Medical Errors in the ICU
What procedures do hospitals have in place for the ethical disclosure of the scope and timing of medical errors in intensive care units?
*NO Introduction and Conclusion
* Endnotes are required, it should be around 100
* use quotations as many as you can
* Reference should be ( Author, pages#)
*please follow outlines in my file
I. Medical Errors in the ICU
A. Definition of Medical Error
B. Potential for Medical Error
C. Types of Medical Errors
1. Error of execution – failure of planned action to be completed as intended
2. Error of planning – use of a wrong plan to achieve and aim
3. Diagnostic errors
a. Error or delay in diagnosis
b. Failure to employ indicated tests
c. Use of outmoded tests or therapy
d. Failure to act on results of monitoring or testing
4. Treatment errors
a. Error in the performance of an operation, procedure, or test
b. Error in administering the treatment
c. Error in the dose or method of using a drug
d. Avoidable delay in treatment or in responding to an abnormal test
e. Inappropriate (not indicated) care
5. Prevention errors
a. Failure to provide prophylactic treatment
b. Inadequate monitoring or follow-up of treatment
c. Preventable adverse outcomes:
1. Event – harm that could be avoided through reasonable planning or proper execution of an action
2. Near miss – the occurrence of an error that did not result in harm
3. Slip – a failure to execute an action due to a routine behavior being misdirected *most common error
4. Lapse – a failure to execute an action due to lapse in memory and a routine behavior being omitted *most common error
5. Mistake – a knowledge based error due to an incorrect thought process or analysis
6. Error of omission – failure to perform an appropriate action
7. Error of commission – performing an inappropriate action
6. Medication errors – preventable events that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.
a. Ordering – wrong dose, wrong choice of drug
b. Transcribing – Prescriptions written or read incorrectly may result in an incorrect amount or frequency of drug administration.
c. Dispensing – drug not sent in time to be administered at the time ordered, wrong drug, wrong dose
d. Administering – wrong dose of drug administered, wrong technique used to administer the drug
e. Monitoring – not noting the effects of the given medication
a. Failure of communication
b. Equipment failure
c. Other system failure
D. Causes of Medical Errors
1. Adverse event – injury caused by medical management rather than by the underlying disease of condition of the patient.
2. Adverse drug event (ADE) – injury resulting from a medical intervention related to a drug such as: heart rhythm disturbances, diarrhea, fever, nausea and vomiting, renal failure, mental confusion, rash, low blood pressure and bleeding.
3. Any error in the medication – The largest cause of medical errors in hospitals are with the use and management of drugs, affecting 3.7% of all patients or 6, 224 patients.
4. Human Error
a) Human Error Performance
b) Skill, Rule and knowledge-based Error
a. Poor patient outcomes that occur as a result of chance rather than an identifiable error.
II. Statistics about Medical Errors in the ICU
A. Injury and error rates and costs extrapolated to the U.S. population
1. Between 44,000 and 98,000 people die in all parts of U. S. hospitals each year (Institute of Medicine, 1999) – the 8th leading cause of preventable death
2. Financial cost of these errors estimated to be $17-$29 billion/year in (Institute of Medicine, 1999); and $19.5 billion in 2008 (Millennium Research Group, 2010) – $17 billion due to prescription drugs
B. Inpatient and outpatient injuries
1. The cost of inpatient error ($22,012) is four times the cost of outpatient error ($4, 814)/year = $2.749 million/year vs. $0.615 million/year (Society of Actuaries, 2010).
2. Outpatient errors (127,830) slightly outnumber inpatient errors (124, 866) (Society of Actuaries, 2010).
C. Percent occurrences by error
III. Risk Factors for Medical Errors in the Intensive Care Unit (Moyen, Camiré, & Stelfox, 2008)
1. Severity of illness
2. Extreme of ages
3. Prolonged hospitalization
1. Types of medications
2. Number of medications
3. Number of interventions
C. ICU Equipment
1. Complex environment
2. Emergency admissions
3. Multiple care providers