Editing Medical error (section)

== Prevention ==
{{Further|Patient safety}}

Medical care is frequently compared adversely to [[aviation]]; while many of the factors that lead to errors in both fields are similar, aviation's error management protocols are regarded as much more effective.<ref>{{cite journal |last1=Helmreich |first1=R. L |title=On error management: lessons from aviation |journal=BMJ |date=18 March 2000 |volume=320 |issue=7237 |pages=781–785 |doi=10.1136/bmj.320.7237.781 |pmid=10720367 |pmc=1117774 }}</ref> Safety measures include [[informed consent]], the availability of a second practitioner's opinion, voluntary reporting of errors, [[root cause analysis]], reminders to improve patient medication adherence, [[hospital accreditation]], and systems to ensure review by experienced or specialist practitioners.<ref>{{cite journal |last1=Espinosa |first1=J. A |last2=Nolan |first2=TW |title=Reducing errors made by emergency physicians in interpreting radiographs: longitudinal study |journal=BMJ |date=18 March 2000 |volume=320 |issue=7237 |pages=737–740 |doi=10.1136/bmj.320.7237.737 |pmid=10720354 |pmc=27314 }}</ref>

A template has been developed for the design (both structure and operation) of hospital medication safety programmes, particularly for acute tertiary settings,<ref>{{cite journal |last1=Relihan |first1=Eileen C |last2=Silke |first2=Bernard |last3=Ryder |first3=Sheila A |title=Design template for a medication safety programme in an acute teaching hospital |journal=European Journal of Hospital Pharmacy |date=23 June 2012 |volume=19 |issue=3 |pages=340–344 |doi=10.1136/ejhpharm-2012-000050 |hdl=2262/66780 |s2cid=54178056 |hdl-access=free }}</ref> which emphasizes safety culture, infrastructure, data (error detection and analysis), communication and training.

Particularly to prevent the medication errors in the perspective of the intrathecal administration of local anaesthetics, there is a proposal to change the presentation and packaging of the appliances and agents used for this purpose. One spinal needle with a syringe prefilled with the local anaesthetic agents may be marketed in a single blister pack, which will be peeled open and presented before the anaesthesiologist conducting the procedure.<ref>{{cite journal | last=Alam | first=Rabiul | year=2016 | title=Spinal needle with prefilled syringe to prevent medication error: A proposal | journal=Indian Journal of Anaesthesia | volume=60 | issue=7 | pages=525–7 | doi=10.4103/0019-5049.186014 | pmid=27512177 | pmc=4966365 | doi-access=free }}</ref>

Physician well-being has also been recommended as an indicator of [[Health care quality|healthcare quality]] given its association with patient safety outcomes.<ref>{{cite journal |last1=West |first1=Colin P |year=2016 |title=Physician Well-Being: Expanding the Triple Aim |journal=Journal of General Internal Medicine |volume=31 |issue=5 |pages=458–459 |doi=10.1007/s11606-016-3641-2 |pmid=26921157 |pmc=4835383 }}</ref> A meta-analysis involving 21517 participants found that physicians with depressive symptoms had a 95% higher risk of reporting medical errors and that the association between physician depressive symptoms and medical errors is bidirectional <ref name="Association Between Physician Depre" />

=== Reporting requirements ===
In the United States, adverse medical event reporting systems were mandated in just over half (27) of the states as of 2014, a figure unchanged since 2007.<ref name="NASHP-2015">{{cite web|last1=Hanlon|first1=Carrie|last2=Sheedy|first2=Kaitlin|last3=Kniffin|first3=Taylor|last4=Rosenthal|first4=Jill|title=2014 Guide to State Adverse Event Reporting Systems|url=http://www.nashp.org/sites/default/files/2014_Guide_to_State_Adverse_Event_Reporting_Systems.pdf|website=NASHP.org|publisher=National Academy for State Health Policy|access-date=22 April 2016|year=2015|archive-date=February 2, 2017|archive-url=https://web.archive.org/web/20170202000851/http://www.nashp.org/sites/default/files/2014_Guide_to_State_Adverse_Event_Reporting_Systems.pdf|url-status=dead}}</ref><ref name="YaleJHealthPolicyLaw-2009">{{cite journal|title=A national survey of medical error reporting laws.|journal=Yale Journal of Health Policy, Law, and Ethics|year=2009|volume=9|issue=1|pages=201–86|pmid=19388488|url=http://www.yale.edu/yjhple/issues/vix-i1-win09/docs/feature.pdf|access-date=22 April 2016|archive-date=December 18, 2015|archive-url=https://web.archive.org/web/20151218195256/http://www.yale.edu/yjhple/issues/vix-i1-win09/docs/feature.pdf|url-status=dead}}</ref> In U.S. hospitals error reporting is a condition of payment by Medicare.<ref>{{Cite web |url=https://www.nytimes.com/2012/01/06/health/study-of-medicare-patients-finds-most-hospital-errors-unreported.html |title=Report Finds Most Errors at Hospitals Go Unreported |website=[[The New York Times]] |access-date=February 27, 2017 |archive-date=February 26, 2021 |archive-url=https://web.archive.org/web/20210226190043/https://www.nytimes.com/2012/01/06/health/study-of-medicare-patients-finds-most-hospital-errors-unreported.html |url-status=live }}</ref> An investigation by the Office of Inspector General, Department of Health and Human Services released January 6, 2012 found that most errors are not reported and even in the case of errors that are reported and investigated changes are seldom made which would prevent them in the future. The investigation revealed that there was often lack of knowledge regarding which events were reportable and recommended that lists of reportable events be developed.<ref>{{Cite web |url=http://oig.hhs.gov/oei/reports/oei-06-09-00091.asp |title=Summary Hospital Incident Reporting Systems Do Not Capture Most Patient Harm |access-date=January 6, 2012 |archive-date=January 14, 2016 |archive-url=https://web.archive.org/web/20160114053151/http://oig.hhs.gov/oei/reports/oei-06-09-00091.asp |url-status=dead }}</ref>

=== Cause-specific preventive measures ===
Traditionally, errors are attributed to mistakes made by individuals, who then may be penalized. A common approach to respond to and prevent specific errors is requiring additional checks at particular points in the system, whose findings and detail of execution must be recorded. As an example, an error of free flow IV administration of heparin is approached by teaching staff how to use the IV systems and to use special care in setting the IV pump. While overall errors become less likely, the checks add to workload and may in themselves be a cause of additional errors. In some hospitals, a regular [[morbidity and mortality conference]] meeting is scheduled to discuss complications or deaths and learn from or improve the overall processes.

A newer model for improvement in medical care takes its origin from the work of [[W. Edwards Deming]] in a model of [[Total Quality Management]].{{Citation needed|date=July 2023}} In this model, there is an attempt to identify the underlying system defect that allowed the error to occur. As an example, in such a system the error of free flow IV administration of heparin is dealt with by not using IV heparin and substituting subcutaneous administration of heparin, obviating the entire problem. However, such an approach presupposes available research showing that subcutaneous heparin is as effective as IV. Thus, most systems use a combination of approaches to the problem.{{Citation needed|date=July 2023}}

=== Anaesthesiology ===
The field of medicine that has taken the lead in systems approaches to safety is [[anaesthesiology]].<ref>{{cite journal |last1=Gaba |first1=David M. |date=18 March 2000 |title=Anaesthesiology as a model for patient safety in health care |journal=BMJ |volume=320 |issue=7237 |pages=785–788 |doi=10.1136/bmj.320.7237.785 |pmc=1117775 |pmid=10720368}}</ref> Steps such as standardization of IV medications to 1&nbsp;ml doses, national and international color-coding standards, and development of improved airway support devices has the field a model of systems improvement in care.

=== Medications ===
Reducing errors in prescribing, dispensing, compounding/formulating, labelling, and handling medications is a priority and has been the subject of systematic reviews and studies. Examples of areas to reduce medication errors and improve safety include: Training professionals or using databases to compare new and previous prescribed medications to prevent mistakes, also known as "[[medication reconciliation]]",<ref>{{Citation |last=Barnsteiner |first=Jane H. |title=Medication Reconciliation |year=2008 |url=http://www.ncbi.nlm.nih.gov/books/NBK2648/ |work=Patient Safety and Quality: An Evidence-Based Handbook for Nurses |editor-last=Hughes |editor-first=Ronda G. |access-date=2023-07-17 |series=Advances in Patient Safety |place=Rockville (MD) |publisher=Agency for Healthcare Research and Quality (US) |pmid=21328749 |archive-date=March 31, 2023 |archive-url=https://web.archive.org/web/20230331081303/https://ncbi.nlm.nih.gov/books/NBK2648/ |url-status=live }}</ref> prescribing through an electronic medical record system and/or using decision support systems that has automatic checks in place, with computerized alerts or other novel technologies, the use of machine-readable [[barcode]]s, healthcare professional and patient training or supplementary educational programs, adding in an extra step for double checking prescriptions (both at the level of the healthcare professional and at the administrator level), using standardized protocols in the workplace that include a check-list, physical markings or writing on syringes to indicate correct doses, programmes that include the person being able to administer the medications themselves, ensuring that the workplace or environment is well-lit, monitoring and adjusting healthcare professional working hours, and the use of an interdisciplinary team.<ref name=":1" /> There is weak evidence indicating that a number of these suggested interventions may be helpful in reducing errors or improving patient safety, however, in general, evidence supporting the best or most effective intervention for reducing errors not strong.<ref name=":1" /><ref>{{Cite journal |last1=Khalil |first1=Hanan |last2=Bell |first2=Brian |last3=Chambers |first3=Helen |last4=Sheikh |first4=Aziz |last5=Avery |first5=Anthony J |date=2017-10-04 |editor-last=Cochrane Effective Practice and Organisation of Care Group |title=Professional, structural and organisational interventions in primary care for reducing medication errors |journal=Cochrane Database of Systematic Reviews |language=en |volume=2017 |issue=10 |pages=CD003942 |doi=10.1002/14651858.CD003942.pub3 |pmc=6485628 |pmid=28977687}}</ref> Evidence supporting improvements aimed at reducing medical errors in medications for pediatric hospitalized patients is also very weak.<ref name=":2">{{Cite journal |last1=Maaskant |first1=Jolanda M |last2=Vermeulen |first2=Hester |last3=Apampa |first3=Bugewa |last4=Fernando |first4=Bernard |last5=Ghaleb |first5=Maisoon A |last6=Neubert |first6=Antje |last7=Thayyil |first7=Sudhin |last8=Soe |first8=Aung |date=2015-03-10 |editor-last=Cochrane Effective Practice and Organisation of Care Group |title=Interventions for reducing medication errors in children in hospital |journal=Cochrane Database of Systematic Reviews |issue=3 |pages=CD006208 |language=en |doi=10.1002/14651858.CD006208.pub3|pmid=25756542 |pmc=10799669 }}</ref>

=== Historically ===
As far back as the 1930s, pharmacists worked with physicians to select, from many options, the safest and most effective drugs available for use in hospitals.<ref>{{cite journal |author=Pease E |year=1936 |title=Minimum standards for a hospital pharmacy |journal=Bull Am Coll Surg |volume=21 |pages=34–35}}</ref> The process is known as the Formulary System and the list of drugs is known as the Formulary. In the 1960s, hospitals implemented [[Dosage form|unit dose]] packaging and unit dose drug distribution systems to reduce the risk of wrong drug and wrong dose errors in hospitalized patients;<ref>{{cite book |author=Garrison TJ |url=https://archive.org/details/handbookofinstit00smit |title=IV.1 Medication Distribution Systems |date=1979  |publisher=Williams and Wilkins |isbn=978-0-683-07884-8 |editor1=Smith MC |editor2=Brown TR}}</ref> centralized sterile admixture services were shown to decrease the risks of contaminated and infected intravenous medications;<ref>{{cite book |author1=Woodward WA |url=https://archive.org/details/handbookofinstit00smit |title=Chapter IV.3 Developing Intravenous Admixture Systems |author2=Schwartau N |date=1979  |publisher=Williams and Wilkins |isbn=978-0-683-07884-8 |editor1=Smith MC |editor2=Brown TR}}</ref><ref>{{cite book |author1=Powell MF |title=Chapter 53 The Patient Profile System |date=1986 |publisher=Williams and Wilkins |isbn=978-0-683-01090-9 |editor1=Smith MC |edition=2 |editor2=Brown TR}}</ref> and pharmacists provided drug information and clinical decision support directly to physicians to improve the safe and effective use of medications.<ref>{{cite book |author1=Evens RP |title=Chapter 31 Communicating Drug Information |date=1986 |publisher=Williams and Wilkins |isbn=978-0-683-01090-9 |editor1=Smith MC |edition=2 |editor2=Brown TR}}</ref> Pharmacists are recognized experts in medication safety and have made many contributions that reduce error and improve patient care over the last 50 years. More recently, governments have attempted to address issues like patient-pharmacist communication and consumer knowledge through measures like the [[Australian Government]]'s [[Quality Use of Medicines]] policy.{{Citation needed|date=July 2023}}