Kingdom of Saudi Arabia

Ministry of Health
Directorate of Health
Affairs in Gurayat
Gurayat General Hospital

MEDICAL ERRORS

Dr. Hisham Abid Aldabbagh

MSc. Internal Medicine
Defining Medical Errors
Can J Surg. 2005

• Medical errors represent a serious public health problem

and pose a threat to patient safety.
• Medical errors can occur anywhere in the health care
system:
In hospitals, clinics, surgery centres, doctors' offices,
nursing homes, pharmacies, and patients' homes.
• Medical Errors can involve medicines, surgery, diagnosis,
equipment, or lab reports.
• An unintended act (either of omission or commission)
• One that does not achieve its intended outcome
• The failure of a planned action to be completed as intended
(an error of execution)
• The use of a wrong plan to achieve an aim (an error of
planning)
• A deviation from the process of care that may or may not
cause harm to the patient.
• Patient harm from medical error can occur at the individual or
system level.
• Medical error—the third leading cause of death in the US
BMJ 2016

• Medical error is not included on death certificates or in rankings

of cause of death.
• The death list is created using death certificates filled out by
physicians, funeral directors, medical examiners, and coroners.
However, a major limitation of the death certificate is that it
relies on assigning an International Classification of Disease (ICD)
code to the cause of death. As a result, causes of death not
associated with an ICD code, such as human and system factors,
are not captured.
 Types of Medical Errors

Diagnostic Preventive
 Error or delay in diagnosis • Failure to provide
 Failure to employ indicated tests prophylactic treatment
 Use of outmoded tests or investigations • Inadequate monitoring or
follow-up of treatment
 Failure to act on results of monitoring or testing

 Treatment Other
 Error in the performance of an operation, procedure, or therapy
 Error in administering the treatment • Failure of communication
 Error in the dose or method of using a drug • Equipment failure
• Other system failure
 Avoidable delay in treatment or in responding to an abnormal test
 Inappropriate (not indicated) care
How common are medical errors?

• Medical errors are, frankly, rampant. A recent

study estimates that “communication breakdowns,
diagnostic errors, poor judgment, and inadequate skill” as
well as systems failures in clinical care result in between
200,000 to 400,00 lives lost per year.
• This means that if medical error was a disease, it would be
the third leading cause of death in the United States.
 Some Facts

• 440,000 patients die every year from preventable medical

errors. [Journal of Patient Safety]
• Preventable medical errors cost USA tens of billions of dollars a
year. [Institute of Medicine]
• One in three patients who are admitted to the hospital will
experience a medical error. [Health Affairs]
• Studies of wrong site, wrong surgery, wrong patient procedures
show that “never events” are happening at an alarming rate of
up to 40 times per week in U.S. hospitals. [Archives of Surgery ]
Data and statistics, WHO 2017

• European data show that medical errors and health-care

related adverse events occur in 8% to 12% of
hospitalizations.
• Infections associated with health care affect an estimated 1
in 20 hospital patients on average every year (estimated at
4.1 million patients).
• 23% of European patients are affected by medical error,
18% experienced a serious medical error in a hospital and
11% to have been prescribed wrong medication.
• Evidence on medical errors shows that 50% to 70.2% of
such harm can be prevented through comprehensive
systematic approaches to patient safety.
• Statistics show that strategies to reduce the rate of adverse
events in the European Union alone would lead to the
prevention of more than 750 000 harm-inflicting medical
errors per year, leading in turn to over 3.2 million fewer
days of hospitalization, 260 000 fewer incidents of
permanent disability, and 95 000 fewer deaths per year.
We learn most from Studying these
our painful mistakes and
mistakes. learning how to
Mistakes can injure prevent, monitor,
patients and land and respond to
physicians in legal them, however,
and professional has changed the
trouble. standards of
care.

By working to eliminate common medical errors,

physicians can protect patients, protect themselves from lawsuits, and help
lower the cost of their professional liability insurance premiums.
In 1976, Dr. Jim At the local hospital,
Styner, an orthopedic the care that he and
surgeon, crashed his his children received
small plane into a was inadequate, even
cornfield in by standards in those
Nebraska, sustaining days.
serious injuries.
His wife was killed,
and 3 of their 4
children were
critically injured

His family's tragedy and the medical mistakes that followed gave birth to Advanced
Trauma Life Support (ATLS) and changed the standard of care in the first hour after
trauma.
Judy was 39 years old The American
when she went to the Society of
hospital for a Anesthesiologists
hysterectomy. After responded with a
she died on the program to
operating table, standardize
autopsy revealed that anesthesia care and
the anesthesiologist patient monitoring
had placed the and in 1985 created
endotracheal tube in the Anesthesia
her esophagus, not •.
Patient Safety
her trachea Foundation.

Standard practices now include the use of pulse oximetry and end-tidal carbon dioxide
monitoring for anesthetized patients.
The push for electronic monitoring systems for patients under anesthesia caused anesthesia-
related deaths to plummet from about 1 in 10,000 to 1 in 200,000 in less than 2 years.
Sally and Ed looked Unfortunately,
forward to the administration of
birth of their first oxytocin led to
child. Sally's labor unrecognized fetal
was long, so her distress, and their
obstetrician added newborn daughter
oxytocin to speed suffered severe
things up. brain injury and
cerebral palsy.

Fetal monitoring to test both uterine contractions and fetal heart rate (FHR) is now the
standard of care.
The purpose of FHR monitoring is to follow the status of the fetus during labor so that
clinicians can intervene if there is evidence of fetal distress.
When EFM is used during labor, the nurse or physicians should review it frequently
Bill had a seizure Unfortunately, the
and crashed his car x-ray technician
into a tree, crushing mislabeled the
both legs. films, mixing left for
Arteriography right, and the
revealed that his orthopedic surgeon
right leg was first amputated
salvageable but his Bill's right leg.
left leg was not

Preventing wrong-site surgery became one of the main safety goals of the Joint
Commission for Accreditation of Healthcare Organizations (JCAHO).
Establishing protocols became an accreditation requirement for hospitals, ambulatory
surgery centers, and office-based surgery sites.
Tom was 12 years old One week later, the
when his appendix surgeon performed a
burst and he was second procedure and
taken to the local found that a surgical
pediatric hospital. sponge had been left
Three days after the inside.
appendectomy, he
developed another
high fever.

Postoperative sponge and instrument counts have been routine for decades. There is no
single standard, although nursing and surgical organizations have developed best
practices for sponge, needle, and instrument counts.
As a young child, Betty No one had asked her
had been given about medication
penicillin, turned blue, allergies.
and was rushed to the
hospital.
She was 15 when she
got strep throat, was
given penicillin, and
died.

Strategies to address the problem include adding visible prompts in consistent and
prominent locations listing patient allergies, eliminating the practice of writing drug
allergens on allergy arm bracelets, and making the allergy reaction selection a
mandatory entry in the organization's order-entry systems
Linda wasn't doing In the emergency
well in her first department, her
trimester. nurse made a
The nausea and mathematical error
vomiting left her and administered too
severely dehydrated much intravenous
and with a low potassium.
potassium level. Within an hour, Linda
was dead.

In the 1980s and 1990s, patient safety groups drew attention to the need for removal of
concentrated potassium chloride vials from patient care areas.
Potassium is now added to IVs by the manufacturer and is labeled.
Additional safety strategies include using premixed solutions, segregating potassium from
other drugs and using warning labels, prohibiting the dispensing of vials for individual
patients, and performing double-checks with a pharmacist.
Frank was 72 years The nurses didn't know
old when he broke that patients needed to
his right leg in a car move regularly, and
accident and had to Frank developed deep
recover for a few decubitus (pressure)
weeks in a ulcers. When these
rehabilitation facility. became infected,
Frank's leg had to be
amputated.

Nursing homes and hospitals now have programs to avoid development of bedsores by
using a set timeframe to reduce pressure and having dry sheets by using catheters or
impermeable dressing.
Pressure shifting on a regular basis and the use of pressure-distributive mattresses are
now common practices.
Lillian was 68 years Lillian's nurse, Millie,
old and weighed 250 wasn't strong enough
lb when she to support her and
underwent surgery they both fell,
to remove her breaking Millie's right
gallbladder. arm and Lillian's left
The second day after leg.
surgery, she needed
help to walk to the
bathroom.

The ANA supports policies that eliminate manual patient lifting.

Safe patient-handling techniques involve the use of such equipment as full-body slings,
stand-assist lifts, lateral transfer devices, and friction-reducing devices
When Christy was 42 By the time it was
years old, her doctor diagnosed,
discovered a large lump the cancer had
in her left breast. progressed beyond
The lump should have cure.
been evident during
Christy's 2 previous
annual examinations if
they had been
complete

Breast examinations by the physician, teaching of techniques for breast self-examination,

and recommendation of mammograms are now the standard of care.
These are but a few examples of medical mistakes that have led to patient injuries or
death -- and have led further to changes in the way physicians practice medicine.
Recognizing that all of these mistakes could have been prevented, medical academies
have developed guidelines for prevention and treatment of many diseases.
 What are the 10 things that can kill a patient in the hospital?

• #1. Misdiagnosis. The most common type of medical error.

A wrong diagnosis can result in delay in treatment, sometimes
with deadly consequences.
• #2. Unnecessary treatment. Thousands of people receive
unnecessary treatment that cost them their lives.
• #3. Unnecessary tests and deadly procedures. Studies show
that $700 billion is spent every year on unnecessary tests and
treatments, it can also be deadly.
• #4. Medication mistakes. Over 60% of hospitalized
patients miss their regular medication while they are in the
hospital. On average, 6.8 medications are left out per
patient.
• Wrong medications are given to patients; a 2006 Institute
of Medicine report estimated that medication error injure
1.5 million Americans every year
• #5. “Never events”. Operating on wrong limb or the wrong
patient.
• Food meant to go into stomach tubes go into chest tubes
• Air bubbles go into IV catheters, resulting in strokes.
• Sponges, wipes, and even scissors are left in people’s
bodies after surgery.
• These are all “never events”, meaning that they should
never happen, but they do, often with deadly
consequences.
• #6. Uncoordinated care. If you’re going to the hospital,
chances that you won’t be taken care of by your regular
doctor, but by the doctor on call.
• You’ll probably see several specialists, who scribble notes in
charts but rarely coordinate with each other.
• You may end up with two of the same tests, or medications
that interfere with each other.
• There could be lack of coordination between your doctor
and your nurse, which can also results in confusion and
medical error.
• #7. Health care associated infections. According to
the Centers for Disease Control, hospital-acquired
infections affect 1.7 million people every year.
• These include pneumonias, infections around the site of
surgery, urinary infections from catheters, and bloodstream
infections from IVs.
• Such infections often involve bacteria that are resistant to
many antibiotics, and can be deadly (the CDC estimates
nearly 100,000 deaths due to them every year), especially
to those with weakened immune systems
• #8. Not-so-accidental “accidents”. Every year, 500,000 patients
fall while in the hospital.
• As many “accidents” occur due to malfunctioning medical
devices. Defibrillators don’t shock; hip implants stop working;
pacemaker wires break.,…..
• They happen for 1 in 100 people.
• #9. Missed warning signs. When patients get worse, there is
usually a period of minutes to hours where there are warning
signs. Unfortunately, these warning signs are frequently
missed, so that by the time they are finally noticed, there could
have been irreversible damage.
• #10. Going home—not so fast. Studies show that 1 in 5
Medicare patients return to the hospital within 30 days of
discharge from the hospital.
• This could be due to patients being discharged before they are
ready, without understanding their discharge information,
without adequate follow-up, or if there are complications with
their care.
• The transition from hospital to home is one of the most
vulnerable times, and miscommunication and
misunderstanding can kill a patient after getting home from
the hospital too.
 Golden professional principles

If We Don’t Own Our Errors, We Are

Destined To Repeat Them

In Medicine, Honesty Is Truly The Best

Policy
 Ongoing Message
Dear Colleagues, Please,
Always Reactivate Your Interest and Efforts in
Eliminating Medical Errors

Thanking You
Email: dr.hishamdabbagh@gmail.com
Email: haldabag@moh.gov.sa
Mobile: 00966536715868