Medical errors represent a serious public health problem and occur frequently in various healthcare settings. They can involve medicines, surgery, diagnosis, equipment, or lab reports. Studies estimate medical errors may be the third leading cause of death in the US, resulting in between 200,000 to 400,000 deaths per year. Many common types of errors like misdiagnosis, unnecessary treatment, medication mistakes, and uncoordinated care have been reduced through standardized protocols and safety practices, but medical errors still frequently harm and kill patients.

1. MEDICAL ERRORS
Dr. Hisham Abid Aldabbagh
MSc. Internal Medicine
Kingdom of Saudi Arabia
Ministry of Health
Directorate of Health
Affairs in Gurayat
Gurayat General Hospital

2. Defining Medical Errors
Can J Surg. 2005
• Medical errors represent a serious public health problem
and pose a threat to patient safety.
• Medical errors can occur anywhere in the health care
system:
In hospitals, clinics, surgery centres, doctors' offices,
nursing homes, pharmacies, and patients' homes.
• Medical Errors can involve medicines, surgery, diagnosis,
equipment, or lab reports.

3. • An unintended act (either of omission or commission)
• One that does not achieve its intended outcome
• The failure of a planned action to be completed as intended
(an error of execution)
• The use of a wrong plan to achieve an aim (an error of
planning)
• A deviation from the process of care that may or may not
cause harm to the patient.
• Patient harm from medical error can occur at the individual or
system level.

4. •Medical error—the third leading cause of death in the US
BMJ 2016
• Medical error is not included on death certificates or in rankings
of cause of death.
• The death list is created using death certificates filled out by
physicians, funeral directors, medical examiners, and coroners.
However, a major limitation of the death certificate is that it
relies on assigning an International Classification of Disease (ICD)
code to the cause of death. As a result, causes of death not
associated with an ICD code, such as human and system factors,
are not captured.

5. PreventiveDiagnostic
• Failure to provide
prophylactic treatment
• Inadequate monitoring or
follow-up of treatment
 Error or delay in diagnosis
 Failure to employ indicated tests
 Use of outmoded tests or investigations
 Failure to act on results of monitoring or testing
Other Treatment
• Failure of communication
• Equipment failure
• Other system failure
 Error in the performance of an operation, procedure, or therapy
 Error in administering the treatment
 Error in the dose or method of using a drug
 Avoidable delay in treatment or in responding to an abnormal test
 Inappropriate (not indicated) care
Types of Medical Errors

6. How common are medical errors?
• Medical errors are, frankly, rampant. A recent
study estimates that “communication breakdowns,
diagnostic errors, poor judgment, and inadequate skill” as
well as systems failures in clinical care result in between
200,000 to 400,00 lives lost per year.
• This means that if medical error was a disease, it would be
the third leading cause of death in the United States.

8. Some Facts
• 440,000 patients die every year from preventable medical
errors. [Journal of Patient Safety]
• Preventable medical errors cost USA tens of billions of dollars a
year. [Institute of Medicine]
• One in three patients who are admitted to the hospital will
experience a medical error. [Health Affairs]
• Studies of wrong site, wrong surgery, wrong patient procedures
show that “never events” are happening at an alarming rate of
up to 40 times per week in U.S. hospitals. [Archives of Surgery ]

9. Data and statistics, WHO 2017
• European data show that medical errors and health-care
related adverse events occur in 8% to 12% of
hospitalizations.
• Infections associated with health care affect an estimated 1
in 20 hospital patients on average every year (estimated at
4.1 million patients).
• 23% of European patients are affected by medical error,
18% experienced a serious medical error in a hospital and
11% to have been prescribed wrong medication.

10. • Evidence on medical errors shows that 50% to 70.2% of
such harm can be prevented through comprehensive
systematic approaches to patient safety.
• Statistics show that strategies to reduce the rate of adverse
events in the European Union alone would lead to the
prevention of more than 750 000 harm-inflicting medical
errors per year, leading in turn to over 3.2 million fewer
days of hospitalization, 260 000 fewer incidents of
permanent disability, and 95 000 fewer deaths per year.

11. Studying these
mistakes and
learning how to
prevent, monitor,
and respond to
them, however,
has changed the
standards of
care.
We learn most from
our painful
mistakes.
Mistakes can injure
patients and land
physicians in legal
and professional
trouble.
By working to eliminate common medical errors,
physicians can protect patients, protect themselves from lawsuits, and help
lower the cost of their professional liability insurance premiums.

12. At the local hospital,
the care that he and
his children received
was inadequate, even
by standards in those
days.
In 1976, Dr. Jim
Styner, an orthopedic
surgeon, crashed his
small plane into a
cornfield in
Nebraska, sustaining
serious injuries.
His wife was killed,
and 3 of their 4
children were
critically injured
His family's tragedy and the medical mistakes that followed gave birth to Advanced
Trauma Life Support (ATLS) and changed the standard of care in the first hour after
trauma.

13. • .
The American
Society of
Anesthesiologists
responded with a
program to
standardize
anesthesia care and
patient monitoring
and in 1985 created
the Anesthesia
Patient Safety
Foundation.
Judy was 39 years old
when she went to the
hospital for a
hysterectomy. After
she died on the
operating table,
autopsy revealed that
the anesthesiologist
had placed the
endotracheal tube in
her esophagus, not
her trachea
Standard practices now include the use of pulse oximetry and end-tidal carbon dioxide
monitoring for anesthetized patients.
The push for electronic monitoring systems for patients under anesthesia caused anesthesia-
related deaths to plummet from about 1 in 10,000 to 1 in 200,000 in less than 2 years.

14. Unfortunately,
administration of
oxytocin led to
unrecognized fetal
distress, and their
newborn daughter
suffered severe
brain injury and
cerebral palsy.
Sally and Ed looked
forward to the
birth of their first
child. Sally's labor
was long, so her
obstetrician added
oxytocin to speed
things up.
Fetal monitoring to test both uterine contractions and fetal heart rate (FHR) is now the
standard of care.
The purpose of FHR monitoring is to follow the status of the fetus during labor so that
clinicians can intervene if there is evidence of fetal distress.
When EFM is used during labor, the nurse or physicians should review it frequently

15. Unfortunately, the
x-ray technician
mislabeled the
films, mixing left for
right, and the
orthopedic surgeon
first amputated
Bill's right leg.
Bill had a seizure
and crashed his car
into a tree, crushing
both legs.
Arteriography
revealed that his
right leg was
salvageable but his
left leg was not
Preventing wrong-site surgery became one of the main safety goals of the Joint
Commission for Accreditation of Healthcare Organizations (JCAHO).
Establishing protocols became an accreditation requirement for hospitals, ambulatory
surgery centers, and office-based surgery sites.

16. One week later, the
surgeon performed a
second procedure and
found that a surgical
sponge had been left
inside.
Tom was 12 years old
when his appendix
burst and he was
taken to the local
pediatric hospital.
Three days after the
appendectomy, he
developed another
high fever.
Postoperative sponge and instrument counts have been routine for decades. There is no
single standard, although nursing and surgical organizations have developed best
practices for sponge, needle, and instrument counts.

17. No one had asked her
about medication
allergies.
As a young child, Betty
had been given
penicillin, turned blue,
and was rushed to the
hospital.
She was 15 when she
got strep throat, was
given penicillin, and
died.
Strategies to address the problem include adding visible prompts in consistent and
prominent locations listing patient allergies, eliminating the practice of writing drug
allergens on allergy arm bracelets, and making the allergy reaction selection a
mandatory entry in the organization's order-entry systems

18. In the emergency
department, her
nurse made a
mathematical error
and administered too
much intravenous
potassium.
Within an hour, Linda
was dead.
Linda wasn't doing
well in her first
trimester.
The nausea and
vomiting left her
severely dehydrated
and with a low
potassium level.
In the 1980s and 1990s, patient safety groups drew attention to the need for removal of
concentrated potassium chloride vials from patient care areas.
Potassium is now added to IVs by the manufacturer and is labeled.
Additional safety strategies include using premixed solutions, segregating potassium from
other drugs and using warning labels, prohibiting the dispensing of vials for individual
patients, and performing double-checks with a pharmacist.

19. The nurses didn't know
that patients needed to
move regularly, and
Frank developed deep
decubitus (pressure)
ulcers. When these
became infected,
Frank's leg had to be
amputated.
Frank was 72 years
old when he broke
his right leg in a car
accident and had to
recover for a few
weeks in a
rehabilitation facility.
Nursing homes and hospitals now have programs to avoid development of bedsores by
using a set timeframe to reduce pressure and having dry sheets by using catheters or
impermeable dressing.
Pressure shifting on a regular basis and the use of pressure-distributive mattresses are
now common practices.

20. Lillian's nurse, Millie,
wasn't strong enough
to support her and
they both fell,
breaking Millie's right
arm and Lillian's left
leg.
Lillian was 68 years
old and weighed 250
lb when she
underwent surgery
to remove her
gallbladder.
The second day after
surgery, she needed
help to walk to the
bathroom.
The ANA supports policies that eliminate manual patient lifting.
Safe patient-handling techniques involve the use of such equipment as full-body slings,
stand-assist lifts, lateral transfer devices, and friction-reducing devices

21. By the time it was
diagnosed,
the cancer had
progressed beyond
cure.
When Christy was 42
years old, her doctor
discovered a large lump
in her left breast.
The lump should have
been evident during
Christy's 2 previous
annual examinations if
they had been
complete
Breast examinations by the physician, teaching of techniques for breast self-examination,
and recommendation of mammograms are now the standard of care.

22. These are but a few examples of medical mistakes that have led to patient injuries or
death -- and have led further to changes in the way physicians practice medicine.
Recognizing that all of these mistakes could have been prevented, medical academies
have developed guidelines for prevention and treatment of many diseases.

23. What are the 10 things that can kill a patient in the hospital?
• #1. Misdiagnosis. The most common type of medical error.
A wrong diagnosis can result in delay in treatment, sometimes
with deadly consequences.
• #2. Unnecessary treatment. Thousands of people receive
unnecessary treatment that cost them their lives.
• #3. Unnecessary tests and deadly procedures. Studies show
that $700 billion is spent every year on unnecessary tests and
treatments, it can also be deadly.

24. • #4. Medication mistakes. Over 60% of hospitalized
patients miss their regular medication while they are in the
hospital. On average, 6.8 medications are left out per
patient.
• Wrong medications are given to patients; a 2006 Institute
of Medicine report estimated that medication error injure
1.5 million Americans every year

25. • #5. “Never events”. Operating on wrong limb or the wrong
patient.
• Food meant to go into stomach tubes go into chest tubes
• Air bubbles go into IV catheters, resulting in strokes.
• Sponges, wipes, and even scissors are left in people’s
bodies after surgery.
• These are all “never events”, meaning that they should
never happen, but they do, often with deadly
consequences.

26. • #6. Uncoordinated care. If you’re going to the hospital,
chances that you won’t be taken care of by your regular
doctor, but by the doctor on call.
• You’ll probably see several specialists, who scribble notes in
charts but rarely coordinate with each other.
• You may end up with two of the same tests, or medications
that interfere with each other.
• There could be lack of coordination between your doctor
and your nurse, which can also results in confusion and
medical error.

27. • #7. Health care associated infections. According to
the Centers for Disease Control, hospital-acquired
infections affect 1.7 million people every year.
• These include pneumonias, infections around the site of
surgery, urinary infections from catheters, and bloodstream
infections from IVs.
• Such infections often involve bacteria that are resistant to
many antibiotics, and can be deadly (the CDC estimates
nearly 100,000 deaths due to them every year), especially
to those with weakened immune systems

28. • #8. Not-so-accidental “accidents”. Every year, 500,000 patients
fall while in the hospital.
• As many “accidents” occur due to malfunctioning medical
devices. Defibrillators don’t shock; hip implants stop working;
pacemaker wires break.,…..
• They happen for 1 in 100 people.
• #9. Missed warning signs. When patients get worse, there is
usually a period of minutes to hours where there are warning
signs. Unfortunately, these warning signs are frequently
missed, so that by the time they are finally noticed, there could
have been irreversible damage.

29. • #10. Going home—not so fast. Studies show that 1 in 5
Medicare patients return to the hospital within 30 days of
discharge from the hospital.
• This could be due to patients being discharged before they are
ready, without understanding their discharge information,
without adequate follow-up, or if there are complications with
their care.
• The transition from hospital to home is one of the most
vulnerable times, and miscommunication and
misunderstanding can kill a patient after getting home from
the hospital too.

30. Golden professional principles
If We Don’t Own Our Errors, We Are
Destined To Repeat Them
In Medicine, Honesty Is Truly The Best
Policy

31. Ongoing Message
Always Reactivate Your Interest and Efforts in
Eliminating Medical Errors
Thanking You
Email: dr.hishamdabbagh@gmail.com
Email: haldabag@moh.gov.sa
Mobile: 00966536715868
Dear Colleagues, Please,