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Initial with care – Doctors, patients work together to ensure medical safety

The facts that medical mistakes occur is troubling to all and along with litigation costs, the obvious reason for rising insurance costs for physicians.

In some cases, the situation is so bad some doctors have simply left the profession, according to Dr. Dale Butler of Grass Valley. Butler is the president of the California Orthopaedic Association, a chapter of the American Academy of Orthopaedic Surgeons, and dedicated to a relatively new academy program for patient safety.

“A lot of times the patients can be safe themselves,” with common sense after surgeries and afflictions by following doctor and pharmacist directions, Butler said. “Sometimes it’s the system.”



For instance, there have been instances where a person’s right leg was opened for surgery, when the left leg needed it.

A new system borrowed from Canadian physicians calls for the area to undergo surgery be marked with the patient or doctor’s initials with a felt-tip pen. It sounds simple, Butler said, but it works.




“Our academy pushed against it and gave it a lot of resistance,” Butler said. “But it’s an accepted thing now.”

Medical people are human, Butler said, “and things happen. It’s usually not an individual’s fault. In the legal system, everybody wants to point to one person. A nurse may get fired but there usually have been a snowballed bunch of problems,” when mistakes occur.

According to the academy and a 1999 Institute of Medicine study, “as many as 44,000 to 98,000 people die in hospitals each year as the result of medical errors.” The report said those errors cost almost $38 billion and almost half were preventable.

Critics and Butler said that number may be high because it was extrapolated out for the entire United States based on one or two area’s statistics.

The academy lists five classic medical errors:

• Diagnosis, which leads to incorrect therapy

• Equipment failure

• Infections

• Blood transfusions

• Misinterpreting medical orders

Americans are aware of the error rate and according to a poll conducted by the National Patient Safety Foundation, 42 percent who responded have been affected by a medical error and 32 percent said a medical error had a negative impact on their health.

Dr. David Wong is an orthopedic spine surgeon from Denver in charge of the orthopaedic academy’s patient safety campaign this year.

The campaign is striving for system solutions to prevent medical mistakes by using a universal protocol.

“That’s what the airline industry has done since the ’70s and ’80s when they had bad accidents,’ Wong said. “It has everyone getting all their ducks in a row.”

The universal protocol Wong and the academy are preaching this year is in three parts. The first is patient identification.

While there have been cases of operating on the wrong body part, patient identification makes sure the right person gets the right procedure. That will help stop knee injury victims from waking up with unexpected appendectomy scars, Wong said.

Second, the surgeons are being asked to sign a surgical area with their initials. Third, surgery and laboratory people are scanning check lists during procedure to make sure nothing is forgotten.

Wong said in a similar program in Canada “the incidence of wrong sight surgery has gone down 65 percent.”

Solutions

There are solutions beyond paying better attention to detail, according to the Institute of Medicine study.

A pharmacist put on medical rounds in a hospital cut errors linked to medication 66 percent. Anesthesiologists using standardized guidelines and protocol have managed to cut the error rate sevenfold.

The institute and Butler said the Veterans Administration hospitals have begun stressing patient safety. One hospital cut medication mistakes by 70 percent by using computers and bar codes.

Patients can prevent errors by knowing all about their prescription medicines, according to the academy. Doctors need to know what they will be mixing in your body, so people need to admit they take dietary supplements, herbs and other over-the-counter medicines.

People need to take their medicine on time and in the dose prescribed. They can also ask for information on side effects.

“A lot of times, the patients can be safe themselves,” Butler said.

While in the hospital, patients should be sure that staff members check their ID bracelets before they take their medicine. Patients also need to have a doctor or nurse explain how to continue care at home.

Home health equipment should be grounded with a three-prong plug, the academy said.


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