This is an article I found in Parade Magazine on May 23, 2004 byTom Clavin.

How you can Protect Yourself

How You Can Protect Yourself

By Tom Clavin
Published: May 23, 2004

In February of 2003, Jesica Santillán, 17, died at the Duke University Medical Center in North Carolina after undergoing a heart and lung transplant. Because of an oversight, no one noticed that the organs she was receiving contained type A blood; Jesica was type O. As soon as the operation began, she was essentially doomed.

On Mother’s Day last year, 5-year-old Matthew Siravo died at Children’s Hospital in Boston, one of the best pediatric facilities in the country. Matthew had undergone an operation to better track his epilepsy. Post-op, the boy had an intense seizure. After 90 minutes of convulsions, Matthew stopped breathing. State officials found that no single doctor had been designated to be in charge of his treatment.

Unfortunately, such hospital foul-ups are not rare. According to a groundbreaking 1999 study by the Institute of Medicine (IOM) of the National Academy of Sciences, as many as 98,000 patients die in the more than 5000 U.S. hospitals each year because of medical errors. Such mistakes are the eighth leading cause of death in America—ahead of car accidents, AIDS and breast cancer—according to the IOM’s most conservative estimates.

“It’s a major cause of preventable death in the U.S., yet there is a lot of denial about it in the hospital industry,” says Arthur Levin of the Center for Medical Consumers, a nonprofit clearinghouse for medical information, who worked on the IOM study. “Most of what happens is not disclosed. In health care, we have the tradition of keeping bad things quiet.”

Levin adds that the total number of deaths may actually be much greater, since the IOM figure does not include outpatient care. What’s more, he notes, “medical mistakes are well known to go unrecognized and undocumented in hospital medical records.”

The most common mistakes. By far the most common problem is when patients receive incorrect dosages or types of medication, according to the Agency for Healthcare Research and Quality (AHRQ). Prescriptions are unreadable or vague, the right medication is given to the wrong patient or different medicines have bad interactions. “In the 21st century, no one should get a handwritten prescription, yet that’s fairly common,” says Dr. Carolyn Clancy, who heads AHRQ, part of the U.S. Department of Health and Human Services.

Other common medical errors:

• a faulty or delayed diagnosis
• the use of outmoded tests
• equipment failure
• surgery on the wrong limb or organ
• tissue samples lost or misread
• an object left inside a patient during surgery
• mistaken patient identities

Why errors occur. Reasons for preventable hospital errors include poor communication among staff, overworked or minimally trained workers and a faulty system of checks and balances. “Starbucks has more procedures in place for catching errors than many hospitals have,” contends Dr. Clancy.

Another important factor is the shortage of nurses. According to the American Nurses Association, there will be a shortage of 139,000 registered nurses this year and 275,000 by 2010.

Nursing
shortages and cost-cutting
can add up
to errors.

There is a direct relationship between the number of nurses, patient care and hospital errors. One study by Linda Aiken and the University of Pennsylvania School of Nursing showed that the number of patients dying after common surgeries in hospitals jumps when there is more than the average 4:1 patient-nurse ratio. A 7% increase in deaths is tied to a 5:1 ratio, and a 31% increase results from an 8:1 ratio.

“The system is overwhelmed,” says Gail Van Kanegan, author of How To Survive Your Hospital Stay. “With the shortage of nurses, lab and X-ray people as well as computer malfunctions, mistakes will happen.”

The type of hospital you’re in also matters. A study by Prof. Eric Thomas of the University of Texas revealed that patients in for-profit hospitals, government-owned minor teaching hospitals and all government-owned nonteaching hospitals are at least 1.6 times more likely to suffer “preventable adverse events” than those in nonprofit hospitals. This suggests that bottom-line concerns may affect the quality of patient care.

One error’s ripple effects. Sometimes a medical error doesn’t cause immediate physical injury to a patient but still has serious consequences. Holly Shivers of Long Island, N.Y., claims that an error will affect her for at least a decade.

During a hospital stay in 2002, the 42-year-old mother of two teenage girls had a lump removed from her breast. Shivers recalls the day her doctor called and began, “I’m sorry.” She was certain she was about to be told she had breast cancer. Instead, Shivers says she was informed that her tissue sample had been lost, and there was no way of knowing if it was malignant because the lump already had been destroyed. As a result, for the next 10 years—the typical “cancer-free” waiting period—she will worry about what the biopsy would have found.

Shivers goes for checkups every six months. “Each time, it’s the longest six months of my life,” she says.

Infections also are a concern. Every year, according to the Centers for Disease Control and Prevention, nearly 2 million people contract infections while hospitalized and 100,000 die. “Hospitals are doing a pretty good job of preventing many types of infection, but they are failing to control the most dangerous one: the antibiotic-resistant infection,” says Dr. Barry Farr, head of infection control at the University of Virginia Medical Center. Causes of infection include staffers who don’t change gloves after every patient and doctors who don’t wash their hands often enough. Staff also may fail to identify and sufficiently isolate contagious patients.

There are simple steps hospitals
can take to improve patient care.

What’s being done. Some states are taking a proactive approach. The Massachusetts Coalition for the Prevention of Medical Errors, the first public-private partnership of its kind in the U.S., was founded in 1998 to improve patient safety and minimize medical errors. Such organizations now exist in about a dozen states.

Some hospitals also are taking steps. Last year, the Cincinnati Children’s Hospital Medical Center implemented a computer-based system in which all patient orders—including medications, special diets, lab and other test results—are documented electronically.

“Studies have demonstrated that as much as 40 minutes per shift can be gained by using electronic charting,” says Terri Price, a nurse in the hospital’s department of patient services. “That’s 40 minutes more that a nurse can spend with patients.” And more nursing care can lead to fewer errors.

There are efforts on the national level too. In 2001, U.S. Health and Human Services Secretary Tommy Thompson announced the formation of a Patient Safety Task Force to coordinate research among his department’s various agencies. Since July 2001, U.S. hospitals have been required by the Joint Commission on Accreditation of Healthcare Organizations to disclose errors that harm patients. Since then, according to one study, 70% of hospitals have increased the number of medical error disclosures. (There isn’t enough data yet on how this impacts the hospitals’ record in patient care.)

Last year, the Patient Safety and Quality Improvement Act was approved by the House of Representatives. A supporter of the bill, Rep. Carolyn McCarthy (D., N.Y.), a former nurse, believes the measure will allow hospitals to share information without assigning blame for mistakes. The Senate has yet to pass the act. Critics say it may conflict with patient privacy rules and may not be as strong as laws already enacted by some states.

But is it enough? “To be fair, there are providers and practitioners who are working hard to make the system better,” says Arthur Levin. “There is, however, a systemic lack of urgency about getting this job done quickly. In part, that’s because no one wants to admit that in every year since the IOM report was issued, we’ve had a large number of people dying unnecessarily. There isn’t enough attention being paid to the fact that, as we speak, people are dying or being injured because we’re not doing enough.”

Take Charge Of Your Care
PARADE Health Editor Dr. Isadore Rosenfeld recommends taking the following precautions if you require hospitalization.

Thousands of people die every year due to medical mistakes. Hospitals are doing what they can by introducing new, fool-proof computerized technology and training their personnel. But you can play a key role in ensuring your own safety during treatment. Here’s what you can do:

Ask about the hospital. Hospitalization is often an emergency. You may not have the time or luxury to inquire about the patient-nurse ratio or how many of the procedures that you will undergo have been successful at that particular institution. So plan ahead: Ask your own doctor to which hospital he would send you, research its track record and assess if it’s the best one for you.

Designate an advocate. In many emergency situations, you can’t call the shots. You may be unconscious, confused or too sick to know what’s going on. Designate a friend or relative to represent you and act on your behalf. Make these arrangements in advance and in writing. Be sure your designee is someone who is willing and able to assume that responsibility.

Know your pills. Ask for a printed list of all your medications and the dosages, how often you must take them and who prescribed them. Was it your doctor or a hospital resident? If it was the latter, make sure your doctor agrees. Every time you’re handed a medication, ask for its name and check it against your prescription list. Don’t rely on appearances. Different brands and generics have varying colors and shapes. Make sure the pill you’re given is for you and not your roommate. If you had a bad reaction to a medication, tell the nurse and doctor before taking it again.

Check hand-washing. Doctors usually wash their hands after seeing a patient. That’s mainly for their own protection. But it’s important for doctors to wash their hands before examining you for your protection. Most hospital rooms now have a washbasin in the entry to each patient’s room. When health-care providers enter your room, pay attention to whether they wash their hands—and comment if necessary.

Explore all your options. Learn as much as you can about your own health status and, if you’re sick, what all your treatment options are. If there’s any question about a proposed therapy, get a second opinion—especially if you’ve been told you need nonemergency surgery.

Mark it. Before undergoing surgery, make sure the right organ or area to be operated on has been tagged. Also check the name tag on your wrist.

Prepare for tests and procedures. If you need an X-ray or other diagnostic procedure that requires an injection, ask what it is. Tell the technician or radiologist if you’re allergic (especially if the injection contains iodine). If you develop any problems during a procedure (even one as simple as a urinary catheterization), let the doctor or technician know. Don’t hesitate to yell, “Ouch!” If you’ve been given an intravenous drip, check your arm for swelling or discoloration (especially if you feel pain). The needle may have slipped out of the vein and into the surrounding tissues, which can cause problems.

Dr. Rosenfeld is the author of “Power to the Patient: The Treatments To Insist on When You’re Sick” (Warner Books).


How You Can Protect Yourself