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Friday, October 13, 2006

Medical error

In the United States medical error is predictable to result in 44,000 to 98,000 unnecessary deaths and 1,000,000 overload injuries each year. It is estimated that in a characteristic 100 to 300 bed hospital in the United States, excess costs of $1,000,000 to $3,000,000 attributable to extended stays and complications presently due to medication errors happen yearly. Medical care is often compared adversely to aviation, in that, while many of the factors which guide to error are similar, aviation's error management protocols are much additional effective.

Medical errors are linked with inexperienced clinicians, new procedures, and extremes of age, complex care and urgent care. Usually, errors are attributed to mistakes made by persons who may be penalized for these mistakes. The common approach to correct the errors is to create new policy with additional checking steps in the system, aiming to stop further errors. As an example, an error of complimentary flow IV administration of heparin is approached by education staff how to use the IV systems and to use particular care in setting the IV pump. While on the whole errors become less likely, the checks insert to workload and may in themselves be a cause of extra errors.

A newer model for development in medical care takes its origin from the work of W. Edwards Deming in a model of Total Quality Management. In this representation, systems of care are evaluated for procedure issues that may contribute to errors in care. As an illustration, in such a system the mistake of free flow IV administration of Heparin is dealt with by not using IV heparin and substituting subcutaneous management of heparin, obviating the whole problem. However, such a move toward presupposes available research showing that subcutaneous heparin is as valuable as IV. Thus, the majority systems use a mixture of approaches to the problem.

The field of medicine that has taken the guide in systems approaches to safety is Anesthesiology. Steps such as consistency of IV medications to 1 ml doses, national and international color coding standards and growth of improved airway support devices has made anesthesia care a model of systems upgrading in care.


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