Strategies to Reduce Medical Errors and Ensure Patient Safety

1. Introduction

   A medical error refers to any preventable adverse event or effect that may occur during medical treatment. It can be the result of a variety of factors, including miscommunication, misdiagnosis, inadequate training, or equipment malfunction. Medical errors can lead to harm, injury, or even death of patients.^[1]

   Patient safety- Patient safety, on the other hand, refers to the proactive measures taken to prevent and reduce the risk of medical errors. It also involves creating a culture of safety within healthcare organizations where patients and healthcare providers work combinedly to minimize risks and prevent errors.

   US hospitals and healthcare institutions rank medical errors as the third leading cause of death, resulting in almost 98,000 deaths each year, as reported by the official Starfield and the American Institute of Medicine (IOM).^[3]

   1.1 The Critical Importance Of Reducing Medical Errors

   Medical errors can harm the patient physically as well as financially, we can overcome the undesired effect of medical errors and decrease the financial loss of patients as well as the healthcare system by reducing medical errors.

   Medical errors can lead to increased healthcare costs due to prolonged hospital stays and additional treatments. By improving safety and reducing errors, healthcare providers can reduce costs associated with preventable adverse events.

   Patients completely rely on their healthcare providers for treatment, if healthcare providers can work on the elimination of errors it will result in building a better patient-physician relationship, and ultimately prove beneficial for the organization’s reputation among other competitors.

2. Understanding The Different Forms and Contributing Factors to Medical Errors

   Several types of medical errors occur, they are classified as:

   • Diagnostic Errors: Diagnostic errors occur during the diagnosis of diseases in patients
   • Surgical Errors: Surgical errors occur during surgical procedures and they may be fatal as compared to other types of medication error
   • Prescribing Errors: Prescribing errors may be defined as incorrect drug selection for a patient
   • Dispensing Errors: Errors during dispensing can happen at any point in the process, starting from when the pharmacy receives the prescription, to when the medication is handed over to the patient.
   • Human Error: Healthcare professionals are prone to making mistakes. It can be due to fatigue, stress, or lack of training.
   • Administration Errors: Administration errors can happen when there is a mismatch between the drug intended by the prescriber and the drug received by the patient. These errors can occur during the medication administration process.

3. Causes of Medical Errors

   Identifying the risk factors for medical errors is the crucial first step towards its prevention and is an important goal of quality care assurance. In general, doctors sometimes made mistakes, but they don’t tell anyone about it, so the cause of the medical errors remains unreported that’s why causes are generally not known but a few causes are listed below:

   • Dosing: Faulty medication dosing is responsible for approximately 25% of medical errors
   • Documentation: One of the major factors contributing to medication errors is documentation. If nursing documentation is missing, inaccurate, or inadequate, it can pose a serious threat to patient safety
   • Burnout: Burnout in healthcare professionals results in suboptimal patient care practices and appreciably increases the risk of medical errors
   • Communication: The most frequent cause of medical errors is breakdowns in communication. Whether it’s in the form of verbal or written communication, these issues can arise within a healthcare system or medical practice, and they can involve any member of the healthcare team, including physicians, nurses, or patients.
   • Organization and training: Insufficient training and inconsistent or inadequate education can result in knowledge gaps that can affect patient care. This transfer of knowledge is especially critical in areas where new employees or temporary staff members are used.^[5]

4. Strategies To Minimize Medical Errors In Healthcare

   Research indicates that the solutions for medical errors vary depending on the type of error. Simple activities such as practicing hand hygiene can help prevent healthcare-associated infections, while more complex solutions involve utilizing technological instruments or methods to prevent errors such as retained surgical instruments.

   4.1 Technology

   One of the most recent developments in the healthcare industry over the past 25 years is the development of the information and communication technology in industry. This technology has a significant impact on healthcare organizations and is helpful in the elimination of medical errors. There are various instruments are used such as:

   • Computerized Physician Order Entry (CPOE): This system can be a powerful solution for reducing hospital medical errors when used as a single intervention. These systems are designed to replace paper-based ordering systems and allow physicians to electronically write a range of orders, maintain medication administration records, and track modifications made to orders by successive health personnel. Studies have shown that using CPOE systems and automated drug distribution systems as single interventions can significantly decrease medication administration errors in hospitals. ⁽⁶⁾
   • Clinical Decision Support Systems (CDSS): This system can provide clinicians with relevant clinical knowledge and patient-related information. These systems intelligently select and display the information at the appropriate time. If used appropriately, CDSS can be very helpful in eliminating medical errors.
   • Electronic Health Record (EHR): EHR is a system that digitally captures individuals’ health information, including allergies, diseases, surgeries, infections, immunization data, and environmental data, throughout their lifetime.^[6] Some of the primary benefits of using EHR include providing medical reminders and warnings, access to medication information and healthcare databases, and the ability to identify abnormal test results and dangerous drug interactions.
   • Barcode medication administration: The shift towards electronic health records has highlighted the importance of using standard barcodes in healthcare. In response to the 1999 IOM report and to enhance patient safety, the FDA mandated the use of barcode labels for drugs and biological products by 2006. The FDA estimated that this requirement would prevent nearly 500,000 adverse medication events and injection errors over the next two decades. Subsequently, the Veterans Health Administration (VHA) implemented the Barcode Medication Administration (BCMA) software, which uses barcoded wristbands containing patient identification information. The barcode is helpful to the pharmacist to prepare and label the medications, which are scanned by the nurse using both the medication label and patient wristband to ensure accurate medication administration. in this way, it is useful in eliminating medical errors.

   4.2 Power of Standardizing Processes and Protocols In Healthcare

   Every year, approximately 234 million surgeries are performed globally. Of these, an estimated seven million complications and one million deaths occur; half of which are thought to be preventable.^[7]

   • Surgical checklist: The surgical checklist is made to reduce mortality and complications that arise during surgery. Although the specific way in which surgical checklists enhance patient outcomes remains unclear, it is believed that various factors contribute to this phenomenon.⁽⁷⁾ Key factors include improved team communication, teamwork, compliance with prophylactic antibiotic administration and monitoring before induction of anaesthesia. The checklist was found to decrease mortality by 37% in a study conducted in 8 hospitals where surgical checklists are used.^[7]
   • Medical reconciliation: The US Institute for Healthcare Improvement (IHI) has introduced the concept of medication reconciliation to healthcare professionals, as it is widely acknowledged that most medical errors occur when patients are transferred between wards. Medication reconciliation involves creating a precise list of a patient’s medications, including the drug name, dosage, frequency, and route, and comparing it with the physician’s admission, transfer, and/or discharge orders. This helps ensure that patients receive accurate medications during all transition points within the hospital. ^[4]

   4.3 Promoting a culture of safety

   Creating a culture that is free from shame, blame, and punishment could be a helpful approach to eliminating medical errors. One common type of error is related to verbal communication, which can be mitigated by using printed prescriptions with correct abbreviation systems in healthcare organizations. Unfortunately, many clinical errors go unreported due to fears of punishment and breaching patients’ trust, but failing to report errors can lead to even more serious consequences. Therefore, it is important to report errors and take steps to prevent them from happening again, such as providing proper training to eliminate errors.

   4.4 Involving patients and families in healthcare decision-making

   Patient participation plays a vital role in preventing and reporting medical errors related to their care. Patients and their families can actively participate by inquiring about their medical condition, gathering medical information, following recommended medical instructions, and exploring alternative treatments.^[8] Patient safety officers are designated to increase patient engagement by providing extensive patient safety campaigns, brochures, and videos. Moreover, the feedback provided by patients regarding the drugs, doses, and side effects they encounter can be used to prevent medical errors. Therefore, patient participation and feedback are crucial in ensuring safer healthcare practices. ^[8]

5. Challenges To Reduce Medical Errors And Improve Patient Safety

   • Limited resources and staff burnout: Reducing medical errors is a significant challenge, especially given the presence of limited resources and staff burnout in healthcare settings. Limited resources can make it difficult to provide optimal care for patients, and often lead to an increase in medical errors, particularly medication-related errors. Furthermore, healthcare providers are increasingly experiencing burnout, which can lead to a lack of concentration and increased incidence of medical errors. If these challenges are not addressed in a timely manner, the consequences can be both financial and physical, with the potential to compromise patient safety and undermine the overall quality of healthcare services. Therefore, it is essential to invest in resources and strategies that support healthcare providers and optimize patient care, to minimize the impact of these challenges on medical errors and patient safety.
   • Lack of standardization and variation in care: The current healthcare system is becoming increasingly complex due to the availability of a large number of treatment options and a vast number of healthcare providers. This complexity can make it difficult to ensure consistent and high-quality care, leading to an increase in medical errors. One solution to this problem is the adoption of standardization processes for every treatment. This approach would help to eliminate medical errors by providing healthcare providers with clear and consistent protocols for patient care. Additionally, standardization can help reduce costs by optimizing the use of resources and reducing the variability in treatment outcomes. By implementing standardized processes across healthcare organizations, patients can receive consistent, high-quality care, regardless of where they receive treatment.
   • High cost of technology implementation: The use of technology to eliminate medical errors has increased significantly in recent years. However, one of the major challenges associated with this approach is the cost of implementing such technology. For example, techniques such as bar coding, electronic health records (EHR), and other related technologies can be very expensive to acquire and maintain, making it difficult for many healthcare organizations to afford them. Consequently, making these technologies more cost-effective is one of the biggest challenges in the healthcare industry. Finding ways to reduce the cost of these technologies will help to increase their adoption and usage, leading to improved patient safety and lesser medical errors.
   • Resistance to change: Resistance to change can be a significant obstacle when it comes to eliminating medical errors and enhancing patient safety. Medical professionals, who possess significant expertise and experience, may be unwilling to alter their traditional practices even if it can lead to better patient outcomes. To address this issue, it is crucial to establish a culture of safety that prioritizes patient well-being over traditional customary practices. Therefore, through the establishment of a culture of safety, healthcare professionals and patients can collaborate to overcome resistance to change, ensuring better healthcare outcomes for all.

6. Conclusion

   Medical errors are a serious concern in the healthcare industry, and different types of errors exist such as diagnostic, surgical, and documentation errors. Identifying the type and cause of medical errors can be crucial in preventing them from occurring in the future, and timely reporting and sharing experiences of medical errors can help improve patient safety.

   To address medical errors, various instruments like barcoding and EFR have been developed, but they do have their limitations. Overcoming these limitations can be essential in reducing medical errors and enhancing patient safety. By continuously improving and upgrading these instruments, we can attempt towards better patient outcomes and a safer healthcare system.

   Medical errors are a significant cause of mortality around the globe and the safety of patients is an important part of the healthcare system. All healthcare providers, organizations and policy maker need to investigate this matter and take some frequent necessary steps too to eliminate medical errors and improve patient safety.

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