How you can reduce preventable mistakes in your medical care

There are nearly 1.5 million Americans who suffer each year from preventable mistakes.  A report by the Institute of Medicine estimates that as many as 98,000 people die in U.S. hospitals each year as the result of medical errors.

Most of these errors are related to drug mistakes.  That’s the bad news.  The good news is that your doctors and hospitals are trying to reduce these errors by using by using new electronic technologies that should significantly reduce these errors.  But there is a lot that you can do to minimize these mistakes associated with drug mix-ups.

In this article I will provide 17 ideas [editor's note: referenced from the AHRQ], that are easy for you to use when interacting with your physician or if you are a patient in the hospital can reduce the likelihood of receiving the wrong medication or the wrong treatment.

1. The single most important way you can help to prevent errors is to be an active member of your health care team. That means taking part in every decision about your health care. Patients who are more involved with their care tend to get better results.

2. Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs. At least once a year, bring all of your medicines and supplements with you to your doctor. “Brown bagging” your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date, which can help you get better quality care.

3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines. This can help you avoid getting a medicine that can harm you.

4. 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!

5. Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.

• What is the medicine for?
• How am I supposed to take it, and for how long?
• What side effects are likely? What do I do if they occur?
• Is this medicine safe to take with other medicines or dietary supplements I am taking?
• What food, drink, or activities should I avoid while taking this medicine?

6. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed? Nearly three-quarters of medicine errors involved the wrong drug or the wrong dose.

7. If you have any questions about the directions on your medicine labels, ask. 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.

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

9. Ask for written information about the side effects your medicine could cause. If you know what might happen, you will be better prepared if it does—or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. Written information about medicines can help patients recognize adverse side effects and then give that information to their doctor or pharmacist.

10. If you have a choice, choose a hospital at which many patients have the procedure or surgery you need. Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition. If you are going to have open-heart surgery, ask how many procedures the hospital does each year and what is their success rate.

11. If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands. Handwashing 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 checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.

12. 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. At the time of your discharge, your doctors may think you understand what you should or should not do when you return home. If necessary, ask for written instructions regarding your diet, medications, and when you need to make a follow up appointment.

13. 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. I suggest you sign your initials with a good felt-tipped pen directly on the site to be operated on before the surgery.

14. Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can’t). Even if you think you don’t need help now, you might need it later.

15. Know that “more” is not always better. 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.

16. If you have a test, don’t assume that no news is good news. Ask about the results. Ask when you can expert to hear from the doctor or the nurse about the results of lab work and x-ray reports.

17. Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources. For example, treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse. Ask your doctor if your treatment is based on the latest evidence.

Bottom Line: Errors in health care will occur but many of these can be minimized and completely eliminated if you and your doctor work together as a team. You must take an active role in your health care. By doing so, you will have better health, better results, and fewer mistakes.

Neil Baum is a urologist at Touro Infirmary and author of Marketing Your Clinical Practices: Ethically, Effectively, Economically. He can be reached at his self-titled site, Neil Baum, MDor on Facebook and Twitter.

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  • http://anapolschwartz.com Karen Swim

    This is a post that I wish every medical consumer would read. The key message is that patients must take an active role in every aspect of their healthcare. Doctors, pharmacists and medical professionals like all humans are fallible. it is not offensive or wrong to get involved, ask questions and have checks and balances in place to reduce the possibility of error. Thank you for your insight and sharing on this issue.

  • MarylandMD

    That’s funny. This list looks one heck of a lot like AHRQs “20 Tips to Help Prevent Medical Errors” which appears to have been originally published in September 2000. If this was the source for this article, it would have been nice to refer to it somewhere in the post, or did I miss it?

    http://www.ahrq.gov/consumer/20tips.htm

    PDF version: http://www.ahrq.gov/consumer/20tips.pdf

  • NEMO

    3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines. This can help you avoid getting a medicine that can harm you.

    In addition they should also know any environmental and/or food allergies too. For example, one may know they’re allergic to thimerisol – a doctor needs to know this because many injectable medications are preserved with thimerisol. With food allergies there are potential allegens in some medications – without knowing food allergies, your doctor could prescribe a medication with that ingredient (ie. a shellfish allergy means one shouldn’t take Lovaza).

    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 nurse can also explain your prescription if the doctor is pressed for time. Main things you want to know is the name and the dose – that way when you pick up your prescription at the pharmacy, you can look at the label and confirm it is correct – write it yourself on paper if you need to remember it and don’t think you will without a written reminder.

    5. Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.

    • What is the medicine for?
    • How am I supposed to take it, and for how long?
    • What side effects are likely? What do I do if they occur?
    • Is this medicine safe to take with other medicines or dietary supplements I am taking?
    • What food, drink, or activities should I avoid while taking this medicine?

    Pharmacists job, not the doctor’s job….seriously, look at the list – does a doctor have another 10-15 minutes to answer all the above questions in depth? NO….ask the pharmacist and read your inserts that are provided with all prescriptions.

    9. Ask for written information about the side effects your medicine could cause. If you know what might happen, you will be better prepared if it does—or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. Written information about medicines can help patients recognize adverse side effects and then give that information to their doctor or pharmacist.

    An absolute MUST READ….if it’s missing from your prescription, go back and ask for it from the pharmacy – if the print is too small, ask they reprint with larger font.

    12. 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. At the time of your discharge, your doctors may think you understand what you should or should not do when you return home. If necessary, ask for written instructions regarding your diet, medications, and when you need to make a follow up appointment.

    Discharge nurses job…..doc is going to hand you off to her/him anyway, so don’t waste his/her time – ask away of the discharge nurse until you’re satistifed – that’s her/his job to make sure you understand what to do and when once you’re discharged.

    13. 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. I suggest you sign your initials with a good felt-tipped pen directly on the site to be operated on before the surgery.

    No, no, no — side or site NOT to be operated on — write WRONG SIDE DOC in black sharpie pen……no worries about contaminating your surgery site and no need for the OR staff to have to clean if off for you.

    15. Know that “more” is not always better. 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.

    One simple question – how does this, or will this, change management?

    If it won’t, it’s a fishing expedition most of the time and isn’t going to change what your doctor is already doing for your treatment or management.

  • just a patient

    When my doctor comes into the room, he makes a gesture at washing his hands by running the water over his fingertips. I can’t imagine me saying, please use soap. Because another time when he was examining me I asked how often stethoscopes are cleaned, and he bristled. I meant it as an academic question, but the way his back stiffened I’m sure he took it as pointed criticism as I never witnessed any such cleaning ever. The remainder of that appointment was awkward. I might have the nerve to question a nurse or medical student on their hygiene habits, but the doctor?….that’s a difficult call

    • http://anapolschwartz.com Karen Swim

      I worked in healthcare for more than two decades and I can assure you that doctors are humans. You should never feel intimidated by your physician or anyone for that matter. They are your doctor and not your superior. Open communication is critical to establishing a good relationship with your doctor and ensuring that you receive the best care. If you’re too afraid to speak up or don’t like your doctor’s attitude, change physicians but never settle for substandard care or fail to ask questions.

  • Reta Russell Houghton

    This was excellent and reminded me of my old primary who told me to become an expert on any disorder I have to protect myself because doctors can’t know everything.

    I have become an active member of my healthcare team and used this advice often. I have had to remind doctors I can not take certain medications and have returned prescriptions after doing more research. I have questioned things doctors have told me that did not appear kosher.

    I have found that not all doctors want this type of patient.
    They resent you asking certain types of questions. I once told a surgeon he had given me incorrect information and he became quite hostile when I pointed it out. The two conditions had similar names (one word different) but were the opposite ends of the scale. He accused me of trying to practice medicine. I was trying to protect myself. We parted company that day and I found another surgeon.

  • Ginny Miller

    Excellent suggestions and advice for every patient! Unfortunately there are doctors and hospitals who do not like the ideas of family members or friends “advocating” at appointments. I had one hospital actually ban me for assisting a friend in this area! My son’s doctor sent me a letter telling me i was NO LONGER allowed in the clinic or any related clinics! I was not allowed to speak to my son’s doctor any more unless my son was there! I had to speak to the patient relations office instead! UP untill this point we thought we had an excellent working relationship with this doctor for the previous year after an up and down working relationship! (our son is medically complex and went through a misdiagnosis with this doctor whom I highly respected and told him this many times!) The letter came on the anniversary of my son’s suicide attempts! I was so very shocked and my husband and I asked for face to face meetings to preserve my son’s medical care. We were denied! We debated leaving the doctor’s care right then, but did not want to just run. We tried to work with him, but he would only speak to me through emails, DId not speak to my son or his dad! Very odd situation.

    All other care we have had, we always recommend having someone go with you to help remember what is said. COmeplex care is difficult. IF the doctor does not understand this, find a new doctor. MIsunderstandings occur, doctors are human. obtain copies of medical records for your own set.

  • http://google Jose

    how can i reduce preventable mistakes in my medical care if the doctor don’t listen or nevere believe what the patient tells him. like in my case, he prescribed me a medicine that was discontinued by my cardiologist because i developed adverse reaction. i told him twice that i’m intolerable to that drug but still insist me to take the “POISON”. the outcome…..i had a heart attack and angioplasty procedure was done.

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