[Good use of medical errors. Medical error, what luck!].
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Medical error is an inevitable occurrence that stresses the relationship between healthcare professionals and their patients. The number of errors is shocking; so too, is the revelation that few medical errors are routinely disclosed. When healthcare providers fail to inform patients of harm-causing medical error, then trust in the patient/provider relationship is broken and many ethical challenges surface. To successfully restore trust and perhaps lower liability costs, healthcare providers must avoid pointing fingers and adopt a policy of honesty and full disclosure.
Medication errors present a significant hazard to patient safety and have been increasingly in the news as studies correlate the nursing shortage and patient death. This article discusses strategies to decrease medication errors and increase patient safety during medication administration.
Medication errors are of interest both as an indication of quality of nursing care and as a measure of cost control. Developed for use in high-risk industries, Failure Mode and Effects Analysis used as an interdisciplinary approach in healthcare offers a comprehensive, individualized way to analyze and lessen medication errors in any institution.
Medical errors can be defined as value laden facts, in relation to guidelines or expectations, to the responsibility involved, to the obligations abated, to the pertinence of excuses afforded because of complexity, compliance and prudence or its aggravation through recklessness. Due care is related to prevention and corresponding attitudes. Professionalism, continuous education and quality control systems to detect errors without dispensing inexcusable faults, are the main tools to avoid medical errors.
Medication errors are recently a more frequent basis for successful malpractice cases against nurses. Here, the author provides case examples and high-risk trends.
The incidence of medication errors has risen dramatically during the last decade to an alarming number. Nurses report only 5% of significant errors, those considered life threatening. Little research has been done related to medication errors at the administration stage or reporting methods. The purpose of this study was to compare medication error rate per 1,000 doses administered before and after the implementation of a bar code medication administration system. The study was conducted on two medical-surgical units at a midwest government hospital 12 months both before and after the implementation of the Bar Code Medication Administration system. The medication error rate per 1,000 doses administered by a nurse after implementation of the Bar Code Medication Administration system showed an 18% increase. The results probably do not indicate an increase in medication errors but rather an increase in the number of medication errors reported. This research highlights problems with programs evaluating medication errors and new technology implementation. Evaluators must have accurate baseline data before implementation. Past research has shown that the medication error rate has been underreported. In contrast to a staff reporting system, the computerization of medication administration improves the reporting system by reporting all errors. Once a more accurate error rate is known, new technology can be created, evaluated, and refined to reduce medication errors.
Is the solution for medical errors medical or cognitive? In this AMIA2001 panel on medical error, we argued that medical error is primarily an issue for cognitive science and engineering, not for medicine, although the knowledge of the practice of medicine is essential for the research and prevention of medical errors. The three panelists presented studies that demonstrate that cognitive research is the foundation for theories of medical errors and interventions of error reductions.
This study explores the impact of eliminating a yearly medication test on the medication error rate reported on both incident reports and questionnaires and describes nurse-identified strategies that may prevent medication errors. Results indicate that eliminating the annual medication test does not significantly change the overall medication error rate. However, the number of errors involving the administration of a medication to the wrong patient has increased significantly. More medication errors have been reported on the questionnaires than on the incident reports. Four factors have been identified by the nurses as being helpful in preventing medication errors. Several limitations of this study dictate that the results be applied with caution. However, in this setting, the use of an annual medication test as a strategy for reducing medication errors has not been supported.
Medical errors have received a great deal of attention in recent years. The phrase medical errors is an umbrella term for all errors that occur within the health care system, including mishandled surgeries, diagnostic errors, equipment failures, and medication errors. This article is a review and discussion of the literature on the scope of medical errors, with a focus on drug-related problems and medication errors. Cost and quality ideas for addressing these issues are provided.
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