Protect Yourself from Medical Errors

No one likes to think medical errors actually happen. Certainly people in healthcare are not purposely neglectful or negligent. In fact, healthcare professionals work very hard, relieve much suffering, save many lives and genuinely care about the welfare of their patients.

However, healthcare workers are human and are thus subject to the possibility of human error. Caring is just not enough to prevent the rare, but potentially deadly medical error from happening. A determined and conscious effort must be made to keep patients safe.

Thus the reality: Medical errors happen. They do not happen often, nor do they always have untoward consequences, but they can (and do) happen. The hard reality is that care givers are human and the practice of caring for patients will always be a work in progress.

Healthcare, as an industry, has done many things to prevent these errors and continues to do so. Regulatory agencies and governments take a big part in mandating improvements to protect patients. Thankfully, medical errors have decreased dramatically in the United States and in other industrialized countries around the world.

While it takes a team of professionals to provide the best and most safe care, people often do not realize the most important member of any healthcare team. This one person can make all the difference in the world in protecting you from medical errors. Who is this person? Believe it or not, this person is YOU!

Because of the nature of disease or injury, you may be too ill at first to play a role on the healthcare team. In this case, ask someone, such as a close family member or a good friend, to be your advocate and participate in your care when you are unable to do so. This determination and agreement with someone is best done prior to needing medical care. Have this conversation soon, if you have not done so already. One can only hope the situation will never arise, but if/when you are injured or suddenly become acutely ill, you will already have someone you trust in the background waiting to help protect you when you are the patient.

As an important part of the healthcare team, you need to know what is going on with your care. Do not hesitate to speak up when you are unsure or have questions concerning any part of your care. Where health related issues are involved, embarrassment or inadequacy is a normal feeling, but please do not let that feeling keep you from asking questions. Asking questions and getting clarification is often your best defense to prevent medical errors.

Ask about your care. If you do not understand what your physician, nurse or other professional has told you, don't let that person leave without getting clarification. Remember, you are the customer and they are there to serve you! Be sure to understand your condition or disease and the plan for your treatment.

Ask about Safety. Ask your physician, nurse or technician how you will be kept safe during a diagnostic procedure or surgery. They should explain what precautions will be taken and how you will be protected when you are in their care.

Ask about your medicines. Ask to know how each of your medicines fits into your treatment plan and what effect they will have on your body. Also, ask what side-affects you may expect (if any) and how will it make you feel.

If at any time, you think you are receiving the wrong medication, STOP and ask the nurse or physician to clarify and be sure the medicine is the correct one for you.

They will ASK YOU to be sure you are the right patient. Expect every healthcare professional to identify you each time they give a medication, perform a diagnostic test or provide a treatment. Be patient with this process. Even if someone has asked before, he/she will ask again to prevent a medical error from happening. They should ask for two personal identifiers, such as your name and date of birth. They will do this each time to assure you are the right person for the medication, test or the treatment they are about to give.

Caregiver Introduction: You care providers should identify themselves and include their title and licensure. If you are unsure of someone's role in your care, be sure to ask.

Remember, you are the paying customer and hospital care is not cheap! There should be no mysteries in your care and treatment plan. Ask questions until you understand everything. If you have any concerns about your treatment plan or your care, voice them to your physician or the nurse in charge of your care.

Hand Washing: Take note if your caregivers wash their hands when they enter your room. Hand washing is imperative to prevent the spread of healthcare acquired infections.

In fact, anywhere you may be, you and your family will be sick less often if you wash your hands frequently with soap and water or use an alcohol based hand sanitizer.

If your caregiver does not wash his/her hands, ask him/her to do so. (This includes physicians too!) This will not be (or should not be) an imposition. Healthcare professionals are well-educated and trained to do this. It is also something hospitals monitor to assure good compliance and thus drastically decrease the spread of infection. Hand washing is part of being good at what they do.

Medications: Take note of the time of day your medicines usually come. With few exceptions, your medicines will be administered at regular times during the day and night. If medicines are administered at a different time than normal, ask about the change. It may be part of the plan, but it is best to ask. The nurse administering your medications should explain the reason for the change.

Also, pay attention to your medications when you take them. The nurse should explain the purpose for each pill and/or injection. If he/she does not do this, ask them to do it. Any nurse administering medications will know what a medication is for and how it may affect you. If your nurse doesn't know, he/she should!! This is part of basic medication safety! If he/she doesn't know and is unwilling to find out, ask for a new nurse!

Make no assumptions when it comes to medications. If you usually take a blue pill for blood pressure and today it is a white pill instead, ask about the change. It may very well be just fine - not all brands of the same medication look alike - but you may be preventing an innocent medication error. It is a simple check. If something doesn't seem quite right, ask!

Here is your chance to really shine on the healthcare team.

Most people have no idea what medications they take or the doses prescribed. They only know they take "a little white pill in the morning" or they take "a blue pill at night." Even if they know the reason a pill is taken, such as "a heart pill," or "a water pill," this is only minimally helpful to those people in whom you trust your care.

Write out a list of your medications. Include the name of the medication, the dose and how often you take it. (See the link to the right for a template you can use to write out your list.) This information is found on the bottle in which the medication was dispensed from your Pharmacy.

Important Note: DO NOT THROW YOUR MEDICATION BOTTLES AWAY! In fact, keep your medications in their original bottles, only dispensing a week or two at a time into your weekly dispensers. (These are the little compartments labeled with "M" for Monday and "T" for Tuesday, etc.)

Carry the list of medications with you everywhere you go. Wallets are the first place healthcare workers look for important information. If you are ever unconscious and unable to answer questions, a list of your medications will tell the physician and the rest of the team a wealth of information that will be very helpful in caring for you.

Also, when you go to the doctor's office, or more important, when you have to go to an Emergency Department, having this list at your fingertips will save time to treatment and make your care even more safe. Medications may have interactions and when it is clear exactly what you are taking (and how much and how often you take it) this will help prevent any accidental overdosing or medication interactions that could possibly occur.

Occasionally there appears a lot of hype in the media about medial errors as they pertain to surgery. Amazingly enough, even after all the improved processes that have been put into place, medical errors still happen in surgery. In fact, a lot of emphasis is on surgery for this very reason. This is where your participation in care will really comes in handy.

Several processes have been mandated to be put into place to help avoid wrong site, wrong procedure and even wrong patient surgery. According to the Joint Commission, the accreditation agency collecting data on patient safety, wrong site surgery is still the number one sentinel event in the United States.

A sentinel event is an event that results in an untoward outcome such as death or severe illness or injury. Some examples would be amputating the wrong limb, removing the wrong organ or performing a surgery on a patient that was meant for another patient. It sounds absolutely unthinkable, negligent and completely unacceptable - and it is just that! There is no defending these occurrences; there is absolutely no excuse for these errors. However, like all other medical errors, your active involvement in your care prior to surgery will help to prevent such medical errors.

Prior to Day of Surgery

Like any other time you seek medical attention, be sure you understand your condition and why it requires surgery. Your surgeon should explain this so you can understand. If you do not understand, ask questions until you do.

Also, ask and understand exactly what procedure(s) will be done. Once again, ask questions if you do not understand what the procedure will entail. Your surgeon will explain it so you can understand. Always, if you have questions, do not be afraid to ask them.

You will have to sign a consent some time prior to surgery. Be sure you understand the risks and the benefits of the surgery. Your surgeon will explain these to you prior to you signing the consent for surgery. Expect this and be sure you understand fully all the risks involved with the surgery as they are weighed against the benefits of having the surgery. The decision to have surgery or not to have surgery is yours alone. You certainly can opt to not have surgery, if you so choose. The risks of not having surgery should be spelled out quite clear, so this can be an educated and informed decision.

Also prior to surgery, be sure you understand and follow closely the instructions given to you by your surgeon and the hospital. This is extremely important to having a successful and safe surgery. Again, if you are not sure about what to do or what you need to have done, ask!

The Day of Surgery

On the day of surgery you will arrive at the hospital or surgery center at the time you were assigned so the staff has plenty of time to prepare you for your scheduled surgery. Surgery departments are very time sensitive and you want to arrive early so there is no rush in the preparation process. This is vital, as this is where mistakes can happen if short cuts are taken.

Prior to surgery, you will be interviewed about your medical history, the medications you take, your symptoms, your conditions, etc. This may be by the anesthesia provider or the nurse, or both.

Some people get impatient and do not want to answer repetitive questions. Most surgery departments and free-standing facilities have tried to eliminate as many duplicate questions as possible, but it may still be necessary to tell the same thing to more than one person. It is important you do this so everyone on the healthcare team has correct information. Again, this time right before surgery is very important to preventing medical errors.

Finally, you will be asked to verify your identity, confirm the procedure you are having done and the site of your surgery. The site will be marked if there is a possibility of operating on the incorrect side. (For example, the surgical site for a knee is marked because there are two of them, but the site for a gallbladder is not marked because you only have one gallbladder.)

In the Operating Room

One more safety mechanism happens after you are asleep. This process is required by all the regulatory agencies and has helped greatly in reducing the occurrence of medical errors. This is called a "Time Out."

What happens in a "Time Out," is right before the surgeon makes the first cut, the entire team stops what they are doing and a designated person on the surgical team who met you and confirmed your identity prior to anesthesia, once again confirms your identity for the team by checking your name band with the two personal identifiers. Everyone in the room must agree you are the correct patient. They also must agree on the procedure to be performed and they must witness and agree that the diagnostics and appliances to be used (if any) are the correct ones for you. All this is documented in the medical record. Then, and only then, will the surgery begin.

Surgery can be such a vulnerable place and patient often feel very vulnerable and fearful as well. But many checks and double checks have been built into the system to avoid medical errors. With your active involvement the likelihood of a medical error occurring is reduced to almost nil.

The theme repeats itself over and over. They best way to prevent medical errors is for YOU to be involved in your care. The primary focus is the hospital setting because that is where the majority of medical errors occur. However, it is important for you to be involved in your care in EVERY healthcare setting.

Use the internet or go to the library to learn about your illness or condition. Some sites on the net even provide a place to search for possible diagnoses based on your symptoms. One such site that gives very good "lay person" advice is Web MD. (See the link in the box to the right.) Web MD is practical and easy to understand. Also, the site is good to recommend a visit to your doctor for symptoms that have the potential to be a serious health problem needing prompt attention. Heed this advice.

There is no better way to say it - be an active participant in your care.

• Ask questions until you understand.
• Pay attention to what is happening around you.
• Speak up when you are unsure of something or if you do not understand.

Always remember, YOU are the most important player on the healthcare team and your active involvement in your care will help to protect you from medical errors.