Your Golden Years, Your Golden Challenge: A Practicing Physicians Prescription for Preventative Heal

---

Some categories of error are more likely to be detected. Treatment-related errors are potentially more detectable than diagnostic and prevention errors, since the associated adverse events may occur quickly and visibly e. We may never recognize that an error occurred in these types of patient care situations, simply because we are not aware of it until a specific adverse event takes place.

These problems will be especially difficult to solve in outpatient care settings, where much of the patient care is non-acute and aimed at managing chronic conditions. Furthermore, more and more procedures currently take place in non-hospital settings. New techniques, equipment, and the drugs developed over the past ten years have made outpatient and office surgery more feasible. In general, procedures with a low rate of post-operative complications can be performed also in the day-hospital setting 8.

Errors can also be classified according to their outcome 9 , the setting where they take place inpatient, outpatient , the kind of procedure involved medication, surgery, etc or the probability to occur high, low. Different classifications have been drawn up to fit fields such as laboratory medicine 9 , anaesthesia 10 , general practice 11 , otolaryngology In otolaryngology, for instance, the critical areas that appear to be the more common cause, in order of frequency, are: The largest population studies come from USA and Australia. The Harvard Medical Practice Study is the reference for estimating the extent of medical injuries occurring in hospitals They reported that preventable adverse events occurred in 3.

In a study on the quality of Australian health care, a population based study modelled on the Harvard study, investigators reviewed the medical records of 14, admissions to 28 hospitals in New South Wales and South Australia in An adverse event occurred in A replication of the Harvard study was performed in Colorado and Utah on 15, patients. The incidence rate of preventable adverse events was 2. Furthermore, again in the US, the national rate of hospital-reported medical errors in hospitalised children was estimated to range from 1.

Medication errors and adverse drug events have been extensively investigated because they are both relevant and preventable. In a study carried out by Bates et al. The medication errors were associated with the use of analgesics, antibiotics, sedatives, chemotherapeutic agents, cardiovascular drugs and anticoagulants Most of the errors were minor, but As far as the type of dispensing error is concerned, Rolland reported that wrong drug and wrong patient combined accounted for Medication errors are also a major cause of morbidity and mortality among hospitalised children.

Due to small volumes of solution involved, even a large error may occur with an unsuspiciously small dose Surgical error complications are common in hospitalised surgical patients. Risk factors such as age, complex care, urgent care and prolonged hospital stay have been associated with a higher rate of errors Slonim reported that the most seriously ill paediatric patients are also more likely to be subjected to prescription errors Miscommunication appears to play an important role in generating diagnostic and treatment errors. Failures in communication sometimes relate directly to poorly written prescriptions.

It is, therefore, not surprising that various bodies the Royal College of Paediatrics and Child Health , the British Medical Association and the Royal Pharmaceutical Society have made explicit guidelines regarding written prescriptions, i.

Introduction

Even if staff usually report the number of hours worked as a factor affecting the chance of committing errors, Davydov concludes that there is no statistically significant correlation between the number of hours worked and the frequency or significance of the errors Instead, the prevalence of medical errors related to the discontinuity of care from the inpatient to the outpatient setting is high and may be associated with an increased risk of re-hospitalisation The individual health professional remains an important contributor to patient safety.

Trainees are more likely to commit prescription errors, as a category Furthermore, a number of individual characteristics and the role they might play in terms of work practices that affect patient safety have been studied. The individual characteristics most likely to affect safety are low risk perception, sensation seeking, Type A behaviour aggressive, competitive and impatient , high self esteem, psychological ill health, and attitudes concerning safety.

More research is needed in this area and psychometrics should be considered as a potential aid in recognizing and addressing potential difficulties Medical errors are also a result of extreme specialization, as specialists generate more diagnostic hypotheses within their domain than outside, and assign higher probabilities to diagnoses within that domain Two approaches to the problem of human fallibility are possible: The individual approach focuses on the errors of individuals, blaming them for forgetfulness, carelessness or moral weakness.

Related Video Shorts (0)

The system approach concentrates on the conditions under which individuals work and tries to build defences to avert errors or mitigate their effects. The basic premise in the system approach is that humans are fallible and errors are to be expected, even in the best organizations.

Blaming individuals is emotionally more satisfying for damaged patients than targeting institutions, but the person approach is weak for two main reasons. Firstly, it is often the best people who make the worst mistakes error is not the monopoly of an unfortunate few. Secondly, far from being random, mishaps tend to fall into recurrent patterns 6. Errors in medicine have to be seen as a dimension of quality of care and organizational performance. An effective response to harm must be based on a reliable risk management policy aimed at minimizing the chances of recurrence of an avoidable medical error.

To analyse and plan to remedy a problem, it is first necessary to collect data about the problem and then to summarize that data. Each strategy has unique strengths and none is sufficient by itself. The analysis of incidents is a powerful method of learning about healthcare organizations and, hopefully, leads to improvements for enhancing patient safety, such as adopting protocols or organizational changes in the field where the error has been found more likely to occur.

A non-punitive method of incident reporting is a key strategy that should be considered by health care providers in an attempt to reduce errors. Near misses are useful tools, supporting patient safety, because they give a wider overview of the issue than only those incidents that really occur do. Incident reporting as a means of identifying the causes of human error in medicine has its limitations: Evaluation of the system for potential causes of error or for errors that have already occurred can be performed using different tools, two of which are presented below.

Failure Mode and Effect Analysis FMEA is a systematic process for identifying potential process failures before they occur, with the intent to eliminate them or minimize the risk associated with them. Initiated in the s by the U. This methodology is to prevention and proactive risk management as Root Cause Analysis RCA is to occurrence of adverse events.

RCA is a structured analytic methodology used primarily to examine the underlying contributors to an adverse event or condition. The validity of the methodology is considered a gold standard, therefore organizations accredited by the JCAHO, for example, are required to conduct at least one HFMEA, or similar proactive analysis, annually. To increase patient safety, one of the major advances, in recent years, has been computerization.

Applications of technology in medicine are: Automation holds substantial promise, for improved safety, but error experts caution that all technology introduces the potential for new and different errors Staff must be taught the use of sophisticated software or automated systems in order to avoid problems. Clinicians who are overconfident believe that they are correct when, in fact, they are not are prone to medical errors Healthcare providers must take a leading role in promoting a culture of safety in their organizations.

All patients are potentially vulnerable to the effects of errors. Therefore, medical errors are costly from a human, economic and social viewpoint.

Reduction of medical error and harm can be put in the broader context of safety and quality of care by providing a framework to assess and evaluate the structure, process and outcomes of care. Healthcare is characterized by a reliance on human operators who work with increasingly complex technology and variable levels of uncertainty. This can lead to error and needs to be managed through a framework where organizations are available for continuously improving the quality of services and safeguarding high standards of care.

A systematic approach to patient safety should be adopted where responsibility for safety is shared by all members of the healthcare teams In fact, significant errors occur in all phases of patient care. There is no single area where change will eliminate error. Likewise, a multitude of individuals and services are involved in errors. Although training physicians or any other single profession about errors should be beneficial, major strides in safety will likely require educating all those involved in patient care Efforts to reduce errors should be proportional to their impact on outcome preventable morbidity, mortality, and patient satisfaction and the cost of preventing them National Center for Biotechnology Information , U.

Journal List Acta Otorhinolaryngol Ital v. Received Sep 1; Accepted Oct 1. This article has been cited by other articles in PMC. Summary Medical errors represent a serious public health problem and pose a threat to patient safety. Medical errors, Adverse events, Clinical risk management. Introduction Medical errors represent a serious public health problem and pose a threat to patient safety. Definitions Several definitions of medical errors exist but only the few formulated by valuable sources are worthy of consideration.

Open in a separate window. Diagnostic Error or delay in diagnosis Failure to employ indicated tests Use of outmoded tests or therapy Failure to act on results of monitoring or testing Treatment Error in performance of an operation, procedure, or test Error in administering treatment Error in the dose or method of using a drug Avoidable delay in treatment or in responding to an abnormal test Inappropriate care Preventive Failure to provide prophylactic treatment Inadequate monitoring or follow-up of treatment Other Failure of communication Equipment failure Other system failure.

Models and management of human error Two approaches to the problem of human fallibility are possible: Detection of medical errors To analyse and plan to remedy a problem, it is first necessary to collect data about the problem and then to summarize that data. Strategies to prevent medication errors: HFMEA and RCA Evaluation of the system for potential causes of error or for errors that have already occurred can be performed using different tools, two of which are presented below.

Health care professionals such as physicians, pharmacists and nurses have significant role in their daily practice to improve patient medication adherence. There are several types of non adherence but most often the categorization is indisputable, and there is a degree of overlap. The first is known as primary non adherence, in which providers write prescription but the medication is never filled or initiated. This type is commonly called non fulfillment adherence. A second type of non adherence is called non persistence in which patients decide to stop taking a medication after starting it, without being advised by a health professional to do so.

Non persistence is rarely intentional and happens when patients and providers miscommunication about therapeutic plans.

Conclusion

Unintentional non adherence arises from capacity and resource limitations that prevent patients from implementing their decisions to follow treatment recommendations e. A third type of non adherence is known as non conforming, this type includes a variety of ways in which medication are not taken as prescribed, this behavior can range from skipping doses, to taking medications at incorrect times or at incorrect doses, to even taking more than prescribed. Rate of adherence is usually reported as the percentage of the prescribed doses of the medication actually taken by the patient over a specified period.

The consequence of non adherence is waste of medication, disease progression, reduced functional abilities, a lower quality of life, increased use of medical resources such as nursing homes, hospital visits and hospital admissions. For instance in a study conducted by Anon, it was shown that the risk of hospitalization was more than double in patients with diabetes mellitus, hypercholesterolemia, hypertension, or congestive heart failure who were non adherent to prescribed therapies compared with a general population.

Medication non adherence can have negative consequences not only for the patient but also for the provider, the physician, and even the medical researchers who are working to establish the value of the medication on the target population. The potential burden of medication non adherence outcomes on health care delivery makes it an important public health concern. Non-adherence is a very common phenomenon in all patients with drug taking behavior. Complexity of adherence is the result of an interplay of a range of factors including patient views and attributes, illness characteristics, social contexts, access and service issues.

Product details

Barriers to the effective use of medicines specifically include poor provider-patient communication, inadequate knowledge about a drug and its use, not being convinced of the need for treatment, fear of adverse effects of the drug, long term drug regimens, complex regimens that require numerous medications with varying dosing schedules, 29 cost and access barriers. It has also been observed that patient non adherence varies between and within individuals, as well as across time, recommended behaviors and diseases. In children, adherence to drug therapy is affected due to their dependence on an adult care giver.

A major reason for non adherence is higher patient-physician discordance leading to decreased patient satisfaction. Non adherence can also occur when the medication regimen is complex which could include improper timing of drug administration, or administration of numerous medications at frequent or unusual times during the day.

These patient behavioral factors may or may not be perceived by the physician and results in decreased therapeutic outcome. Most deviations in taking medication occur as omission of doses rather than additions or delays in the timing of doses. Patients most often become non-compliant for chronic diseases, like hypertension, where they do not have any unpleasant symptoms even without strict compliance to medication regimen. Estimates of medication non adherence illustrates that the non adherence percentage is greatest when the patients are symptom-free.

Patient Medication Adherence: Measures in Daily Practice

Patients with low literacy may have difficulty understanding instructions; this ultimately results in decreased adherence and poor medication management. For instance, women may be better at adhering to their medication regimens than men. This may be particularly so for drugs those treat behavioral health conditions, such as antidepressant medications. The effectiveness of a treatment depends on both the efficacy of a medication and patient adherence to the therapeutic regimen. Patients, health care providers, and health care systems, all have a role to improve medication adherence.

A systematic approach that could be instituted in improving medication adherence is as follows:. Whenever possible, involve patients in decision making regarding their medications so that they have a sense of ownership and they are partners in the treatment plan. Use the most possible simplified regimen based on patient characteristics at the first level of drug use. Address the key information about the drugs what, why, when, how, and how long.

Inform the common side effects and those that patient should necessarily know Patients would be more worried and lead to non adherence due to side effects that was not cautioned to them in advance by health care professionals. Monitoring the medication adherence should also be a criteria while scheduling patient follow up. Measure adherence by various methods which may be dependent on patient as well as drug characteristics. Check the effectiveness of medication adherence aids used, if any. This should be done by physicians as well as pharmacists.

Patient involvement in decision making is essential in improving medication adherence. It is vital for health care providers to identify the underlying causes of patient non adherence to determine appropriate interventional strategy. One of the major reasons that patients become non adherent is because they forget to take their medications.

Results of a study conducted showed that Medication non adherence may also occur because patients perceive it to be unnecessary or because of their fears and beliefs related to adverse effects of drugs. Hence, providing clear medication related information to patients is essential to improve adherence that includes addressing the key information of what, why, when, how and how long.

Patient medication counseling can be supplemented by providing detailed written information about medications. Succinct written instructions which include drug cards, medication charts or any written material in a plastic sheet or laminated sheet also helps in improving adherence especially for elderly patients who find it difficult to comprehend much of the information which is provided during medication counseling.

Patients' fears and concerns about adverse drug reactions can be alleviated by educating patients regarding common side effects of the drugs which they are taking, how to prevent an adverse drug reaction, if possible, and also convincing the patient of the need for treatment. Complexity of drug regimen is found to negatively affect medication adherence.

Patient-health care professional, especially patient-physician or patient-pharmacist communication is central to optimizing patient adherence. Various methods have been reported and are in use to measure adherence. The methods available for measuring adherence can be broken down into direct and indirect methods of measurement. Direct methods include direct observed therapy, measurement of the level of a drug or its metabolite in blood or urine and detection or measurement of a biological marker added to the drug formulation, in the blood. Direct approaches are one of the most accurate methods of measuring adherence but are expensive.

Moreover, variations in metabolism and "white coat adherence" can give a false impression of adherence. Each method has its own advantages and disadvantages and no method is considered as the gold standard. Though this method is simple, it has many disadvantages that the patients can switch medicines between bottles and may even discard pills before hospital visits in order to appear to be following the regimen.

Medical errors and clinical risk management: state of the art

Furthermore, this method does not provide information on dose timing and drug holidays, where the medication has to be omitted on 3 or more sequential days, both of which help to determine clinical outcomes. Rates of refilling prescriptions are an accurate measure of overall adherence in a closed pharmacy system health maintenance organization countries with universal drug coverage since refills are measured at several points in that time. Electronic monitors capable of recording and stamping the time of opening bottles, dispensing drops eye drops or activating canister metered dose inhaler for asthma can also give a measure of adherence.

The disadvantage with this method is that the measure of adherence is not accurate as the patients may open the container and not take the medication, take the wrong amount of medication or take multiple doses out of the container at the same time or place multiple doses in another container.

Patient medication non adherence is a major medical problem globally. There are many inter related reasons for the same. Though patient education is the key to improving compliance, use of compliance aids, proper motivation and support is also shown to increase medication adherence. Health care professionals should identify practically possible strategies to improve medication adherence within the limits of their practice eventually enhancing therapeutic outcome.

It should be a multidisciplinary approach that needs to be carried out with the support of all those who are involved in medication use. The authors reported no conflict of interest and no funding was received for this work. National Center for Biotechnology Information , U. Journal List Oman Med J v. Received Feb 3; Accepted Apr 9. This article has been cited by other articles in PMC. Abstract Adherence to therapies is a primary determinant of treatment success. What influences medication adherence? Methods to improve medication adherence The effectiveness of a treatment depends on both the efficacy of a medication and patient adherence to the therapeutic regimen.

A systematic approach that could be instituted in improving medication adherence is as follows: Introduce a collaborative approach with the patient at the level of prescribing Whenever possible, involve patients in decision making regarding their medications so that they have a sense of ownership and they are partners in the treatment plan. Simplify medication taking Use the most possible simplified regimen based on patient characteristics at the first level of drug use. Schedule appropriate follow up Monitoring the medication adherence should also be a criteria while scheduling patient follow up.

Assess adherence during consequent follow ups Measure adherence by various methods which may be dependent on patient as well as drug characteristics. Identify difficulties and barriers related to adherence. Inform the patients accordingly how the problems have been addressed Patient involvement in decision making is essential in improving medication adherence. Methods to measure adherence Various methods have been reported and are in use to measure adherence.

Conclusion Patient medication non adherence is a major medical problem globally. Acknowledgements The authors reported no conflict of interest and no funding was received for this work. Compliance, adherence, and concordance: Jul; 1 Suppl: Understanding compliance with the medical regimen: Arthritis Care Res Doctor—patient communication and adherence to treatment.

Myers LB, Midence K, eds. Adherence to treatment in medical conditions.

• The Ways of Metatron - A Book of Enoch
• The Devils Highway (The Roland Longville Mystery Series Book 7)
• Mehr wissen: Das große ZEIT ONLINE Quiz (German Edition)
• The Early History of Jerusalem - (Before A. D. 71)
• Prescription for Excellence: Leadership Lessons for Creating a World Class Customer Experience from
• Dirty Weekend