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20 Tips to Help Prevent Medical Errors from the Agency for Healthcare Research and Quality

Medical errors are one of the Nation's leading causes of death and injury. A recent report by the Institute of Medicine estimates that as many as 44,000 to 98,000 people die in U.S. hospitals each year as the result of medical errors. This means that more people die from medical errors than from motor vehicle accidents, breast cancer, or AIDS.
Government agencies, purchasers of group health care, and health care providers are working together to make the U.S. health care system safer for patients and the public. This fact sheet tells what you can do.

What are Medical Errors?

Medical errors happen when something that was planned as a part of medical care doesn't work out, or when the wrong plan was used in the first place. Medical errors can occur anywhere in the health care system: 
· Hospitals. 
· Clinics. 
· Outpatient Surgery Centers. 
· Doctors' Offices. 
· Nursing Homes. 
· Pharmacies. 
· Patients' Homes.

Errors can involve:
· Medicines. 
· Surgery. 
· Diagnosis. 
· Equipment. 
· Lab reports. 

They can happen during even the most routine tasks, such as when a hospital patient on a salt-free diet is given a high-salt meal.

Most errors result from problems created by today's complex health care system. But errors also happen when doctors and their patients have problems communicating. For example, a recent study supported by the Agency for Healthcare Research and Quality (AHRQ) found that doctors often do not do enough to help their patients make informed decisions. Uninvolved and uninformed patients are less likely to accept the doctor's choice of treatment and less likely to do what they need to do to make the treatment work. 

What Can You Do? Be Involved in Your Health Care

1. The single most important way you can help to prevent errors is to be an active member of your health care team.
That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. Some specific tips, based on the latest scientific evidence about what works best, follow.

Medicines

2. Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.

At least once a year, bring all of your medicines and supplements with you to your doctor. "Brown bagging" your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date, which can help you get better quality care.

3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
This can help you avoid getting a medicine that can harm you. 

4. When your doctor writes you a prescription, make sure you can read it.
If you can't read your doctor's handwriting, your pharmacist might not be able to either.

5. Ask for information about your medicines in terms you can understand-both when your medicines are prescribed and when you receive them.
· What is the medicine for? 
· How am I supposed to take it, and for how long? 
· What side effects are likely? What do I do if they occur? 
· Is this medicine safe to take with other medicines or dietary supplements I am taking? 
· What food, drink, or activities should I avoid while taking this medicine?

6. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?
A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose. 

7. If you have any questions about the directions on your medicine labels, ask.
Medicine labels can be hard to understand. For example, ask if "four doses daily" means taking a dose every 6 hours around the clock or just during regular waking hours.

8. Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you're not sure how to use it.
Research shows that many people do not understand the right way to measure liquid medicines. For example, many use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people to measure the right dose. Being told how to use the devices helps even more.

9. Ask for written information about the side effects your medicine could cause.
If you know what might happen, you will be better prepared if it does-or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.

Hospital Stays

10. If you have a choice, choose a hospital at which many patients have the procedure or surgery you need.
Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.

11. If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands.
Handwashing is an important way to prevent the spread of infections in hospitals. Yet, it is not done regularly or thoroughly enough. A recent study found that when patients checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.

12. When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home.
This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors think their patients understand more than they really do about what they should or should not do when they return home.

Surgery

13. If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done.
Doing surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery. 

Other Steps You Can Take

14. Speak up if you have questions or concerns.
You have a right to question anyone who is involved with your care. 

15. Make sure that someone, such as your personal doctor, is in charge of your care.
This is especially important if you have many health problems or are in a hospital. 

16. Make sure that all health professionals involved in your care have important health information about you.
Do not assume that everyone knows everything they need to. 

17. Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can't).
Even if you think you don't need help now, you might need it later. 

18. Know that "more" is not always better.
It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it. 

19. If you have a test, don't assume that no news is good news.
Ask about the results. 

20. Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.
For example, treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse at http://www.guideline.gov Ask your doctor if your treatment is based on the latest evidence.

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Notes and Insights:

Happy Birthday!
Harv, Karen Peo aka KP, Dian, Darla S., Gaetan Michiels and Tresa!!  Check out all the birthdays at community/birthday/ and make sure to send them an arthritis-friendly e-card: cgi-bin/postcards/postcard.pl  

Wanna help?
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Write an article! We always need articles on all subjects relating to arthritis. 
C'mon folks, we can't do this without you.

Weekly News Summary
Karen Sears

NIH LAUNCHES ALTERNATIVE MEDICINE DATABASE
Looking for information on herbs, acupuncture or the benefits of biofeedback? A new database from the National Institutes of Health (news -web sites) (NIH) may help.
Reuters Health, Feb 6
http://dailynews.yahoo.com/h/nm/20010206/hl/database_1.html 


EU EXPANDS REMICADE'S RHEUMATOID ARTHRITIS INDICATION
Schering-Plough said on Monday that its rheumatoid arthritis drug Remicade (infliximab) has been approved in the European Union for use with methotrexate to improve physical function and reduce joint damage in patients with refractory rheumatoid arthritis.
Reuters Health, Feb 5
http://rheumatology.medscape.com/
reuters/prof/2001/02/02.06/20010205rglt008.html
(free registration required)

NASAL SPRAY GIVES CHILDREN NEEDLE-FREE PAIN RELIEF
Children and parents who hold their breath at the mere sight of a needle can now exhale. Doctors in Great Britain say giving a pain-killing drug by nasal spray is as effective, faster, and less painful than giving it by injection during treatment for a broken bone.
Reuters Health, Feb 5
http://dailynews.yahoo.com/h/nm/20010205/hl/nasalspray_1.html 

PRESCRIPTION PAINKILLERS LINKED TO MISCARRIAGE
Taking painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy may raise a woman's risk of miscarriage, findings from Denmark show. The study is the first to link miscarriage to this common class of drugs.
Reuters Health, Feb 2
http://dailynews.yahoo.com/h/nm/20010202/hl/pain_1.html 

COMPANIES MAY CUT MANGANESE LEVELS IN SUPPLEMENTS
Following the announcement of new recommended tolerable intake levels of manganese, two companies whose supplements currently contain higher amounts said they may reformulate their products with lower levels of the mineral.
Reuters Health, Feb 2
http://dailynews.yahoo.com/h/nm/20010202/hl/manganese_1.html 

'OBESITY HORMONE' DROPS WITH DIET, EXERCISE
It is no mystery that eating a healthy diet and exercising can make extra pounds disappear. But the results of a new study suggest that lifestyle changes may also lower levels of leptin, the ``obesity hormone'' thought to be involved in appetite regulation.
Reuters Health, Feb 2
http://dailynews.yahoo.com/h/nm/20010202/hl/diet_1.html 

ANTIFILAGGRIN ANTIBODIES IN THE 'HIGH' NORMAL RANGE PREDICT RHEUMATOID ARTHRITIS
Individuals with rheumatoid factor levels in the high end of the normal range are predictive of rheumatoid arthritis (RA), according to a report in the December 2000 issue of the Journal of Rheumatology.
Reuters Health, Feb 1
http://rheumatology.medscape.com/
reuters/prof/2001/02/02.02/20010201epid002.html

INFLAMMATORY BREAST CANCER ON THE RISE
A rare and deadly form of breast cancer is on the rise. Most women haven't heard of it, and its symptoms are so unusual, doctors often misdiagnose it. Inflammatory breast cancer is rare, but the number of cases is growing. In fact, the latest research shows the number of cases has doubled in the last 15 years. And most women don't even know what it is.
KIRO 7 NEWS, Feb 1
http://www.seattleinsider.com/living/health/breast_cancer.html 

EXPERIMENTAL MOLECULE HELPS DRUG TARGET T-CELLS
Researchers have moved one step closer to developing drugs that selectively target immune system cells, which may lead to better treatments for diseases that cause the body's defense mechanisms to go awry [such as RA].
Reuters Health, Feb 1
http://dailynews.yahoo.com/h/nm/20010201/hl/tcells_1.html 

SUPPLEMENTS MAY HAVE TOO MUCH MANGANESE
The levels of manganese in some over-the-counter dietary supplements--most touted as treatments for joint and muscle problems--exceed government recommended levels for safe consumption of the element.
Reuters Health, Feb 1
http://dailynews.yahoo.com/h/nm/20010201/hl/supplements_2.html 

CHRONIC FATIGUE SYNDROME STIGMA HURTS PATIENTS
Patients with chronic fatigue syndrome are not just fatigued, often they are severely disabled. Yet, many patients have trouble getting good care and physicians at a conference here said that is partly due to the disease's name.
Reuters Health, Jan 31
http://dailynews.yahoo.com/h/nm/20010131/hl/fatigue_1.html 

HEALTH INSURANCE TAKES BACKSEAT IN WASHINGTON
Expanding health insurance coverage to the uninsured will take a backseat to such issues as a Medicare prescription drug benefit and Medicare reform over the next 2 years on Capitol Hill.
Reuters Health, Jan 31
http://dailynews.yahoo.com/h/nm/20010131/hl/congress_insurance_1.html 

Big step toward cure for arthritis
SCIENTISTS have cured arthritis in mice, paving the way for a human version of the treatment. The Melbourne researchers also believe the therapy might ultimately help patients with chronic diseases such as emphysema and bronchitis.
http://www.theadvertiser.com.au/common/
story_page/0,4511,1666561%255E911,00.html 

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A Closing Thought

In 1982 Steven Callahan was crossing the Atlantic alone in his sailboat when it struck something and sank. He was out of the shipping lanes and floating in a life raft, alone. His supplies were few. His chances were small. Yet when three fishermen found him seventy-six days later (the longest anyone has survived a shipwreck on a life raft alone), he was alive -- much skinnier than he was when he started, but alive. 

His account of how he survived is fascinating. His ingenuity -- how he managed to catch fish, how he fixed his solar still (evaporates sea water to make fresh) -- is very interesting. 

But the thing that caught my eye was how he managed to keep himself going when all hope seemed lost, when there seemed no point in continuing the struggle, when he was suffering greatly, when his life raft was punctured and after more than a week struggling with his weak body to fix it, it was still leaking air and wearing him out to keep pumping it up. He was starved. He was desperately dehydrated. He was thoroughly exhausted. Giving up would have seemed the only sane option. 

When people survive these kinds of circumstances, they do something with their minds that gives them the courage to keep going. Many people in similarly desperate circumstances give in or go mad. Something the survivors do with their thoughts helps them find the guts to carry on in spite of overwhelming odds. 

"I tell myself I can handle it," wrote Callahan in his narrative. "Compared to what others have been through, I'm fortunate. I tell myself these things over and over, building up fortitude...." 

I wrote that down after I read it. It struck me as something important. And I've told myself the same thing when my own goals seemed far off or when my problems seemed too overwhelming. And every time I've said it, I have always come back to my senses. 

The truth is, our circumstances are only bad compared to something better. But others have been through much worse. I've read enough history to know you and I are lucky to be where we are, when we are, no matter how bad it seems to us compared to our fantasies. It's a sane thought and worth thinking. 

So here, coming to us from the extreme edge of survival, are words that can give us strength. Whatever you're going through, tell yourself you can handle it. Compared to what others have been through, you're fortunate. Tell this to yourself over and over, and it will help you get through the rough spots with a little more fortitude. 

Tell yourself you can handle it. 

~Author Unknown
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Arthritis Insight Newsletter Copyright 2001

Staff
Page last updated on February 7, 2001