Patients rely on health care professionals and institutions for their safety and well-being (“Quality and patient,” 2009). According to Agency for Healthcare Research and Quality (2000), “medical errors are responsible for injury in as many as 1 out of every 25 hospital patients; an estimated 48,000-98,000 patients die from medical errors each year. Errors in health care have been estimated to cost more than $5 million per year in a large teaching hospital, and preventable health care-related errors cost the economy from $17 to $29 billion each year”. In addition to the monetary cost of errors, the physical and psychological costs such as pain, loss of loved ones, human suffering, disability or death are the greatest indelible mistakes. Medical errors lead to distrust of the health care system and drive patients away from visiting doctors leading to poor utilization of the health care system and consequently worse health care. Researchers estimate that about half of all medication errors are preventable.
They suggest that when a medication error occurs, it is not the result of a single mistake, but rather a series of breakdowns in the health care delivery system therefore, this suggests that more checks and balances in patient care could prevent or remediate medication errors. Medical errors are significant issues affecting patient safety and costs in hospitals often posing dangerous consequences for patients. It is important to understand how medical errors occur so healthcare professionals and managers can identify problems and provide insight into how to make improvements to remedy, reduce, and ultimately prevent medical errors. The Quality of Health Care in America Committee of the Institute of Medicine (1999) concluded, “it is not acceptable for patients to be harmed by the health care system that is supposed to offer healing and comfort”.
Because medical errors have a large impact on patient care, it is important to consider the ethical issues regarding disclosure that arise when health care providers make or witness errors. Medical errors traumatize patients but also negatively affect nurses. The psychological trauma caused by committing a medical error can be overwhelming to a nurse. Nurses who are committed to their patients feel responsible for their wellbeing. Nurses may feel upset, guilty, and terrified about making an error. In addition, they can experience a loss of confidence in their clinical practice abilities. Finally, they can become angry at the system of patient care. For various reasons: including nurse inability to detect medical errors, perceptions that certain errors will not harm patients, or fear of consequences associated with reporting, nurses do not report all detected medical errors. However, patients have a right to know about critical incidents even if they do not physically harm them. The rationale for disclosure, based on ethical issues of autonomy, goes beyond what the law might require one to do.
Ethics, law, and the literature suggest that when a health care provider makes a mistake, he or she has a moral obligation to reveal the errors to the patient with a timely and honest disclosure. Overlooking errors and disclosure undermines public trust in medicine because patients feel that providers are more interested in protecting themselves and their colleagues than patient well being. According to The Code of Medical Ethics, when an adverse event may have resulted from the medical provider’s mistake or misjudgment, the provider is ethically required to fully inform the patient about the error, and its likely consequences. Additionally, nurses and other health care providers also have the obligation to report an adverse event to hospital authorities and to colleagues. Disclosing errors, thus, needs tremendous moral courage and commitment to professional integrity. Several factors militate against error disclosure: legal (the hazard of malpractice litigation), economic (effect on professional practice if the error is leaked to the public) and psychological (erosion of self-esteem). None of these is more important for nurses as recognizing professional responsibility.
A disclosure of error can be challenging for most nurses because they find it difficult to acknowledge their errors openly before patients and colleagues. It is painful to admit one’s errors, especially to those who have been harmed by them. Nevertheless, honesty and offering an apology for harming a patient should be considered to be one of the ethical responsibilities of the profession of medicine. Full and honest disclosure of errors is most consistent with the mutual respect and trust patients expect from their providers. Medical ethics insist that the interests of patients must override the self-serving interest. Nurses should ensure that all relevant information regarding the sequence of events leading to the adverse outcome is presented as clearly and openly as possible. This strategy can help avoid suspicions about a “cover-up.” Patients and families may accept what has happened to them if they can be reassured that medical care will be improved in the future.
Disclosure should, of course, take place at the right time, when the patient is medically stable enough to absorb the information, and in the right setting. An order for the healthcare professional and the profession of healthcare in general can receive the trust of the public; healthcare professionals must adopt a venerable attitude toward the disclosure of human frailty and medical error. Reducing the number of medical errors is quite challenging in improving the American health care system. There is a three-step approach in reducing the number of errors. The first approach is an overall improvement in the health care system. Currently, there is a national focus with health care leaders working to collect data, enhancing their knowledge to reduce the number of medical errors. The second approach is an effort on each individual health care provider to provide safe and effective care. Lastly, each patient needs to be an active consumer of health care.
Many federal, state, and private sector organizations work together to reduce medical errors and improve patient safety. For example, the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) conduct surveillance and collect information about adverse events resulting from treatment or the use of medical devices, drugs, or other products. Professional societies are also concerned with patient safety. More than 50% of all Joint Commission on Accreditation of Healthcare Organizations (JCAHO) hospital standards relate to patient safety. Hospitals seeking accreditation from the JCAHO are required to adhere to revised and strengthened patient safety standards to prevent medical errors. The JCAHO standards also require hospitals and individual health care providers to inform in the course of treatment.
The new standards place even greater emphasis on medication safety. Safe medical care is also a top priority of the states and the private sector. In 2000 some of the nation’s largest corporations, including General Motors and General Electric, joined together to address health care safety and efficacy called “The Leapfrog Group”. What challenges do nurses face to avoid medical errors? The first challenge is for nurses to be diligent and careful when administering medications, treatments, diagnostic tests or any intervention. Awareness can prevent errors. Similar sounding and appearing medication, the use of abbreviations, medication interactions, poor hand writing, confusing drug labels, and a lack of knowledge are all potential causes of errors. A strategy to reduce the number of errors includes double-checking one’s work or having another health care provider check ones work which will help assure accuracy. In addition, the use of abbreviations should be avoided such as using “qd” instead of “everyday”. Verbal/telephone errors are large sources of error within the health care system.
In an emergency situation the use of a verbal order is appropriate. In this situation the nurse taking the order should read back the order to the prescriber. Nurses should spend more time teaching patients about their medications. Ultimately, it is important for health care providers to not hide from their errors but learn from them. More educational seminars on how to track errors and have discussions about them will help staff develop a system that will teach providers how to be better workers and improve the system to help assure that it is as safe as possible. Additional challenges and opportunities to improve safety focuses on education and technology are required. By intensifying provider education, they will upgrade their overall safety knowledge as well as the prevention of errors. By applying informational technology to a medical setting, computerized medical records, computer reminder systems, electronic prescribing, and test ordering may reduce errors and enhance the quality in the work place.
Many factors contribute to the medical errors. One of them is the use of multiple medical specialists or medical systems to care for one individual. When multiple doctors and nurses treat a patient, there is a risk for duplication of services, such doing the same test, prescribing similar or duplicate medications, or too few tests being run. Poor communication between the specialists is commonplace and one specialist often is not aware what the other specialist is doing. Similar problems may arise with using different pharmacies and hospitals. Most health care takes place at a rapid rate. Doctors see a large volume of patients each day, pharmacists fill a large number of prescriptions each day, and nurses are often faced with caring for an overload of patients. Health care providers can become overwhelmed with large amounts administrative work. They need to respond quickly to meet the demands of patients, administrators, and be aware of the financial issues.
Unfortunately, this high acceleration on all fronts of healthcare often results in human and patient care error. Good listening is critical and requires that the nurses and other health care providers take time to understand and hear their patients. In addition to listening, health care providers need to communicate information accurately and simply. After communicating with patients, it is equally as critical to communicate with other health care providers. A lack of communication is critical to convey accurate information in order to reduce errors. Medication errors are considered to be one of the most seriously issues concerning patients’ safety in the health care systems (Joolaee, Hajibabaee, Peyrovi, Haghani & Bahrani, 2011). There are several types of medication errors: wrong dosage, wrong patient, wrong route, wrong time, or wrong medication. In the hospital, nurses are very busy and care for multiple patients with whom the nurse is often unfamiliar.
In a hospital setting, errors often result from lack of attention rather than lack of knowledge. If nursing staff is overworked, there is a likelihood of error in administering medicine. Work schedules also contribute to errors. Overworked nurses, physicians, residents and pharmacists contribute to the problem. Nursing shortages often necessitate nurses picking up extra shifts or working a double shift. When health care providers are tired and fatigued, they are more prone to make mistakes. Working overtime increases the likelihood of medical errors. The chance of a hospital nurse making a mistake was three times higher once a shift exceeded 12.5 hours, according to researchers from the University of Pennsylvania. The risks of making an error are significantly increased when work shifts are longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week.
IOM along with professional associations and patient advocacy groups recommends limiting nurses’ workdays to twelve hours. In addition, per-diem and traveling nurses may cause errors because they are not given a complete orientation to the hospital that they are in and consequently may not be as prepared to care for patients. These nurses must spend more time trying to figure out mundane details; such as where do they keep the intravenous tubing, what is the attending physician’s phone number, and how to order a meal for their patient, which leaves less time for patient care. Again, this time crunch leads to medical errors. Medical errors are a major problem in health care. Typically the problem is a system problem and not necessarily the result of one individual. The system needs to be fixed and the government and other organizations are working to improve the system. Nonetheless, each individual health care provider needs to be aware of common errors and be aware of steps to prevent them.