HOW SAFE ARE YOU IN AN AMERICAN HOSPITAL?
HOW SAFE ARE YOU IN AN AMERICAN HOSPITAL?
By Robert George Sprackland, Ph.D.
Are you afraid of flying? Do you know anyone who is afraid of flying? Fearful or not, you have probably heard that flying is the safest form of vehicular transportation. In reality, the number of crash fatalities on U.S. airlines averages about 120 per year, far less than the 40,000 people who are killed by cars over the same period of time. That means you are about 333 times more likely to die in a car than on an airplane. But we hear more about airline accidents than car accidents on the news and in papers, giving most of us the impression that flying is pretty much a death-defying act.
Now can you imagine what we would be hearing from the press and outraged public if five airliners crashed in the U.S. each week? That would be 260 crashes each year, and we would all be seriously concerned and raising a revolt against the FAA and airline operators. Thankfully, this abominable situation is only fantasy; why, then, do I bring it up?
There is a parallel situation taking place in the United States that is causing the deaths of tens of thousands of people every year, but because the victims do not die together in a gruesome manner we don't all know about the problem. The place these deaths occur is in our hospitals, and the overall cause of the deaths is called medical error. About 37 million Americans visit one of the 5,747 registered hospitals each year, and somewhere between 120,000 and 195,000 patients will dies as a result of medical error while under treatment. A report published in the Journal of the American Medical Association claims that number may actually be about 225,000 per year! Taking the smallest fatality number of 120,000 that toll averages 308 deaths per year per hospital.
That gruesome number doesn't count natural or untreatable deaths from the many diseases and injuries that put people under medical care. It does not count the 20,000 people who die from the flu each year. That number is the result of medical error. What is medical error? Most commonly, it occurs as a failure to fulfill one of the "Five Rs" of health care: right medicine, right dose, right route, right time, and right patient. We can easily see the result of a failure to provide the right treatment to the right patient in those cases where, for example, a college football player is supposed to be treated for a shoulder injury but wakes up to find a leg was amputated.
One particular error is particularly common: giving a patient the wrong amount of a medicine. The way this often happens is when a nurse misreads a handwritten prescription order from a doctor. What should have been a 0.25 mg dose becomes an accidental 25 mg dose because the physician didn't enter the zero and the decimal was too small to be seen. By getting 100-times the true dose, the patient will certainly have distressing symptoms, and these may lead to death. In fact, the problem of getting doctors and nurses to properly and clearly write dosage numbers has been given a special name of its own by the American Nurses Association: Death by Decimal.
"She endured--taking on two more patients when her peers called out sick, two more when the census increased--and so it went. Then one day, after an even more stressful week that included two days of mandatory overtime, it happened--"death by decimal," as [Michael] Berens refers to it in one of the articles. The overworked, exhausted warrior had a lapse in consciousness as she prepared a patient's IV medication. It cost the patient his life--and a good nurse her career."
-- Kay Bensing, Advance for Nurses magazine.
In this example we see a pitiful nurse, already overworked, having to take on additional duties. When a nurse gets extra work, it means responsibility for the lives of more people. The existance of mandatory overtime is bad enough, but allowing a nurse to take on an overload in addition to an overload-there is no excuse. Add to that the ridiculous hours expected of physicians and interns, and it is a wonder that the death toll isn't much higher.
Here are some other common causes of medical error with number of deaths per year:
Negative effects of drugs--106,000
Infections in hospitals--80,000
Miscellaneous errors, such as leaving surgical instruments inside patients--20,000
It is not surprising that so many patients become infected while they are hospitalized; after all, hospitals are filled with sick people. But what excuses accompany those other problems? What does this mean for us? According to Barbara Starfield, M.D., Thus, America's healthcare-system-induced deaths are the third leading cause of the death in the U.S., after heart disease and cancer.
While many of us hadn't heard about, or appreciated, the staggering death toll inflicted by our health-care givers, those health-care givers have been very aware. There has been adamant stonewalling by the medical establishment to restrict doctor's hours to something reasonable and it will take more than pressure from within the medical community to change that. On the other hand, the computerization of writing prescriptions is a rapidly spreading practice, which has had a positive impact on reducing "Death by Decimal" and other medical administration errors.
One very effective practice has been the implementation of automated pharmacy systems. The pharmacy has incredible power to help ensure that proper medicines get to their patients. The system is computer-based and can keep track of the patient, medication, dosage, times given, and route of administration (orally, injection, intravenous, and such). How effective is this approach? Statistics consistantly show a 70- to 90-percent reduction in prescription-related errors, and that is a significant improvement.
Perhaps the most important safeguard you, as a patient, can take to protect yourself in a hospital is to take someone with you. Not as a roommate, but as a friend who can oversee your care during admission and prior to being given any treatment. Being properly admitted is important, but most of us don't see it as part of our treatment. Yes, we need to provide insurance information, but we must also make sure that the admitting staff know whether we have a regular physician and a specialist, if we have any allergies or existing medical conditions, whether we have our necessary prescription medicines with us, and other vital facts.
When it comes to reporting any medicines that you are taking, be sure to include any vitamins, supplements, and herbal products that you are using. Contrary to what many people believe, some otherwise harmless herbs react badly with certain medications.
Your friend or family member is also there to ask questions on your behalf. What medicine are you being given, when will your doctor come to see you, what warning signs should you look for? It's not a bad idea to double check that a surgery patient is being taken for the correct surgery, and that a tonsilitis patient doesn't come back missing a leg or gall bladder.
It is also important that you and your partner understand what is being done and why. You have the right to know about your condition and the intended treatment, and if you don't understand something keep asking questions until you do.
Hospitalized patients are often given antibiotics-certainly after surgery-and you must be sure to take them, and take them all as prescribed. One of the most common causes of post-surgical death is from a secondary infection-an illness you pick up as a result of having part of your body opened to the air. For an antibiotic to work, it must be taken as prescribed.
As for any other major event in your life, take a hospital visit seriously, even for "minor" procedures. Be sure you understand your condition, the proposed treatment, and options. If you don't understand something, push for clarification. If you feel unsure-or if you have been diagnosed with a serious problem-don't hesitate to get a second opinion. After all, it's your body and health at stake. And by all means, have someone you trust accompany you to the hospital and be available to ask questions on your behalf.
Don't you become one of those 120,000-plus hospital deaths. For additional information about patient safety, visit these web resources:
And for healthcare givers:
Robert Sprackland, Ph.D., taught anatomy and physiology to health-care students for nearly two decades. He is now a busy science and technical writer.
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