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Posts Tagged ‘Medical errors’

Sleeping sickness is a resident evil

Sanchita Sharma, Hindustan Times
June 26, 2011
Truncated sleep ups your risk of almost every known disease, from heart attacks (by pushing up blood pressure), to the common cold (by lowering immunity). It turns your brain to mush by lowering its ability to learn and store new information. It makes you irritable, impatient and emotionally fragile. It also causes people to nod off while driving, which is the biggest cause of road accidents after speeding and drink driving.Sleeplessness, however, is at its most lethal when the insomniac is a doctor or a surgeon taking decisions that can make or break your fever – or your life.

Working for more than 16 hours without sleep results in resident doctors committing serious, preventable medical errors, reported the journal Nature & Science of Sleep on Saturday. While there is no data for India, the US Health and Human Services reports that 180,000 (1.8 lakh) patients die of medical negligence each year in that country.

Work shifts longer than 16 hours increased medical errors by 35.9 per cent while shorter shifts reduced errors, reported Harvard Medical School researchers in the New England Journal of Medicine (NEJM). Following the report, Harvard Medical School announced a 16-hour limit on the time resident doctors can work at a stretch.

In India, resident doctors live in the doctors’ duty room 24×7, on call at all hours for any length of time. They routinely do 24-hour shifts, which can go up to 36 hours in departments such as neurosurgery, where emergency cases such as accidents and stroke need immediate attention. By the end of a shift, the fatigue is apparent not only in the dramatically shortened fuses but also in cases needing a second opinion for final diagnosis.

Rising patient load and staff shortages are too blame. While patients at teaching hospitals have more than doubled in the past decade, medical staff strength remains the same. Given the easy access to medication and addictive medicines, addictions are a norm. Apart from smoking, most residents take stimulants or “uppers” to see them through the day. “What are we to do? After MBBS, we do 3-5 years of junior residency and another 3 years of senior residency. Most of the time we are too tired to keep our eyes open,” says a senior resident at the All India Institute of Medical Sciences.

The US Institute of Medicine has recommended major changes in residency training programmes, including re-designing training to eliminate dangerously long shifts (over 16 hours without sleep), and reducing residents’ workload by focusing on academic training and transferring a lot of the routine things they do – bandaging, drawing blood, filling out paperwork and starting intravenous lines – to nurses and other health personnel.

“It’s an abuse of patient trust,” says Dr Lucian Leape, adjunct professor of health policy at the Harvard School of Public Health and a co-author of the NEJM report. “Few people enter a hospital expecting that their care and safety are in the hands of someone who has been working a double-shift or more with no sleep. If they knew, and had a choice, the overwhelming majority would demand another doctor or leave.”

Try as they might, teaching hospitals cannot shorten resident work hours because of financial and staffing shortages. If hours for residents are reduced, other staff – such as teaching faculty and consultant physicians – need to step in, who have to be paid overtime. But given that resident doctors are staffing emergency rooms, an urgent overhaul of hospital work policy is needed. For when it comes to medical errors, saying sorry is not enough.

Source:- Hindustan Times

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Medical errors in top 10 killers: WHO

April 20, 2011 Leave a comment

Malathy Iyer, TNN | Apr 20, 2011, 12.59am IST

MUMBAI: Medicine heals, but this fact doesn`t hold true for every 300th patient admitted to hospital. Call it the law of averages or blame human error for it, but the World Health Organization believes that one in 10 hospital admissions leads to an adverse event and one in 300 admissions in death.

An adverse event could range from the patient having to spend an extra day in hospital or missing a dose of medicine, said Dr Nikhil Datar, a gynaecologist and health activist. Unintended medical errors are a big threat to patient safety.

Although there is no Indian data available on this topic, WHO lists it among the top 10 killers in the world. While a British National Health System survey in 2009 reported that 15% of its patients were misdiagnosed, an American study published in the Journal of the American Medical Association in 2000 quantified this problem most effectively.

It said that there are 2,000 deaths every year from unnecessary surgery; 7,000 deaths from medication errors in hospitals; 20,000 from other errors in hospitals; 80,000 from infections in hospitals; and 106,000 deaths every year from non-error, adverse effects of medications. In all, 225,000 deaths occur per year in the US due to unintentional medical errors.

It is to create awareness both among doctors and patients about errors dubbed as unintended medical errors that Datar organized a seminar to discuss patient safety at the Indian Medical Associations office on Sunday. “In the western nations, it is believed that the incidence of unintentional medical errors is between 10% and 17% of all cases,” said Datar.

The Indian government has woken up to the concept. It set up the National Initiative on Patient Safety in the All-India Institute of Medical Sciences a couple of years back.

But the idea, as Dr Akhil Sangal of the Indian Confederation for Healthcare Accreditation, points out is not to apportion blame. “When medical negligence occurs, the first question to be asked is who is to blame. We instead have to evolve to a system in which we ask questions about how, when and where the negligence occurred,” said Delhi-based Dr Sangal.

Datar illustrates with an example of a 10-year-old leukemia patient in Britain who had to be given a chemotherapy injection. “This is a published report of how due to a series of unintended changes the boy died due to a wrong injection being given to him,” said Datar. The boy ate food that was prohibited before the procedure; he was hence taken hours later by a different department than the cancer doctors. “The injections were given in a particular order but that day due to the mix-up he got the wrong injection and died five days later.” The committee exonerated the doctor because it found the other factors — the when, where and how — had all played a role in the boy`s death.

“By talking about patient safety, we can reduce the overall mortality and morbidity associated with hospitalization. Even hospitalization time and costs could come down as a result,” said Dr Mathew Joseph who is attached to PGI Chandigarh and is involved in a nationwide study on clinical practices. “One of our earlier studies had shown unsafe practices associated with 70% of the injections administered in our country,” Joseph said.

BOX

* One in 10 patients is harmed while receiving hospital care

* The risk of health care-associated infection in some developing countries is as much as 20 times higher than in developed countries

* At any given time, 1.4 million people worldwide suffer from infections acquired in hospitals

* At least 50% of medical equipment in developing countries is unusable or only partly usable. Often the equipment is not used due to lack of skills or commodities. As a result, diagnostic procedures or treatments cannot be performed. This leads to substandard or hazardous diagnosis or treatment that can pose a threat to the safety of patients and may result in serious injury or death

* In some countries, the proportion of injections given with syringes or needles reused without sterilization is as high as 70%. This exposes millions of people to infections. Each year, unsafe injections cause 1.3 million deaths, primarily due to transmission of blood-borne pathogens such as hepatitis B virus, hepatitis C virus and HIV

* Over 100 million people require surgical treatment every year. Problems associated with surgical safety in developed countries account for half of the avoidable adverse events that result in death or disability

* There is a one in 1,000,000 chance of a traveller being harmed while in an aircraft. In comparison, there is a one in 300 chance of a patient being harmed while being given health care

Source: Medical errors in top 10 killers: WHO