Question

As of 2016, there were more than 250,000 deaths per year in the United States due to medical errors.148 Such errors, fatal or otherwise, represent clear violations of the bio-medical ethical principle of nonmaleficence. What might be the drivers of many of these errors? What institutional policies and public policies are neede d to reduce the overall incidence of medical errors?

Answer 1

Certainly this “first, do not harm” concept does not mean that you cannot ever cause harm to patients in order to treat them. Sometimes harmful action is necessary, but it should never be automatic. The benefits that you provide through your procedure should outweigh the suffering that you cause. Nonmaleficence has been upheld in both the ethical and legal prac- tices of health care. Using utilitarian logic, the benefit of procedures is balanced against the harm. If there is greater benefit, the act is viewed as an ethical one. In fact, you have a duty to provide appropriate care to avoid further harm to the patient under whatsome legal texts call a due care standard. This basically means that you have taken all necessary action to use the most appropriate treatment for the condition and have provided that treatment with the least amount of pain and suffering pos- sible. From an administrative standpoint, the care should be provided by professionals with appropriate levels of education and training.

Type of medical errors

1 Medication errors

2 Errors related to daily routine procedures

3 Errors related to invasive procedures

1. Error in peripheral venous catheter

2. Errors in peripheral inserted central venous catheters

3. Error in umbilical catheter

B. Respiratory procedures errors

1. Error in intubation

2. Error inmMechanical ventilation

3. Errors in chest tube

4. Error in continuous positive air way pressure (CPAP)

5. Error in nasal prong

C. Errors in blood sampling

D. Urinary tract catheters errors

E. Phototherapy errors

F. Errors in blood transfusion

4 Nutrition errors

A. Poor milk bottle storage

B. Abdominal distension and vomiting (overfeeding of crying babies)

C. Delayed initiation of trophic feeding as ordered

D. Increased caloric intake (amount of milk)

5 Equipment Errors

A. Nonworking equipment (X-ray and portable suction)

B. Processing errors (incubators, laryngoscope, ventilators)

C. Necessary equipment unavailable (monitors, pulse oximeter and blood pressure cuff)

D. Not easy to use (unfamiliar new apparatus

6 Administration errors

A. Decrease in resources (syringe pump, IV lines, betadine, scalpels different sizes of ETT, umbilical catheters)

B. Medication not available

7 Staffing errors

A. Lack of supervision (mislabelling drugs, IV fluid preparation, storage of medication

and milk bottles storage)

B. Shortage of nurses

C. Handoff and documentation errors including laboratory investigations, invasive

manoeuvres and radiographs not registered in nursing sheets

D. Error in collection of laboratory reports and X-rays in patient files

According to a recent study more than 250,000 people in the United States die every year because of medical mistakes, making it the third leading cause of death after heart disease and cancer.

Other studies report much higher figures, claiming the number of deaths from medical error to be as high as 440,000. The reason for the discrepancy is that physicians, funeral directors, coroners and medical examiners rarely note on death certificates the human errors and system failures involved. Yet death certificates are what the Centers for Disease Control and Prevention rely on to post statistics for deaths nationwide.

‘The system is to blame’

a death due to medical error as one that is caused by inadequately skilled staff, error in judgment or care, a system defect or a preventable adverse effect. This includes computer breakdowns, mix-ups with the doses or types of medications administered to patients and surgical complications that go undiagnosed.

“Currently the CDC uses a deaths collection system that only tallies causes of death occurring from diseases, morbid conditions, and injuries,” in a letter urging the CDC to change the way it collects the nation’s vital health statistics.

“It’s the system more than the individuals that is to blame,” The U.S. patient-care study, which was released in 2016, explored death-rate data for eight consecutive years. The researchers discovered that based on a total of 35,416,020 hospitalizations, there was a pooled incidence rate of 251,454 deaths per year — or about 9.5 percent of all deaths — that stemmed from medical error.

Afterward Chris said he discovered that pharmacy technicians, rather than well-trained and educated pharmacists, are compounding nearly all of the IV medications for patients. And many states have no requirements, or proof of competency, for these pharmacy technicians.