MoonDragon's Health & Wellness
ALLOPATHIC (CONVENTIONAL) MEDICINE
Health Care Issues & Concerns
"For Informational Use Only"
For more detailed information contact your health care provider
about options that may be available for your specific situation.
ALLOPATHIC HEALTH CARE CONCERNS
CONVENTIONAL & COMPLEMENTARY THERAPY
As you visit several of MoonDragon's pages on health related issues you may find that complementary therapies, including nutrition, have been included in with conventional medical approaches. Research any information you find about disorders and find those approaches which will be most appropriate for you and your particular situation. Discuss options with your health care provider before starting any new therapy or treatment. This information is not meant to replace recommended conventional treatments or medications prescribed by your health care provider, but to supply options to supplement and expand current therapies and treatments. It is meant to help open up dialog between practitioner and patient and to become an informed consumer, taking an active part in your health care.
Each person is unique and should be treated holistically as an entire person and not just a body part or disease. Ask questions about proposed therapies and expect answers that are accurate and easy to understand so you can make an informed choice about your health care and your health wellness. Do not go blindly into any treatment or therapy. Do not be afraid to get a second or third opinion or consult an alternative therapy health care provider and a nutritionist before starting conventional medical therapies involving chemical-radiation, drugs and surgeries. Keep in mind that many of the alternative or complementary therapies can be combined with conventional therapies and nutrition for a more complete approach to treatment.
A medical error occurs when a health care provider chooses an inappropriate method of care or improperly executes an appropriate method of care. Medical errors are often described as human errors in healthcare. However, medical error definitions are subject to debate, as there are many types of medical errors from minor to major and causality is often poorly determined.
Globally it is estimated that 142,000 people died in 2013 from adverse effects of medical treatment up from 94,000 in 1990. A 2000 Institute of Medicine report estimated that medical errors result between 44,000 and 98,000 preventable deaths and 1,000,000 excess injuries each year in U.S. hospitals.
Some researchers questioned the accuracy of the IOM study, criticizing the statistical handling of measurement errors in the report, significant subjectivity in determining which deaths were "avoidable" or due to medical error, and an erroneous assumption that 100% of patients would have survived if optimal care had been provided. A 2001 study in the Journal of the American Medical Association of seven Department of Veterans Affairs medical centers estimated that for roughly every 10,000 patients admitted to the subject hospitals, one patient died who would have lived for three months or more in good cognitive health had "optimal" care been provided.
A 2006 follow-up to the IOM study found that medication errors are among the most common medical mistakes, harming at least 1.5 million people every year. According to the study, 400,000 preventable drug-related injuries occur each year in hospitals, 800,000 in long-term care settings, and roughly 530,000 among Medicare recipients in outpatient clinics. The report stated that these are likely to be conservative estimates. In 2000 alone, the extra medical costs incurred by preventable drug related injuries approximated $887 million - and the study looked only at injuries sustained by Medicare recipients, a subset of clinic visitors. None of these figures take into account lost wages and productivity or other costs.
According to a 2002 Agency for Healthcare Research and Quality report, about 7,000 people were estimated to die each year from medication errors - about 16 percent more deaths than the number attributable to work-related injuries (6,000 deaths). Medical errors affect one in 10 patients worldwide. One extrapolation suggests that 180,000 people die each year partly as a result of iatrogenic injury. One in five Americans (22%) report that they or a family member have experienced a medical error of some kind.
DIFFICULTIES IN MEASURING FREQUENCY OF ERRORS
About one percent of hospital admissions result in an adverse event due to negligence. However, mistakes are likely much more common, as these studies identify only mistakes that led to measurable adverse events occurring soon after the errors. Independent review of doctors' treatment plans suggests that decision-making could be improved in fourteen percent of admissions; many of the benefits would have delayed manifestations. Even this number may be an underestimate. One study suggests that, in the United States, adults receive only fifty-five percent of recommended care. At the same time, a second study found that thirty percent of care in the United States may be unnecessary. For example, if a health care practitioner fails to order a mammogram that is past due, this mistake will not show up in the first type of study. And because no adverse event occurred during the short follow-up of the study, the mistake also would not show up in the second type of study, because only the principal treatment plans were critiqued. However, the mistake would be recorded in the third type of study. If a health care practitioner recommends an unnecessary treatment or test, it may not show in any of these types of studies.
CAUSES OF MEDICAL ERRORS
A VARIETY OF CAUSAL FACTORS
Medical errors are associated with inexperienced practitioners (both physicians and nurses), new procedures, extremes of age, and complex or urgent care. Poor communication (whether in one's own language or, as may be the case for medical tourists, another language), improper documentation, illegible handwriting, inadequate nurse-to-patient ratios, and similarly named medications are also known to contribute to the problem. Patient actions may also contribute significantly to medical errors. Falls, for example, may result from patients' own misjudgements. Human error has been implicated in nearly eighty percent of adverse events that occur in complex healthcare systems. The vast majority of medical errors result from faulty systems and poorly designed processes versus poor practices or incompetent practitioners.
A "practitioner" is usually considered the physician, who is basically responsible for the overall patient care and is supposed to supervise those under him or her in the care of the patient. However, for the sake of discussion in this article, it may also include a physician's assistant, an intern, a nurse, a medical or nursing student, a pharmacist, a technician, orderly, emergency worker, or any other individual that has any contact with or is involved in the diagnosing, preparation, treatment, dosing, and care of any patient, directly or indirectly. This can even go so far as to include the dietician setting up proper nutrition to janitorial care involved in proper cleaning and sterilizing of surgical suites, exam and patient rooms as well as equipment and instruments used in the care of a patient.
CONTAMINATED MEDICATIONS RESULTED IN PATIENT ILLNESS AND DEATHS
In October 2012, an outbreak of fungal meningitis was reported in the United States, It was traced to a fungal contamination in three lots of medication called methylprednisone used for epidural (spinal) steroid injections. The medication was packaged and marketed by the New England Compounding Center (NECC), a compounding pharmacy in Framingham, Massachusetts. Doses from these three lots had been distributed to 75 medical facilities in 23 states, and doses had been administered to about 14,000 patients after May 21 and before September 24, 2012. Patients began reporting symptoms in late August, but, because of the unusual nature of the infection, clinicians did not begin to realize the cases had a common cause until late September. Infections other than meningitis were also associated with this outbreak, which spanned 19 states. As of March 10, 2013, 48 people had died and 720 were being treated for persistent fungal infections. In November 2012, some patients recovering from meningitis were reported to be experiencing secondary infections at the injection site. Although no cases of infection were reported to be associated with any other lots of medication, all lots of all medications distributed by NECC were recalled in separate actions by NECC and regulators. Subsequent analysis identified some contamination in other lots.
On October 9, 2012, members of the United States Congress asked federal health officials for briefings on the outbreak as a first step toward possible legislative action to strengthen federal drug safety regulations. On November 14, 2012, members of a congressional committee investigating the outbreak accused the Food and Drug Administration (FDA) of failing to prevent the crisis by moving too slowly against the Massachusetts pharmacy. In the same hearing, the co-owner of NECC chose to plead the Fifth, refusing to answer all questions. By mid-December, over 400 lawsuits had been filed against NECC.
In October 2012, Massachusetts shut down two more compounding pharmacies over sterility concerns after they conducted a surprise inspection. In December, unexpected inspections of three more Massachusetts pharmacies found problems, as well.
On December 21, 2012, the New England Compounding Center filed for Chapter 11 bankruptcy protection in the Massachusetts district bankruptcy court. On September 4, 2014, pharmacist Glenn Adam Chin, 46, was arrested at Boston's Logan International Airport before boarding a plane headed to Hong Kong, and was charged with one count of mail fraud. Chin was responsible for supervising the clean rooms at the NECC and was involved in the compounding the contaminated methylprednisolone. The FDA affidavit states that Chin used improper sterilization and testing techniques, unsafe practices, falsified cleaning logs, and ordered pharmacy technicians to fraudulently mislabel vials. Chin is the first to be charged in the ongoing inquiry.
On December 17, 2014, 14 former NECC executives and technicians, including co-founder and president Barry Cadden, were indicted on a host of federal charges related to the outbreak. Most seriously, Cadden and Chin were charged with helping orchestrate a massive racketeering conspiracy that led directly to 25 of the deaths.
PROBLEMS AT OTHER COMPOUNDING PHARMACIES
The FDA reported several previous incidents related to tainted drugs packaged at compounding pharmacies. Fungal contamination in relation to sterile drug recalls represents the second-most common form of microbiological contamination. In August 2011, the FDA reported that repackaged injections of Avastin (bevacizumab) caused serious eye infections in the Miami, Florida, area. A pharmacy had repackaged the Avastin from single-use vials into multiple single-use syringes, distributing them to multiple eye clinics, and infecting at least 12 patients. Some patients lost the remaining vision in the eye being treated.
From November 2011 to April 2012, 33 eye-surgery patients in seven states suffered a rare fungal eye infection tied to injectable drug products made by a compounding pharmacy in Ocala, Florida. Most of those patients suffered partial to severe vision loss.
In October 2012, Massachusetts shut down another compounding pharmacy over sterility concerns after they conducted a surprise inspection. Inspectors went to the Waltham, Massachusetts, location of the Rhode Island-based Infusion Resource company and found, "significant issues with the environment in which drugs were being mixed". The manager of the company was a former employee at Ameridose, which is owned by the same people who ran NECC.
On November 13, manufacturing problems were reported to be found at Ameridose, a Massachusetts company that makes injectable drugs. Ameridose and NECC were founded by brothers-in-law Barry Cadden and Greg Conigliaro. According to an FDA spokesperson, an inspection revealed the firm "fails to test finished product for potency, failed to investigate complaints for ineffective products, failed to investigate violations of their own environmental sampling plan and fails to adequately maintain equipment and facilities used to manufacture sterile drug products". The FDA report also revealed the company had received 33 complaints claiming "lack of effect" and "ineffectiveness" about its drugs. The same problem was found at the plant in 2008, and the FDA spokesperson said the FDA is checking to find what, if any, action was taken in 2008. According to the report, when doctors contacted the firm to say problems with its drugs had been found, the complaints were not classified as adverse events. That included "incidents when women given Ameridose's oxytocin, a drug used to bring on labor, reported fetal distress, severe postbirth bleeding and shortness of breath. A blood thinner, heparin, had a complaint that the patient had a life-threatening adverse event [and when] the firm's pain medication fentanyl, given to cancer patients and as an anesthetic, was used, two patients were reported to have gone into respiratory distress."
The New York Times interviewed eight former employees of NECC and Ameridose. Some defended the company, but six said the corporate culture encouraged shortcuts, even when it compromised safety. At Ameridose, a pharmacist complained to management that quality control workers, who were not trained pharmacists, did work they should not have done. She said "near misses" of wrong doses were caught before they were shipped. A quality control technician tried to stop an assembly line and was eventually fired. An industry newsletter said Ameridose was shipping drugs without waiting the 14 days it took for the sterility test results to come back. Compounding pharmacies are only allowed to ship drugs for specific patients; a former NECC salesman said that NECC sold large quantities without the patients' names, and would put the names in the file as the drug was used, a practice that was accepted by some hospitals, but not others.
On December 7, Massachusetts regulators had taken action against three more compounding pharmacies following unannounced inspections. The Whittier Pharmacist, in Haverhill, was ordered to cease sterile compounding after unspecified violations were found, and OncoMed Pharmaceutical Services was ordered to close its Waltham facility after problems with the storage of chemotherapy drugs were found. Pallimed Solutions, based in Woburn, was told to halt production of sildenafil citrate, which is sold as Viagra, after inspectors found it had been prepared with improper components.
Two compounding pharmacies issued drug recalls in March 2013. Med Prep Consulting Inc and Clinical Specialties Compounding Pharmacy both issued recalls after Med Prep found particles floating in five doses of a compounded solution, and Clinical Specialties heard about five eye infections in patients who had received compounded eye injections.
Alleged victims of the fungal meningitis outbreak linked to NECC's epidural steroid injections may be entitled to compensation for medical expenses, lost wages, pain and suffering, and more. In October, plaintiffs in federally filed fungal meningitis lawsuits petitioned the U.S. Judicial Panel on Multidistrict Litigation (JPML) for establishment of a consolidated litigation in Minnesota federal court. NECC has requested that the litigation be transferred to federal court in Massachusetts. In December, U.S. District Judge Dennis Saylor ruled that meningitis lawsuits pending in Massachusetts federal court would be consolidated and allowed to move forward. By mid-December, over 400 lawsuits had been filed against NECC.
On December 17, federal prosecutors in Boston unsealed a 131-count federal criminal indictment related to the outbreak. It charged 14 former NECC employees, including president Barry Cadden and pharmacist Glenn Chin, with a host of criminal offenses. It alleged that from 2006 to 2012, NECC knowingly sent out drugs that were mislabeled, unsanitary, or contaminated - forming the basis for a massive RICO indictment against six individuals, including Cadden and Chin. The RICO count alleged 68 overt acts - including 25 counts of second-degree murder in seven states against Cadden and Chin. If convicted, Cadden and Chin could potentially get life in prison.
U.S. Representative Fred Upton introduced the Drug Quality and Security Act (H.R. 3204; 113th Congress) in response to this meningitis outbreak. Rep. Upton's district had three deaths and 19 total deaths occurred in Michigan. The bill passed the United States House of Representatives on September 28, 2013 by a voice vote. The United States Senate began working on the bill November 12, 2013. The bill that would modify the Federal Food, Drug, and Cosmetic Act to grant the FDA more authority to regulate and monitor the manufacturing of compounding drugs.
CONTRIBUTING FACTORS IN MEDICAL ERRORS
Complicated technologies, powerful drugs, intensive care, and prolonged hospital stay can contribute to medical errors.
System & Process Design
In 2000, The Institute of Medicine released "To Err Is Human," which asserts that the problem in medical errors is not bad people in health care - it is that good people are working in bad systems that need to be made safer. Poor communication and unclear lines of authority of physicians, nurses, and other care providers are also contributing factors. Disconnected reporting systems within a hospital can result in fragmented systems in which numerous hand-offs of patients results in lack of coordination and errors.
Other factors include the impression that action is being taken by other groups within the institution, reliance on automated systems to prevent error, and inadequate systems to share information about errors, which hampers analysis of contributory causes and improvement strategies. Cost-cutting measures by hospitals in response to reimbursement cutbacks can compromise patient safety. In emergencies, patient care may be rendered in areas poorly suited for safe monitoring. The American Institute of Architects has identified concerns for the safe design and construction of health care facilities. Infrastructure failure is also a concern. According to the WHO, fifty percent of medical equipment in developing countries is only partly usable due to lack of skilled operators or parts. As a result, diagnostic procedures or treatments cannot be performed, leading to substandard treatment.
The Joint Commission's Annual Report on Quality and Safety 2007 found that inadequate communication between healthcare providers, or between providers and the patient and family members, was the root cause of over half the serious adverse events in accredited hospitals. Other leading causes included inadequate assessment of the patient's condition, and poor leadership or training.
Competency, Education, & Training
Variations in healthcare provider training and experience and failure to acknowledge the prevalence and seriousness of medical errors also increase the risk. The so-called July effect occurs when new residents arrive at teaching hospitals, causing an increase in medication errors according to a study of data from 1979 to 2006.
Human Factors & Ergonomics
Cognitive errors commonly encountered in medicine were initially identified by psychologists Amos Tversky and Daniel Kahneman in the early 1970s. Jerome Groopman, author of How Doctors Think, says these are "cognitive pitfalls", biases which cloud our logic. For example, a practitioner may overvalue the first data encountered, skewing his thinking. Or recent or dramatic cases which come quickly to mind and may color judgement. Another pitfall is where stereotypes may prejudice thinking.
Sleep deprivation has also been cited as a contributing factor in medical errors. One study found that being awake for over 24 hours caused medical interns to double or triple the number of preventable medical errors, including those that resulted in injury or death. The risk of car crash after these shifts increased by 168 percent, and the risk of near miss by 460 percent. Interns admitted falling asleep during lectures, during rounds, and even during surgeries.
Practitioner risk factors include fatigue, depression, and burnout. Factors related to the clinical setting include diverse patients, unfamiliar settings, time pressures, and increased patient to nurse staffing ratio increases. Drug names that look alike or sound alike are also a problem.
DIAGNOSTIC & PROCEDURAL ERRORS
Errors can include misdiagnosis or delayed diagnosis, administration of the wrong drug to the wrong patient or in the wrong way, giving multiple drugs that interact negatively, surgery on an incorrect site, failure to remove all surgical instruments, failure to take the correct blood type into account, or incorrect record-keeping. A large study reported several cases where patients were wrongly told that they were HIV-negative when the physicians erroneously ordered and interpreted HTLV (a closely related virus) testing rather than HIV testing. In the same study, greater than 90 percent of HTLV tests were ordered erroneously. It is estimated that between 10 to 15 percent of physician diagnoses are erroneous.
Regarding mental illnesses, sufferers of dissociative identity disorder usually have psychiatric histories that contain three or more separate mental disorders and previous treatment failures. The disbelief of some practitioners around the validity of dissociative identity disorder may also add to its misdiagnosis. Female sexual desire sometimes used to be diagnosed as female hysteria. Sensitivities to foods and food allergies risk being misdiagnosed as the anxiety disorder Orthorexia. Studies have found that bipolar disorder has often been misdiagnosed as major depression. Its early diagnosis necessitates that clinicians pay attention to the features of the patient's depression and also look for present or prior hypomanic or manic symptomatology. The misdiagnosis of schizophrenia is also a common problem. There may be long delays of patients getting a correct diagnosis of this disorder.
The DSM-5 field trials included "test-retest reliability" which involved different clinicians doing independent evaluations of the same patient - a new approach to the study of diagnostic reliability.
Most Common Misdiagnoses
A 2009 meta-analysis identified the 5 most commonly mis-diagnosed diseases as: infection, neoplasm, myocardial infarction, pulmonary emboli, and cardiovascular disease. Physician familiarity with this information is variable.
Outpatient VS Inpatient
Misdiagnosis is the leading cause of medical error in outpatient facilities. Since the National Institute of Medicine's 1999 report, "To Err is Human,": found up to 98,000 hospital patients die from preventable medical errors in the U.S. each year, government and private sector efforts have focused on inpatient safety.
After An Error Has Occurred
Mistakes can have a strongly negative emotional impact on the health care practitioners who commit them.
Recognizing That Mistakes Are Not Isolated Events
Some health care practitioners recognize that adverse outcomes from errors usually do not happen because of an isolated errors and actually reflect system problems. This concept is often referred to as the Swiss Cheese Model. This is the concept that there are layers of protection for clinicians and patient to prevent mistakes from occurring. Therefore, even if a practitioner makes a small error (incorrect dose of drug written on a drug chart) this is picked up before it actually affects patient care (e.g., pharmacist checks the drug chart and makes rectifies the error). Such mechanisms include practical alterations (e.g.-medications that cannot be given IV, are fitted with tubing which means they cannot be linked to an IV even if a clinician makes a mistake and tries to), systematic safety processes (e.g., all patients must have a Waterlow score assessment and falls assessment completed on admission), training programs and continuing professional development courses are measures that may be put in place.
There may be several breakdowns in processes to allow one adverse outcome. In addition, errors are more common when other demands compete for a practitioner's attention. However, placing too much blame on the system may not be constructive.
Essayists imply that the potential to make mistakes is part of what makes being a physician rewarding and without this potential the rewards of medical practice would be less. Laurence states that "Everybody dies, you and all of your patients. All relationships end. Would you want it any other way? [...] Don't take it personally" Seder states "[...] if I left medicine, I would mourn its loss as I've mourned the passage of my poetry. On a daily basis, it is both a privilege and a joy to have the trust of patients and their families and the camaraderie of peers. There is no challenge to make your blood race like that of a difficult case, no mind game as rigorous as the challenging differential diagnosis, and though the stakes are high, so are the rewards."
Forgiveness, which is part of many cultural traditions, may be important in coping with medical mistakes. Inability to forgive oneself may create a cycle of distress and increased likelihood of a future error. However, Wu et al. suggest "...those who coped by accepting responsibility were more likely to make constructive changes in practice, but [also] to experience more emotional distress." It may be helpful to consider the much larger number of patients who are not exposed to mistakes and are helped by medical care.
DISCLOSURE TO PATIENTS
Patients want information about what happened, why the error happened, how the error's consequences will be mitigated, and how recurrences will be prevented. Interviews with patients and families reported in a 2003 book by Rosemary Gibson and Janardan Prasad Singh, that those who have been harmed by medical errors face a "wall of silence" and "want an acknowledgement" of the harm. With honesty, healing can begin not just for the patients and their families but also the doctors, nurses and others involved. Detailed suggestions on how to disclose are available.
A 2005 study by Wendy Levinson of the University of Toronto showed surgeons discussing medical errors used the word "error" or "mistake" in only 57 percent of disclosure conversations and offered a verbal apology only 47 per cent of the time. Patient disclosure is important in the medical error process. The current standard of practice at many hospitals is to disclose errors to patients when they occur. In the past, it was a common fear that disclosure to the patient would incite a malpractice lawsuit. Many practitioners would not explain that an error had taken place, causing a lack of trust toward the healthcare community. In 2007, 34 states passed legislation that precludes any information from a physician's apology for a medical error from being used in malpractice court (even a full admission of fault). This encourages physicians to acknowledge and explain mistakes to patients, and keeping an open line of communication.
The American Medical Association's Council on Ethical and Judicial Affairs states in its ethics code: "Situations occasionally occur in which a patient suffers significant medical complications that may have resulted from the physician's mistake or judgment. In these situations, the physician is ethically required to inform the patient of all facts necessary to ensure understanding of what has occurred. Concern regarding legal liability which might result following truthful disclosure should not affect the physician's honesty with a patient."
From the American College of Physicians Ethics Manual: "In addition, physicians should disclose to patients information about procedural or judgment errors made in the course of care if such information is material to the patient's well-being. Errors do not necessarily constitute improper, negligent, or unethical behavior, but failure to disclose them may." However, "there appears to be a gap between physicians' attitudes and practices regarding error disclosure. Willingness to disclose errors was associated with higher training level and a variety of patient-centered attitudes, and it was not lessened by previous exposure to malpractice litigation". Hospital administrators may share these concerns. Consequently, in the United States, many states have enacted laws excluding expressions of sympathy after accidents as proof of liability; however, "excluding from admissibility in court proceedings apologetic expressions of sympathy but not fault-admitting apologies after accidents." Disclosure may actually reduce malpractice payments.
Disclosure to non-physicians: In a study of physicians who reported having made a mistake, disclosing to non-physicians sources of support may reduce stress more than disclosing to physician colleagues. This may be due to the physicians in the same study, when presented with a hypothetical scenario of a mistake made by another colleague, only 32 percent of physicians would have unconditionally offered support. It is possible that greater benefit occurs when spouses are physicians.
Disclosure to other physicians: Discussing mistakes with other physicians is beneficial. However, medical providers may be less forgiving of each other. The reason is not clear, but one essayist has admonished, "Don't Take Too Much Joy in the Mistakes of Other Doctors."
Disclosure to the physician's institution: Disclosure of errors, especially 'near misses' may be able to reduce subsequent errors in institutions that are capable of reviewing near misses. However, practitioners report that institutions may not be supportive of the doctor.
Use of rationalization to cover up medical errors: Based on anecdotal and survey evidence, rationalization (making excuses) is very common amongst the medical profession in covering up medical errors. A survey of more than 10,000 physicians in the United States came to the results that, on the question "Are there times when it is acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?", 19 percent answered yes, 60 percent answered no and 21 percent answered it depends. On the question "Are there times when it is acceptable to cover up or avoid revealing a mistake if that mistake would potentially or likely harm the patient?", 2 percent answered yes, 95 percent answered no and 3 percent answered it depends.
CAUSE-SPECIFIC PREVENTIVE MEASURES
Traditionally, errors are attributed to mistakes made by individuals who may be penalized for these mistakes. The usual approach to correct the errors is to create new rules with additional checking steps in the system, aiming to prevent further errors. 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.
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. In this model, there is an attempt to identify the underlying system defect that allowed the opportunity for 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.
IN SPECIFIC SPECIALTIES
The field of medicine that has taken the lead in systems approaches to safety is anaesthesiology. Steps such as standardization of IV medications to 1 ml doses, national and international color-coding standards, and development of improved airway support devices has made anesthesia care a model of systems improvement in care.
Pharmacy professionals have extensively studied the causes of errors in the prescribing, preparation, dispensing and administration of medications. As far back as the 1930s, pharmacists worked with physicians to select, from amongst many options, the safest and most effective drugs available for use in hospitals. The process is known as the Formulary System and the list of drugs is known as the Formulary. In the 1960s, hospitals implemented unit dose packaging and unit dose drug distribution systems to reduce the risk of wrong drug and wrong dose errors in hospitalized patients; centralized sterile admixture services were shown to decrease the risks of contaminated and infected intravenous medications; pharmacy computers screened each patientís medication list for drug-drug interactions; and, pharmacists provided drug information and clinical decision support directly to physicians to improve the safe and effective use of medications. 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-pharmacists communication and consumer knowledge through measures like the Australian Government's Quality Use of Medicines policy.
LEGAL PROCEDURE - MEDICAL MALPRACTICE
Standards and regulations for medical malpractice vary by country and jurisdiction within countries. Medical professionals may obtain professional liability insurances to offset the risk and costs of lawsuits based on medical malpractice.
Prevention & 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. 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.
Reporting Requirements: In the United States reporting medical errors in hospitals is a condition of payment by Medicare. 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.
Misconceptions: Common misconceptions about adverse events are the following, and in parentheses are the arguments and explanations against those misconceptions:
- "Bad apples" or incompetent health care providers are a common cause. (Although human error is commonly an initiating event, the faulty process of delivering care invariably permits or compounds the harm, and is the focus of improvement.
- High risk procedures or medical specialties are responsible for most avoidable adverse events. (Although some mistakes, such as in surgery, are harder to conceal, errors occur in all levels of care. Even though complex procedures entail more risk, adverse outcomes are not usually due to error, but to the severity of the condition being treated.). However, USP has reported that medication errors during the course of a surgical procedure are three times more likely to cause harm to a patient than those occurring in other types of hospital care.
- If a patient experiences an adverse event during the process of care, an error has occurred. (Most medical care entails some level of risk, and there can be complications or side effects, even unforeseen ones, from the underlying condition or from the treatment itself.
See Wikipedia.org: Medical Error for complete article and references.
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Causes of Medical Mistakes - WrongDiagnosis.com
(Grand Rapids, January 27, 2003, 6:47 p.m.)
Doctors are human and that means they can make mistakes. Most of the time there are no long-lasting effects, but sometimes, mistakes are life-threatening. There are things you can do to avoid being on the wrong end of a medical mistake.
Dr. Mark Novick a Radiologist says, "I think mistakes tend to occur because physicians and health care providers are in a rush. They're overworked, they oftentimes don't have complete information or they get misinformation." And sometimes, a simple lab error can lead to a terrible mix-up. This woman had both of her breasts removed because a doctor examined the wrong biopsy slide.
Experts estimate one out of every 500 people admitted to the hospital is killed by a mistake. But that estimate is probably low because a lot of mistakes are never reported. Doctors say the best way to prevent mistakes is for patients to get a second opinion, especially if a doctor recommends surgery or some other invasive procedure. That is what happened to Irene Taylor.
Taylor says, "I went for my yearly checkup and my OB/GYN, and the doctor felt something in my breast. He felt that it was a lump, and I should be seen by a breast surgeon. He felt it should come out." But a second, and third opinion, saved her from an unnecessary procedure. Taylor says, "I think that anybody can make a mistake, so get more than one opinion. The more opinions you get, the better. Especially if they are all the same." Dr. Novick says, "I feel that patients should be skeptical of the physician provider who is reluctant to advise the patient to get a second opinion, or who expresses some arrogance concerning the request for a second opinion." In addition to getting a second opinion, experts say it is important to ask questions. Make sure your doctor explains your diagnosis and treatment options. Also keep a list of all your medications and make sure to get the results of any tests you have. Then your doctors will have all the information they need.
CNN.com: Genetic Counseling
Doctors making mistakes in genetic counseling, study finds
March 19, 1997
Web posted at: 10:35 p.m. EST (0335 GMT)
BALTIMORE, Maryland (CNN) -- A new study in the New England Journal of Medicine on genetic counseling suggests doctors often make mistakes interpreting the results.
Researchers at Johns Hopkins Medical Institutions looked at how commercial lab tests for a rare form of colon cancer were evaluated. Fewer than 20 percent of those tested were given genetic counseling or offered informed consent before the test. That kind of advice could affect their plans to have children or their ability to get medical insurance.
Even more troubling, about one-third of the doctors misinterpreted the test results, concluding that patients were not at risk for colon cancer when they might actually get the disease. Genetic counselor Jill Brensinger one of the researchers, called the results "frightening." A total of 177 patients from 32 states were studied overall.
The research suggests doctors need to do a better job of genetic counseling and educating themselves about the new technology, but an accompanying editorial notes that the researchers themselves may be guilty of an ethical breach since they did not get consent from the doctors or patients they studied.
But Brensinger said there was no ethical lapse because the Hopkins researchers were simply functioning as consultants in these cases as they normally would. She also says no confidential information was leaked and patients who got the wrong information from their doctor were given the benefit of correct advice from the Hopkins consultant.
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Mothering Magazine: Revealing the Real Risks- Obstetrical Interventions & Maternal Mortality
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
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MOONDRAGON'S REALM - WEBSITE DIRECTORY
A website map to help you find what you are looking for on MoonDragon.org's Website. Available pages have been listed under appropriate directory headings.