What’s Your Pain Level? Medical Errors
The next time you check into a hospital, don’t be surprised to hear the same questions time and time again. What is your name? What is your pain level? It can really be annoying, but it can save your life. Every health care professional must always have you identify yourself and check your wristband.
According to a recent 2018 study by Johns Hopkins, more than 250,000 people in the United States die every year because of medical mistakes, making it the third leading cause of death after heart disease and cancer.
Other studies report much higher figures, claiming the number of deaths from medical errors to be as high as 440,000. The reason for the discrepancy is that physicians, funeral directors, coroners and medical examiners rarely note on death certificates the human errors and system failures involved. Yet, death certificates are what the Centers for Disease Control and Prevention rely on to post statistics for deaths nationwide.
Identifying patients accurately and matching the patient’s identity with the correct treatment or service is a critical factor of patient safety.
The most common “wrong patient” treatment error many people may first think of is that of a patient receiving a medication that was intended for another patient. However, wrong patient medication errors can occur for a variety of reasons—and during any point—in a patient encounter.
Patient identification mistakes can lead to errors in medication administration, incompatible blood transfusion reactions, failure to treat a serious illness or disease, medical treatment for erroneous diagnostic lab results, and procedures being performed on the wrong patient.
To prevent instances of misidentification and near-misses, The Joint Commission requires that two identifiers—such as a patient’s full name, date of birth and/or medical identification (ID) number—be used for every patient encounter.
Here is an example: Many patients identify themselves by their middle name or a nickname instead of the name on their patient record. If a caregiver were to assume they have the correct patient based on the name the patient uses versus their legal name, it could create a serious and potentially life-threatening problem when it comes to treatments or procedures.
Likewise, if a patient has the same name as another patient, or patients who share names with people in their family and omit the proper suffix (e.g. a Junior or Senior designation), there is also a risk of misidentification. The practice of engaging the patient in identifying themselves and using two patient identifiers (full name, date of birth and/or medical ID number) is critical in improving the reliability of the patient identification process. To reduce harmful outcomes from avoidable patient identification errors, “Do-the-2”. Verify two patient identifiers—every patient, every time.
In a recent 2015 study, it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands.
Failing to associate the right patient with the appropriate action, referred to as wrong-patient errors, is a prevalent occurrence with potentially fatal consequences according to a report from the ECRI Institute, a nonprofit research group that studies patient safety.
The ECRI report examined 7,613 wrong-patient events occurring from January 2013 to July 2015 that were submitted by 181 healthcare organizations.
Of the 7,613 wrong-patient events studied, about 9 percent led to temporary or permanent harm or even death.
“Although many healthcare workers doubt they will actually make a mistake in identifying their patients, ECRI Institute PSO [Patient Safety Organization] and our partner PSOs have collected thousands of reports that show this isn’t the case,” William M. Marella, ECRI Institute executive director of PSO operations and analytics, said in a statement. “We’ve seen that anyone on the patient’s healthcare team can make an identification error, including physicians, nurses, lab technicians, pharmacists and transporters.”
The report found that the majority of wrong-patient events (72.3 percent) took place during patient encounters, while another 12.6 percent occurred during the intake process.
Also, researchers said, more than half of wrong-patient events involved either diagnostic procedures (2,824 or 36.5 percent) or treatment (1,710 or 22.1 percent). Diagnostic procedures cover laboratory medicine, pathology and diagnostic imaging. Treatment covers medications, procedures, and transfusions.
And the two wrong-patient events associated with patient deaths involved documentation failures; in one event, the wrong patient record was accessed, and in the other event, the wrong patient’s documentation was used to give another patient clearance for surgery, researchers said.
In addition to an accurate identification process, HIPPA is also for the patient’s protection.
HIPPA has four main purposes: Privacy of health information, security of electronic records, administrative simplification, and insurance portability. HIPPA provides detailed instructions for handling and protecting a patient’s personal health information.
Questions rating the amount of pain a person is experiencing are frequently asked. These pain scales give people a simple way to rate their pain intensity.
This is used by physicians to determine what the options are for pain relief. These options can include, but are not limited to, therapies like ice packs, which pain medication is needed, and deciding on a surgical intervention. It is also helpful in assessing how effective the therapy was in decreasing the level of pain.
Ask questions. Gain as much insight as you can from your health-care provider. Ask about the benefits, side effects and disadvantages of a recommended medication or procedure.
Seek a second opinion. If the situation warrants or if uncertainties exist, get a second opinion from another doctor. A good doctor will welcome confirmation of their diagnosis and resist any efforts to discourage the patient from learning more.
Bring along an advocate. Sometimes it’s hard to process all the information by yourself. Bring a family member or a friend to your appointment — someone who can understand the information and suggestions given and ask questions.
Always have a wristband on and check it to make sure the information is correct.
NEVER allow being admitted to a hospital or having any diagnostic tests such as: blood work, imaging X-rays, MRI, Cat Scan, or Ultrasound, or any out-patient procedure without having the correct wristband on you with the accurate identifying information on it. Never.
Never go to the pre-op area of a hospital without having the body part to be operated on marked on your body. Never. There are many cases documented when the wrong arm or leg have been operated on or removed!
Medical errors occur every day. Don’t be one of them.