Medical Errors in the ICU - Article Example

MEDICAL ERRORS IN THE ICU By Medical Errors in the ICU Definition of Medical Error Research highlights that errors are common in daily medical practice. More specifically, the intensive care unit is one of the sections in many hospitals that have been investigated to determine the level of error. The criticality of this unit and the level of care needed by the patients transferred to the ICU serve to increase the chances of errors occurring. Notably, most of the patients in the ICU exhibit complicated medical conditions and require specialized care. In a bid to deliver such care, errors usually occur. A medical error can be defined as any event which is a deviation of the planned treatment or observation, and which is not a characteristic of the disease in the first place. Medical errors therefore refer to a broad range of incidences in the ICU. This may be in reference to errors in medications, infusions, mistakes done using medical technical equipment, failure to conform to standard protocol and other human errors which may compromise medical practice. In other cases, medical errors are defined as any failure of implementing the designated action in the intended way or using the wrong strategy in a bid to achieve what was planned. Medical errors often present adverse effects to the patient. However, errors differ in their level of seriousness. Some errors do not cause any physiological or biochemical changes in the patient and require no intervention. In other cases, a level of change occurs and an appropriate intervention strategy is implemented. Such changes may either be temporary or permanent. In the worst case, a medical error leads to the death of the patient. Worth noting is the fact that medical errors should not be confused with other types of complications or events resulting from allergic reactions to treatments. This is because medical errors are categorized as adverse events that can potentially be prevented considering the modern advances in medical practice and knowledge. The facts that there are standard operating procedures, staffs working in a medical institution are expected to follow them stringently in a bid to avoid medical errors. Medical errors can either be in medical systems, products, procedures or in the general practice. Potential for Medical Error Although the healthcare providers working in the intensive care unit usually undergo a rigorous training process before being posted to the ICU, there are humans and can make errors. One of the highly influential medical publications highlighted that to err is human. This article sought to acknowledge the fact that there is a high potential of the medical errors in the ICU and other hospital units. However, the ICU possesses a higher potential for errors because patients admitted to the ICU have life threatening conditions. They may exhibit serious complications from accidents, infections, surgery or cardiac attacks. Therefore, they are in need of critical care which involves a constant check up by the health care providers. In the process of delivering such care, there is a high potential for medical errors to occur. Usually, the fragmented nature of health care provision which does not outline directly how a systematic health care provision network should operate serves to increase the potential for medical errors. Moreover, the processes of accrediting and licensing health care professionals does not focus on ensuring that they have the potential to prevent the occurrence of medical errors. These factors have been highlighted as some of the primary causes of medical errors. However, medical errors are highly associated to faulty systems and processes as well as other conditions that prompt people to err, or lack the capacity to prevent such occurrences. These means that, not all errors occur because or recklessness exhibited by the health care providers. Certain situations serve to increase the chances of errors occurring. For example, a health care institution may have the habit of stocking all their drugs in high concentrations despite the proven toxicity of such drugs. Such a situation may increase the chances of health care providers administering those drugs without diluting them. Such a medical error is attributable to the faulty system and not necessarily to the health care provider who does that. Such a health institution should foster systems that reduce chances of medical errors therefore it should store such drugs in the diluted concentration. Intensive care units usually require health systems that promote the safety of the patients. If such a system fails, then the chances of medical errors in this unit increase. In addition to faulty health systems, individuals may sometimes hold the responsibility for some errors because of the lack of the required level of vigilance. The criticality of the intensive care unit seems to increase the potential of medical errors occurring. Although it is evident that medical errors occur, it proves difficult to estimate or measure the exact frequency of such errors. This is because health care providers only report some medical errors while a broad range of other errors go unreported. Although there are existing statistics, experts have highlighted that such statistics are under estimates of the real potential for medical errors. The fact that some mistakes are not recognizable after they happen by other health care providers makes I extremely difficult to identify the real frequency at which medical errors occur. Despite the current studies that seek to identify the real potential for medical errors, there are limitations of accessing data concerning some errors and such researchers only end up with estimates which are far below the real values. Types of Medical Errors Different types of medical errors have been categorized and described by the numerous researchers who have focused on addressing this issue. One of the common types of errors is the error of execution. This type of error usually occurs in the execution phase of a planned action. A health care provider may successfully and effectively plan the appropriate action that needs to be taken. However, the planned action may not be executed in manner in which it was intended. This will definitely lead to an error. In other cases, the health care provider may fail in the planning process. Notably, health care providers need to undertake effective planning of the actions or intervention strategy that they intent to carry out. If a health care provider develops an ineffective plan of carrying out the action, then eventually the error of planning occurs. There is usually o confusion between these two types of errors. However, a close analysis of the processes involved when heath care providers are completing an action reveals that there is a difference between them. Some individuals fail in the initial planning while others exhibit failures in the execution phase. Diagnostic errors form the other category of medical errors that frequently occur in the intensive care unit. Before any treatment or medication is given, there is a salient need for accurate diagnosis of the patient’s condition. It proves impossible to administer any medication or treatment without proper diagnosis. In the intensive care unit, where all the patients exhibit critical conditions, it becomes highly necessary to carry effective diagnosis. This is because errors emanating from the diagnostic process may threaten the life of the patient further. Some diagnostic errors usually result from unnecessary delays of the diagnosis process. Prompt diagnosis is critical in a bid to deliver high quality care. However, health care providers occasionally delay such diagnosis. In other cases, the diagnostic process may be performed in good time but involve numerous errors. Such a situation may result because the health care provider interprets the diagnostic results wrongly or relies on previous experience in the diagnostic process. Instead on considering the specific case at hand, errors may also result from a confusion of the findings obtained from the diagnostic tests. Some health care providers may fail to use the standard diagnostic procedures or rely on outdated diagnostic methods. Research has revealed that, the use of outdated kits even when the procedure is right leads to error. Some diagnostic tests require proper monitoring and the reliance on a controlled experiment and some health care providers usually make assumptions and skip such steps. In other cases, health care providers usually rely on expert opinion without considering the validity of the test results they have at hand. There is need for critical thinking in the diagnostic process if the health care providers are to avoid the diagnostic errors. In the intensive care unit, where each patient requires constant and prompt attention, proper diagnosis is to be emphasized. However, in a bid to deliver such care, health care providers end up with multiple diagnostic errors as they struggle to carry out fast diagnosis of the patients. In addition to diagnostic errors, treatment errors also occur. These ones are likely to result when healthcare providers are unable to accurately carry out a treatment procedure. For example, operations, tests or procedures that define the treatment of a certain disease may not be executed properly. These types of errors occur as health care providers strike to administer different types of treatment. Evidently, each medical condition requires a specified type of treatment. And doctors and other health care providers usually confuse certain conditions. Some confusioninvolves the dosages of certain medications and the administration of certain drugs offered in unique circumstances. There have reports of preventable delay of the treatment process, a factor which falls under the treatment errors. There is also evidence that some health care providers give patients inappropriate care. Medical errors also occur in regard to prevention of diseases. As highlighted above, the intensive care unit is one of the most critical hospital units and prevention measures of the highest rank are required. However, there are cases when the health care providers fail to offer prophylactic treatment to patients who need it. This is a critical error which may result to serious consequences. Despite its seriousness, it often occurs in in the ICU. In other cases, health care providers exhibit the lack of capacity or fail to have a clear follow up of all the treatment procedure as required. Evidently, there are some treatment procedures that require a constant monitoring, and health care providers should strive to monitor the treatment procedures according to its protocol. Other prevention errors are classified as preventable adverse outcomes. One of these outcomes is an event that health care providers can easily eliminate through proper planning or appropriate execution of an intended action. An additional adverse outcome that has been described as preventable is a near miss, which denotes an error that occurred but did not present any negative consequences. Researchers have also identified the slip which denotes an error that results from a misdirected routine in the execution of an action. This type of error is common and many health care providers report a high frequency of making this error. Sometimes, a health care provider may fail to implement a planned action because he or she experiences a memory lapse and hence omits behavior that is considered routine in medical practice. Some health care providers often make mistakes when an improper thorough process of a false analysis takes place. Mistakes are often denoted as “knowledge based errors.” other preventable adverse outcomes include the error of omission and that of commission. The error of omission means that a health care provider omits a critical action in medical practice while that of commission means that a health care provider carries out an improper action in the medical practice. Medical errors also occur when health care providers are administering different types of medication. These are referred to as medication errors. Notably, the errors described under the medication errors are potentially preventable but often occur. Heath care providers may perform different actions that may compromise the dosage or the route of administration of a certain medication. Such errors also compromise the safety of the patient. One of the common errors occurs when health care providers order medication for patients. In the ordering process, they may prescribe the wrong dosage or the wrong drug entirely. This may present critical consequences to the patient. In other cases, a health care provider may order the right prescription but the professional giving out the medication may misinterpret what is written, hence giving out either the wrong drug or the wrong dosage. Other errors result in the process of dispensing medication. Such errors may concern a delay in administering the drug or sending out the wrong drug or indicating the wrong dosage of the right drug. Health care providers also make errors when administering drugs to patients. These mistakes may involve relying on the wrong route of administration and administering a drug in the wrong concentration or dosage. According to pharmacological experts, health care providers have the responsibility of maintaining constant monitoring of the physiological and biochemical effects of a certain drug administered to a patient. This is because each drug has a varied effect on different patients. When health care providers fail to do his, then it becomes a medication error that may pose critical consequence to the patient. In addition to the above categories of errors, research has revealed that failure of effective communication within the intensive care unit may present a level of error. There is a salient need for health care providers to develop effective communication channels regarding the progress of different patients in a bid to eliminate the probability of errors occurring. Intensive care units rely on numerous facilities in a bid to sustain the life of patients. Such equipment may often register technical failures resulting to medical error. Some of the equipment failures have been described as preventable because the health care providers are required to ensure that all the facilities are properly functioning. Sometimes, such checkups often fail to identify a dysfunction in the equipment eventually resulting into error. Intensive care units usually operate using a defined health system. Any failure in this system may result to medical errors. Causes of Medical Errors Researchers have been striving to identify the principle causes of medical errors. One of the causes has been highlighted as adverse events. As mentioned above, the management system of the intensive care unit is of critical significance to the safety of the patients. There is a salient need of adopting the effective management approaches in any medical institution in a bid to ensure that all the operations in every unit of the hospital are well coordinated. The intensive care unit requires a high level of efficiency in management because the lives of the patients are at stake because of the life threatening conditions. Despite the awareness that effective management is needed, some healthcare institutions usually fail in ensuring that a proper management approaches of the intensive care unit is adopted. Such a situation triggers the occurrence of errors in the ICU. Researchers have identified errors resulting from poor medical management as adverse events. Similar to other medical errors, adverse events man be prevented if proper management is considered a priority by healthcare institutions. Moreover, regarding the intensive care unit, with the seriousness it deserves, health care institutions should ensure that proper medical management is adopted. Adverse drug events are an additional cause of medical errors. This denotes any damage caused by a faulty medical intervention, specifically a drug administered wrongly. Administering drugs wrongly usually presents physiological and biochemical effects that are unwanted in the patient. Medical errors of different levels and types usually present a range of adverse drug events. Some of these include fever, vomiting and nausea, kidney failure, body rush, low blood pressure, diarrhea, heat rhythm disturbances, mental confusion and bleeding. Some medical errors usually present a combination of these events compelling health care provided to seek intervention strategies to counter the adverse drug events. Notably, all drugs have the potential of exhibiting or triggering adverse reactions even when administered properly. However, the adverse drug events mentioned as a result of medical errors are potentially preventable if the right drug is administered properly and in the right dosage. Normal adverse drug reactions that result from the usage of certain drugs are not classified under medical errors as they are usually beyond human control. Moreover, the drug testing procedure ensures that the range of adverse drug reactions is manageable and does not cause any permanent organ damage. On the contrary, adverse drug events resulting from medication errors have the potential of inflicting permanent organ damage to an individual. Other medical errors often result from mistakes made in the process of prescribing, dispensing or administering a drug. Moreover, hospitals have a system of managing and storing their drugs. Usually, this may involve transference from large bottles dosmaller containers in diluted concentrations. Theprocess of handling drugs within the health institution may create gaps that often result to errors. Depending on the management system adopted by the health institution, the potential for error may be highly increase or decreased. Some reliable statistics indicate that errors in medication affect an approximate of 3.7% of patients. Human errors have been described as a significant cause of multiple medical errors. This occurs either because of poor performance or negligence while inn other cases human errors result from lack of vigilance of the required level. Many theories have been developed to explain the contribution of human errors in increasing the number of medical errors in hospitals and specifically the intensive care unit. In some years back, the bad apple theory was used to explain human errors resulting to terrible medical errors. According to this theory, it was reasoned that health systems in the intensive care unit were functional but some of the health care providers were the source of errors. This is the reason why they were referred to as bad apples among the competent health care providers who are god apples. However, a close view of the occurrence of medical errors revealed that this theory was ineffective in explaining the contribution of human error in increasing medical errors. Research has revealed that many health systems are dysfunctional or ineffective presenting certain circumstances and situations to health care providers and prompting them to be more prone to error. Other errors result from lack of effective communication between the different health care providers in the intensive care unit. Fragmentation of communication within a fragmented health system is a sure combination that leads to medical errors. Fragmentation of health systems creates a level of confusion because the health care providers of different ranks are unaware of their level of authority and hence cannot perform effectively. In other cases faulty health systems often make the assumptions that automated systems will serve to prevent medical errors. However, this assumption if flawed because automated systems need proper management need constant monitoring by trained technicians if they are to deliver. Some intensive care units have been reported to lack systems of sharing information a factor which contributes to increased errors. This is because health care providers attending a certain patient at different times are unable to share their findings or medical reports. This only means that each health care provider continues with delivering care to the patient without considering what other health care providers had done to the patient. Lack of shared information concerning patients and the level of care delivered hinders effective analysis of the patient’s medical condition and the monitoring of treatment. Such a situation results to increased medical errors. Cognitive errors exhibited by doctors have been categorized as human errors which contribute to increased medical errors. There is a certain process of thinking adopted by many doctors which does not conform to logic or reason. Such thinking processes have been classified as cognitive pitfalls for doctors. Examples of such occurrences are certain beliefs held by doctors which serve to hinder their level of clear judgment. For example, a health care provider may hold on to the conviction of initial data obtained concerning a patient and fail to monitor other phases of treatment that present a different set of data. In other cases, dramatic events in the medical practice usually hinder the level of critical judgment exhibited by doctors. These cognitive errors are significant factors that contribute to increasing human errors in the medical practice. Other human errors are attributable to ineffective skills and inadequate knowledge, factors that compromise the competence of health care providers. Many training institutions for health care providers do not focus on offering the required level of training that health care providers need to minimize medical errors. Moreover, such training institutions do not recognize the seriousness of medical errors and the potential effects on patients. Health institutions hire such health care providers to work in the intensive care unit even when they do not understand the salient need of reducing medical errors through increased vigilance. In other cases, health care providers working in the intensive care unit lack the proficiency required to operate the equipment in that unit. This serves to increase the frequency of errors. Moreover, some health care institutions do not offer advanced training on the use of modern diagnostic kits which are products of new technologies. Such health care providers are then unable to utilize new technologies and techniques as they strive to offer critical care to ICU patients. Other types of errors are cause by chances and not directly identifiable medical errors. this means that, some negative patients outcome arise because of chance and are not attributable to any specific medical error. Read More