repairing them, ordering them and even maintaining them. It is common to have flaws, misuse, and malfunction of devices that eventually causes medical errors. Finally, systemic failures are one of the common types of medical errors.

Factors that increase the types of medical errors

There various issues that can increase the prevalence of medical errors in the medical practice. First, fatigue is one of the major causes of medical errors. At many times, people that overwork or work in a double shift are more prone to medical errors. As per the research conducted by Landrigan et al (2004), reducing the hours of work can reduce the prevalence of medical errors. Alcohol and drugs are totally incompatible with professional competence and safe patient care. Unfortunately, most of the healthcare providers get so stressed and have an easy access to medication which increases the chances of them using drugs. Illness is also another cause of medical errors. When a doctor goes to work when they are sick, then there are probabilities that they can commit medical errors. Distraction or inattention is also another common cause of errors in the provision of medical services. Common distractions include noise, busy emergency department and even pressure from the patients (Institute of Medicine, 2000). Emotional state of the doctors can also increase the chance of accidents in medical practice. If the doctor, nurse or physician is angry, afraid, anxious or bored then they might probably cause a lot of errors. In some case, a medical practitioner can be unfamiliar with a problem or a situation and thus make mistakes on their diagnosis and treatments. There can also be chances of equipment flaws that can also cause medical errors. Some medical practitioners have also mentioned that inaccurate and incorrect labeling causes many errors. Lastly, communication errors can also cause most of the errors.

Populations of special vulnerability

It is a thing of absolute importance for the medical practitioners to provide safety to the patients under their care. However, incidents of errors in the medical field are common, and it is of absolute importance for medical practitioners to find a way to reduce these errors. The groups that are commonly vulnerable to medical errors include the young and the older groups (Institute of Medicine, 2000). They are particularly vulnerable because of their inability to participate fully in the process of getting treatment. The older generation aged over 65 years is used to taking a lot of over the counter drugs. Although the medications they take can help improve their health, there is always the danger of misuse, overuse, and other complication. Among the problems these people might easily get is the polypharmacy, and this is where they use multiple drugs that eventually cause adverse effects. Another problem that they can easily face is visual, cognitive and hearing problems. As well, they might face a problem of slow metabolism. Infant children are even vulnerable to medical errors than any other group. The younger the child, the more vulnerable they are. There is always a problem of weight-based dosing. In most cases, physicians make mistakes while converting dosage from pounds to kilograms (Landrigan et al., 2010). Intensive care unit patients are another group of patients that are at a grave danger of medical errors (Institute of Medicine, 2000). Previous researchers have argued that most of the errors that occur in the ICU are cases that are preventable. Ideally, the intensive unit patients require extremely complex care, and this is what puts them at a greater risk of medical errors. Some common errors that occur in these situations include tubing misconnections, catheter-related infections, and respiratory complications.

Strategies to prevent infections, falls, and medication errors

Prevention of errors, falls, and infections is an important thing that healthcare practitioners need to learn. There is an increase in healthcare-associated infections that patients encounter while they are under the care of health practitioners. There are various ways that health care practitioners can use to deal with these problems. For instance, to deal with catheter-associated tract infections, the practitioners need to get good training on how to use a catheter, and they also need to comply with the CDC hand and hygiene standards recommendations. As well, there is a need for medical practitioners to take precaution during the surgical operations. Most importantly medical practitioners need to be careful before surgery and ensure that they administer the right antimicrobial prophylaxis. These should be administered in the accordance with the evidence-based standards and guideline. During the surgery process, the doors should be kept closed. Ideally, there are many regulations that guide surgical operations, and it is just necessary for the medical practitioners to observe these rules carefully. It’s also up to the hospital to come up with intervention that can reduce patient falls in the hospital. One way of dealing with patient falls is to identify the causes of the falls. After identifying the causes, the hospital has the responsibility of designing the appropriate fall prevention strategy. Medical errors can be reduced in the hospital if the medical practitioners observe the following rights. These are the right patient, right time, right, route, right dosage form, right dose, and the right drug. With this “six rights” then medical errors can be reduced.

Elements that comprise the root cause analysis (RCA)

Root cause analysis is a tool used to identify preventive strategies (Andersen & Fagerhaug, 2006). With such a strategy, it is possible to move away from the culture of blame and build a culture of safeguard. The main components of a route cause analysis are

What happened?

Why it happened
What things can be done to prevent the same from happening? A root cause analysis should also be thorough and credible.

Sentinel Events

The joint commission has been in a continuous process to evaluate healthcare centers to assess if they meet the commission's standards (Jost 1994). An area that the commission has been very keen on is on the sentinel event policy. These are the standards that the joint commission has set. A healthcare organization should have a process to recognize sentinel events. The organization should also conduct a thorough and also a credible RCA. The analysis should focus on process and the system factors rather than focusing on individuals and blaming them. It also requires the organization to document internal corrective action plan and also document a risk-reduction strategy. This should be done in 45 days.
There are four major goals that that the Commission has (Jost 1994). First, it aims to have a positive impact on trying to improve patient care, treatment and prevention of sentinel events. It also aims at making the healthcare organization that has experienced the sentinel to focus on the root problems. It also aims at increasing the general knowledge about the sentinel events, contributing factors and the prevention strategies. Lastly, it seeks to maintain the confidence of the public as well as a credible organization the accreditation process.

Steps patients can take to help prevent errors

Patients are also part of the team that can help in reducing errors in health care organization. These are the steps that they can take to reduce the errors. As a patient, you should ensure that you get your doctors aware of anything you are taking. This could include things like over the counter medication and even dietary supplements. Once a year you need to bring all your medication to the doctor. Get all your doctors informed of all any allergies you have to any medications. It is important that you ask your doctor to write your medication in a way that you can properly understand and read. If you cannot read what the doctor has written then you better talk to the doctor. When picking your medicine from the pharmacist, ensure that you inquire if that is the medicine that the doctor prescribed. If you have qualms about the prescription and directions, then you better make an inquiry before leaving the hospital. Lastly, you should ask the pharmacist to direct you to the best device that you can use to measure your medicine.
In conclusion, medical errors are a thing that the medical practitioners can deal with. It is up to the organization to come up with the best medical procedures so as to deal with these problems. There are interventions that organizations can take to deal with the problems. Understanding the major problems that result to most of the errors in the organization is the first step towards reducing error in the healthcare organization. Other factors that increase medical errors can be analyzed when the organization seeks to reduce these errors. Ideally, it is important for the patients also to see what they can do to help an organization in reducing errors that occur during the medical practice.

References

Andersen, B., & Fagerhaug, T. (2006). Root cause analysis: simplified tools and techniques. ASQ Quality Press.
Centers for Disease Control and Prevention (CDC).(2009). National Hospital Discharge Survey: Survey results and products. Retrieved from http://www.cdc.gov
Jost, T. S. (1994). Medicare and the Joint Commission on Accreditation of Healthcare Organizations: a healthy relationship?. Law and contemporary problems, 15-45.
Landrigan, C., P., Parry, G., J., Bones, C., B., Hackbarth, A., D., Goldmann D., A., & Sharek, P., J. (2010). Temporal trends in rates of patient harm resulting from medical care. New England Journal of Medicine, 363(22), 2124–2134.
Landrigan, C., P., Rothschild, J., M., Cronin, J., W., et al. (2004). Effect of reducing interns’ work hours on serious medical errors in intensive care units. New England Journal of Medicine, 351, 1838–48. Retrieved from http://content.nejm.org
Sackett, D. L. (2000). Evidence‐based medicine. John Wiley & Sons, Ltd.