PATIENT FACT SHEET:  TIPS TO HELP PREVENT MEDICAL ERRORS

A 2004 source edited and added to by a patient without medical training. Update 6 April 2005

Where do medical errors occur?

                        

            •    Medicines        •    Surgery      •    Diagnosis      •    Equipment      •    Lab reports

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 healthcare system.

Medical errors can occur 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 a complex healthcare 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.

Being an active member of your healthcare team is the single most important way you can help to prevent errors is to ASK LOTS OF QUESTIONS.  That means taking part in every decision about your healthcare by learning about your disease, the treatment options, the medications and procedures, and the relative risks of each possible action.

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.

The best way to make sense of your disease is to keep a daily log of symptoms, reactions to medications, appointments,   questions, and your physician’s answers to your questions.

Include information on your parents, grandparents and other family members as to what diseases they suffered and their causes of death.

Make sure that all of your doctors and pharmacists are aware of all the medications, supplements, and alternative medication treatments you are taking.  

Maintain a history of medications and take an updated copy to each office appointment, ER, or hospital.  This list should include all prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.  Include even those you take occasionally.

"Brown bagging" means taking your medicines to your physician so she/he can talk with you about them and find out if there are any problems.

This can help you avoid getting a medicine that can harm you.

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.

A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that percent of medicine errors involved the wrong drug or the wrong dose.
    
If you have any questions about the directions on your medicine labels, be sure to ask them.

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.

Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you're not sure how to use a medicine.

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.

If you know what might happen or are prepared for the unexpected, you'll be much better equipped to deal with the problem. 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 improve their ability to relay that information to a doctor or pharmacist.

If you have a choice about where to receive treatment, choose a hospital that is known to perform the most, or a comparatively high number of, the procedure or surgery you need.  Research shows that hospitals that have a high level of experience in performing a treatment or procedure achieve better results for patients than hospitals with less experience.

If you are in a hospital, ask all healthcare workers who have direct contact with you-including physicians-to wear a new pair of latex gloves (unless allergic).  If without new gloves, insist they wash their hands thoroughly. Ask them this before they touch you or begin to perform any of their duties.

Insist that all persons not gloved who enter your room to do thorough hand washing before contacting your your bed linen, towels, etc..  Hand washing 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 directly inquired about whether healthcare workers washed their hands, the workers washed their hands more often and used more soap.

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.

Arrange for visiting nurse care in advance if it will be needed.

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 Orthopedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery.  If the surgeon doesn't do it, then you mark with your initials. Use a permanent marker.

Do not assume that everyone knows everything they need to.

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.

Don't assume that no news is good news.   Arrange for the lab performing the test to mail you a copy of the test results or   reports from radiographers or other specialists who interpret the test results.

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.

Source: 20 Tips to Help Prevent Medical Errors. Patient Fact Sheet.
AHRQ Publication No. 00-PO38, February 2000.
Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/consumer/20tips.htm