Safety in medicine

Medication errors and diagnostic mistakes are among the areas of concern that will be discussed at the First Asean Patient Safety Congress to be held on June 25 at the Sofitel Manila.

Organized by the team of Dr. Agnes Mejia, dean of the University of the Philippines College of Medicine, the conference will highlight the safety perspective in Asean, to be presented by Dr. Shin Young-soo, regional director of the World Health Organization. Health Secretary Janette Garin will talk about the national state of medical safety.

The human factors in patient safety will be discussed by Dr. Vic Malabonga, deputy chief of staff of Central Texas Veterans Health Care System, and the ergonomics perspective by Rosemary Seva, dean of De La Salle University’s Gokongwei College of Engineering. I will talk about the safety perspective in pediatrics.

Some of the other topics to be discussed are: error reduction in healthcare, effective teamwork, minimizing infection through improved infection control, patient safety in surgery, multiprofessional approach to antibiotic stewardship, and integration of patient safety in the health science curriculum.

Significant problem

Worldwide, patient safety is now recognized as a significant problem. Ten percent of hospitalized patients in the United States suffer from harm and injury as a result of processes involved in medical care. The harm to patients results in high healthcare costs and loss of productivity amounting to about $17 billion every year in the United States. Unfortunately, there is no study in our country in this regard.

Ten years ago, the Society to Improve Diagnosis in Medicine was founded by Dr. Mark Graber in the United States. In 2005, the Dalhousie workshop on diagnostic error was hosted by Dr. Pat Croskerry; it was attended by 40 international experts on safety and human error. This gathering snowballed into yearly meetings of researchers and experts on safety and reduction of diagnostic errors in the United States and Canada.

The Patient Safety Congress on June 25 will hopefully start a new era in medical practice in the Asean countries, from diagnosis and treatment focus to reducing and preventing harm and injury in hospitals, medical offices, and at home. All of us will benefit from this shift in medical thinking.

Kids at higher risk

In 1972, I was accepted as a member of the medical staff of a medical center in Maine in the United States. Within a year, a mother at the obstetric ward developed kidney failure because she was given the wrong medication. A nurse had misread the physician’s order because the handwriting was not clear. A few years before I retired, a pediatrician in another hospital gave intravenous medication to an infant without reading the label. It turned out to be a dangerous drug, and the baby died.

Children are at higher risk than adults when medication errors occur. Several studies in hospitalized children found the rate of medication errors ranging from 4.5 to 5.7 errors per 100 medication orders.

Medication errors are more common in children under 2 years old, those in intensive care especially the newborn, those in the emergency room from 4 to 8 a.m., those receiving chemotherapy, those getting intravenous medications, and those whose weight is not documented.

To reduce the chance of medication errors, prescriptions should be printed, preferably using a computer.

Bigger concern

The bigger safety concern in medicine is diagnostic errors. In a review of more than 350,000 paid claims from 1986 to 2010 included in the US National Practitioner Data Bank, errors in diagnosis were shown to be the cause of more deaths, disabilities and medical liability payment than any other kind of medical error.

Of more than 100,000 medical liability cases, errors in diagnosis make up 30 percent of the total, compared to treatment mistakes (27 percent) and surgical errors (24 percent).

Dr. Leonardo L. Leonidas ([email protected]) retired in 2008 as assistant clinical professor in pediatrics from Boston’s Tufts University School of Medicine, where he was recognized with a Distinguished Career in Teaching Award in 2009. He is a 1968 graduate of the UP College of Medicine and now spends some of his time in the province of Aklan.