Surgery Complications Common

Recent research has indicated that medical errors are currently the third most common cause of death in the United States. Despite improvements in risk prevention programs and increased patient care, surgery complications are still a common threat to a patient’s well being.

Although some surgery complications are impossible to prevent, some are due to doctor error and medical malpractice. Even simple procedures carry some level of risk. It is for this reason that patients are required to sign consent forms before undergoing even routine procedures. Surgery complications are less common than many years ago, but they are still common today.

What Can Go Wrong

There are different types of complications that can occur during surgery. A common complication is excessive bleeding. Although there are average clotting rates that surgeons use to make decisions during procedures, every person clots at his or her own rate. This makes it impossible to know if a specific patient will have complications after an incision is made during a standard procedure.

Sometimes the procedure is done correctly and the patient still bleeds more than is expected. Sometimes doctors exacerbate bleeding issues by nicking an artery. These situations may require a blood transfusion or even cause long-term damage to the patient.

While bleeding risks are serious, they are by far the less concerning complications that patients experience. Doctors work long hours and sometimes make mistakes due to fatigue or stress. These complications are not only more serious, but they can sometimes be considered negligence. The following are some other problems that can occur during surgery, causing serious damage to the patient.

Surgical equipment left inside the patient: Sometimes surgeons leave behind a foreign object inside a patient after a surgery. This is much more common if a doctor is distracted or in a hurry. The most commonly left behind objects are forceps, tweezers, gauze, needles, scopes, or ties. If these foreign objects are not quickly discovered and removed, they can cause the patient severe pain and discomfort. More importantly, they can cause infections, sepsis, or even permanent organ damage.

Organ or tissue damage: Occasionally, surgeons make an error during a procedure that does damage to surrounding organs or tissues. Even a tiny slip of the hand can cause serious injury to a patient. Sometimes this can be quickly fixed by a few stitches or cauterization. Other times, the damage is permanent. It may lead to even more problems like infection, paralysis, or the loss of a limb.

Nerve damage: Just as a slip of the scalpel can cause injury to tissues in the body, a mistake can do serious damage to nerves. Nerve damage may leave the patient in horrible, untreatable pain. More serious nerve damage can lead to a loss of control of parts of the body or bodily functions, or even paralysis.

Anesthesia errors: One of the riskiest procedures of surgery is the anesthesia. Too little anesthesia can cause a patient unnecessary pain. Too much anesthesia can cause a lack of oxygen, brain damage, and even death.

Incorrect procedures: A lack of communication between hospital staff members can cause a patient to have the wrong procedure entirely. Perhaps the doctor removes the wrong organ or operates on the wrong side of the body. One of the more common examples of this is when doctors remove the wrong breast during a mastectomy or perform a double mastectomy when only one breast needs to be removed. In rare cases, doctors perform the wrong procedure on a patient entirely.


Metric Doses for Liquid Children’s Medication Could Prevent Errors

A new study that was funded by the National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Center for Research Resources has shown that parents who measured liquid medications for their children using teaspoon or tablespoon units were twice as likely to give an incorrect dosage compared to parents who used milliliter units. The new evidence published online July 14, 2014 in Pediatrics indicates that by using non-metric units, parents are more likely to make medication errors.

These medication errors can cause serious problems ranging from ineffective treatment to overdose. Medication errors currently cause around 7,000 deaths in the United States every year, and children are more likely to be seriously affected by an incorrect dosage than adults are. The authors of this study suggest that consistently using metric units to give dosing instructions could significantly reduce these medication errors.

Risk Factors for Medication Errors

This study tested the ability of 287 parents on their abilities to correctly measure a dose of medicine. Parents not using metric units were twice as likely to measure a dose more than 20% different from the correct amount. Furthermore, parents measuring doses in teaspoons or tablespoons were 30 times more likely to use a kitchen spoon rather than a correctly measured instrument.

Using a kitchen spoon to give medication automatically increases the risk of error. Kitchen spoons are not usually accurate, nor are they reliable measuring tools. Moreover, many parents confuse teaspoons and tablespoons when using kitchen spoons, which make the errors more significant.

Dr. Shonna Yin, a doctor from the Department of Pediatrics at New York University School of Medicine associated with the study, thinks the best way to avoid this risk is to include a proper metric dosing instrument with every liquid medication. By including marked syringes, droppers, or cups with every medicine, parents would be less likely to seek out improper instruments.

A further risk factor for medication errors is a lack of health literacy. Health literacy is a person’s ability to read and use health information correctly. Although this is a more personal factor, making the administration of medication simpler by using uniform units of measure and including appropriate dosing instruments reduces the influence of this factor.

Overall, the authors of the study found the healthcare system’s lack of uniformity to be a large cause of medication errors. Switching uniformly to metric units would reduce the confusion for parents when they administer medication to their children. By adhering to the recommendations of this study, doctors and pharmacists could prevent serious medication errors and even save many lives.


How to Reduce Children’s Medication Errors

Every year, between five and 27 percent of all medications ordered for children results in medication errors. Many children either do not take their prescribed medications or receive an incorrect dose. The process of prescribing medications to filling prescriptions to administering the medications often has many inconstancies and gaps that put children in danger.

A new review of 63 studies on pediatric medication errors found that there are many strategies that can be taken to reduce these errors. Cooperation between doctors, pharmacists, and families is key in any approach. Since almost 7,000 deaths occur every year due to medication errors, adults involved in medicating children must be especially attentive. The review identified two easy changes as consistently effective in decreasing medication errors.

 Easy to Understand Prescriptions

Doctors not only prescribe medication, but they also have an important role in making sure that no medication errors occur once the child is at home. When doctors make prescriptions easy to understand for children and parents fewer medication errors occur.

Standard forms for prescriptions are an important way to make dosing instructions and other important information about medications clearer. For example, using preprinted prescription order forms that are both legible and easy to follow reduced errors significantly. When these forms are generated by a computer, the orders are even less likely to have errors.

By using a computer program that includes extra information such as clinical guidelines, diagnostic criteria, and computerized reminders, the risk of error was even lower. If parents are given more information about medication, they are better equipped to administer it effectively to their children. For this reason, doctors, nurses, and pharmacists should also teach parents how to administer medications and answer any questions.

Clearer Dosages

Although it is easy to give dosage information with pills, very few children’s medications are prescribed in pill form. A common way children take medicine is in liquid form. Unfortunately, many errors in dosing occur when parents administer liquid medications. Medication errors are significantly less likely if liquids are dosed in milliliters instead of teaspoons and tablespoons.

An important reason behind this is that one in six parents use a non-standard measuring device, such as a kitchen spoon that greatly varies in actual size, to measure the correct dose. While this is mitigated when parents use a dropper or a cup measure, many pharmacies do not include these instruments with the medication.

However, even when using a standard measuring device, parents who used teaspoon or tablespoon units are twice as likely to give the wrong amount of medicine to the child as parents who only used milliliter units are. Even though parents may not typically use metric units, they understand how to dose using milliliters and do so effectively.

If these two simple techniques can be employed more widely, the number of pediatric medication errors is likely to decrease. Doctors would reduce their liability and ensure a proper duty of care. Parents would be better informed about the medication that they are giving their children. Most importantly, children would stay healthier.


High Risk Medical Devices to be Fast-Tracked for Approval?

Patients who suffer from life-threatening illnesses and injuries sometimes have to wait to receive medical treatment. Their doctors may not have access to resources to treat their conditions, or they may have to wait for a more effective medicine to emerge on the market to keep their health conditions under control. The time that people must wait often proves to be expensive and painful; if not lethal. To minimize the number of patients who must wait for care, the FDA now offers medical manufacturers an expedited review process to bring vital healthcare products to the market sooner.

The expedited review process does not minimize the need for safety and effectiveness. As the product is prepared for public use, the FDA requires that several criteria be met. First, leaders from the FDA will work with manufacturing executives to gather preliminary data and review reports to ensure that the product can indeed be made available for use. During this earliest stage, adjustments can be made before the medical item obtains permission for manufacturing.

Next, the FDA will ensure that managers from this agency, as well as executives from healthcare manufacturers, review cross-disciplinary reports of the product to ensure its full safety and viability. Case managers from the FDA will review applicants’ data and development plans, and act as liaisons between the product’s corporate sponsors and senior reviewers within the FDA.

The last phase of bringing the product to market involves a priority review process. This process entails presenting manufacturers with pre-market data,  post-market data, as well as answering manufacturers’ concerns and other agencies’ requests to speed up the timeframe by which the device can be commercialized and made fully available for sale.

This expedited process, however, is only available for medical devices and products that are deemed critical to patient care and for which no substitute can be found. People who are suffering from serious diseases and illnesses that prove to be life-threatening can benefit the most from this FDA expedition. They can get the care they need, and look forward to recovering sooner.

Likewise, the process can be applied to devices and products that are identified to feature breakthrough technology. As the medical field continues to embrace and utilize technological inventions, patients who otherwise would suffer disabling health conditions, or even die from their illnesses, can benefit when breakthrough inventions are made available for their doctors’ immediate use. Medical manufacturers can find out more if their products qualify for this EAP process by contacting the FDA or by reading information online.


Outpatient Misdiagnosis Information

Although there have been few studies about patient misdiagnosis, a new study published in the BMJ Quality & Safety shows that 5.08 percent of adults are incorrectly diagnosed annually, which translates to about 12 million adults in the US. More than 6 million patients face serious risks due to misdiagnosis a year in the US alone. The situation also leads to wasted medical resources.

However, proper investigation of outpatient misdiagnosis has been challenging because the complex process involves several providers in different settings. It is important to get the perspectives of physicians for a better understanding of delayed, missed and incorrect diagnoses.

According to a report published by the National Institutes of Health, one study involving internists showed that processes tended to break down in the testing phase while another study involving primary care physicians revealed that medical errors resulted from poor processes of care of test results.

Unfortunately, many physicians do not know about their misdiagnoses and have no way to determine the patients who were misdiagnosed. Nevertheless, the doctors can easily report the challenges they face in the diagnostic processes.

Researchers surveyed 1,817 physicians and received responses from 1,054–80 percent of whom primarily practiced in outpatient settings. The respondents had practiced for an average of 13 years, with 32 percent reporting to have worked in private practice before.

The cognitive factor that was most commonly reported was inadequate knowledge base, with more seasoned physicians reporting relatively less diagnostic difficulty. More diagnostic difficulty arose from problems associated with the referral process and information processing. The strategies most frequently used for improvement concerned workload issues, such as reducing the sizes of physicians’ panels and increasing patient visit times. The respondents also reported that diagnostic delays would be reduced by better access to specialists.

However, the referral process was seen as hindering complete and timely diagnosis even where sub-specialists were readily available. The PCPs reported difficulties communicating with the sub-specialists.

In addition, two factors related to the patients consistently appeared in the responses: failure to provide details about symptoms, and non-adherence to diagnostic evaluation and physician recommendations.

The study showed that diagnostic safety concerns could be reduced by addressing practice-level issues like the time for processing diagnostic information.