Current Situation of Medical Errors Prepared by Asma Alshammari Alhanoof Alaniz Teflah Ali Mai Alrweeli Munyfaa Aldhafeeri Norah Almoteri Introduction Health care processes are increasingly being implicated in causing harm to patients. Medical errors and adverse events are primarily responsible for this harm. These errors, which may occur at every level of the custom are both common and diverse in nature. Medical errors can occur anywhere in the health care system in hospitals, clinics, surgery centers, doctors' offices, nursing homes, pharmacies, and patients' homes and can have serious consequences. Errors can involve medicines, surgery, diagnosis, equipment, or lab reports. Medical errors represent a serious public health problem and pose a threat to patient safety. As health care institutions establish “error” as a clinical and research priority, the answer to perhaps the most fundamental question remains elusive: What is a medical error? To reduce medical error, accurate measurements of its incidence, based on clear and consistent definitions, are essential prerequisites for effective action. Despite a growing body of literature and research on error in medicine, few studies have defined or measured “medical error” directly. Instead, researchers have adopted surrogate measures of error that largely depend on adverse patient outcomes or injury (i.e., are outcome-dependent). A lack of standardized nomenclature and the use of multiple and overlapping definitions of medical error have hindered data synthesis, analysis, collaborative work and evaluation of the impact of changes in health care delivery. Medical error is defined as “failure of a planned action to be completed as intended or use of a wrong plan to achieve an aim”. A medical error is a threat to patient safety and has a negative effect on health as well. Definition of Medical Error Medical error the term “error” has been variously defined. The Oxford Dictionary of Current English (1998) defines it as “mistake” or the condition of being morally “wrong”. Error has also been defined in a wider context as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim (Reason, 1990). Although the definition of “error” has its origins in behavioral psychology, the term is appropriate for medical usage. Using Reason's definition, IOM has tried to separate medical error into two parts (Kohn et al., 2000): the first half of the definition constitutes “error of execution” and the latter half, “error of planning.” In this context, two other related terms, “adverse event” and “patient safety.” Bates et al. (1997) defined adverse events as injuries that result from medical management, rather than from the underlying disease. Patient safety, as defined by IOM, is freedom from accidental injury (Kohn et al., 2000). All three terms, “medical error,” “adverse event,” and “patient safety” complement one another. Type ...

1. Current Situation of Medical Errors
Prepared by Asma Alshammari Alhanoof Alaniz Teflah
Ali Mai Alrweeli Munyfaa Aldhafeeri Norah Almoteri
Introduction
Health care processes are increasingly being implicated in
causing harm to patients. Medical errors and adverse events are
primarily responsible for this harm. These errors, which may
occur at every level of the custom are both common and diverse
in nature.
Medical errors can occur anywhere in the health care system in
hospitals, clinics, surgery centers, doctors' offices, nursing
homes, pharmacies, and patients' homes and can have serious
consequences. Errors can involve medicines, surgery, diagnosis,
equipment, or lab reports.
Medical errors represent a serious public health problem and
pose a threat to patient safety. As health care institutions
establish “error” as a clinical and research priority, the answer
to perhaps the most fundamental question remains elusive: What
is a medical error? To reduce medical error, accurate
measurements of its incidence, based on clear and consistent

2. definitions, are essential prerequisites for effective action.
Despite a growing body of literature and research on error in
medicine, few studies have defined or measured “medical error”
directly. Instead, researchers have adopted surrogate measures
of error that largely depend on adverse patient outcomes or
injury (i.e., are outcome-dependent).
A lack of standardized nomenclature and the use of multiple and
overlapping definitions of medical error have hindered data
synthesis, analysis, collaborative work and evaluation of the
impact of changes in health care delivery.
Medical error is defined as “failure of a planned acti on to be
completed as intended or use of a wrong plan to achieve an
aim”. A medical error is a threat to patient safety and has a
negative effect on health as well.
Definition of Medical Error
Medical error the term “error” has been variously defined.
The Oxford Dictionary of Current English (1998) defines it as
“mistake” or the condition of being morally “wrong”. Error has
also been defined in a wider context as the failure of a planned
action to be completed as intended or the use of a wrong pl an to
achieve an aim (Reason, 1990). Although the definition of
“error” has its origins in behavioral psychology, the term is
appropriate for medical usage. Using Reason's definition, IOM
has tried to separate medical error into two parts (Kohn et al.,
2000): the first half of the definition constitutes “error of
execution” and the latter half, “error of planning.” In this
context, two other related terms, “adverse event” and “patient
safety.” Bates et al. (1997) defined adverse events as injuries
that result from medical management, rather than from the
underlying disease. Patient safety, as defined by IOM, is
freedom from accidental injury (Kohn et al., 2000). All three
terms, “medical error,” “adverse event,” and “patient safety”

3. complement one another.
Type of medical error
· Their two types of medical error according to moral and
medical error according to sit or event
Medical error According to moral:
Error is a disorder of an intentional act, and they distinguish
between errors in planning an act and errors in its execution. If
a prior intention to reach a specified goal leads to action, and
the action leads to the goal, all is well. If the plan of action
contains some flaw, that is a ‘mistake’. If a plan is a good one
but is badly executed, that is a failure of skill.
This approach Mistakes can be divided into
· knowledge-based errors:
Knowledge-based errors can be related to any type of
knowledge, general, specific, or expert. It is general knowledge
that penicillin's can cause allergic reactions; knowing that your
patient is allergic to penicillin is specific knowledge; knowing
that co-fluampicil contains penicillin's is expert knowledge.
Ignorance of any of these facts could lead to a knowledge-based
error.

4. · rule-based errors. Failures of skill can be divided into
Rule-based errors can further be categorized as
the misapplication of a good rule or the failure to apply a good
rule;
the application of a bad rule.
· action-based errors ('slips', including technical errors)
An action-based error is defined as ‘the performance of an
action that was not what was intended. A slip of the pen, when a
doctor intends to write diltiazem but writes diazepam, is an
example. Technical errors form a subset of action-based errors.
They have been defined as occurring when ‘an outcome fails to
occur or the wrong outcome is produced because the execution
of an action was imperfect’ An example is the addition to an
infusion bottle of the wrong amount of drug
· memory-based errors (‘lapses’).
Memory-based errors occur when something is forgotten; for
example, giving penicillin, knowing the patient to be allergic,
but forgetting.
How to prevent this type of error:
Knowledge-based errors can obviously be prevented by
improving knowledge,
e.g., by ensuring that students are taught the basic principles of
therapeutics and tested on their practical application and that
prescribers are kept up to date. Computerized decision-support
systems can also train prescribers to make fewer errors
Mistakes that result from applying bad rules, or misapplying or
failing to apply good rules (rule-based errors), can be prevented
by improving rules.
Training can help in preventing technical (action-based) errors.
Memory-based errors are the most difficult to prevent. They are
best tackled by putting in place systems that detect such errors
and allow remedial actions. Check lists and computerized
systems can help.

5. The second typey of medical error: According to sit or events
1/ medication
Type of medication error
· .Prescribing error
· Omission error
· .Wrong time error
· Unauthorized drug
· Improper drug error
· Wrong dose form error
· Wrong dose preparation error
· Wrong administration technique errors
· .Deteriorated drug errors
· Monitoring error
· Compliance error
How to prevention of medication error
· Failure mode and effects analysis
· Legal requirements
· Policies & procedures
· Education and training
· Standardized order forms
2/ surgical
Types of surgical error
· Failure to diagnose a dangerous medical condition during
surgery
· Operating on the wrong part of a patient’s body
· Damaging healthy organs during surgery
· Leaving instruments in a patient’s body following surgery
· Failure to prevent or fix complications during surgery
How to prevent surgical error
· Mark the operation sits
· Improving communication in operation room
· Use new technology in operation room
3/ diagnostic error

6. · Diagnostic
· Error or delay in diagnosis
· Failure to employ indicated tests
· Use of outcome ded tests or investigations
· Failure to act on results of monitoring or testing
· Preventive
· Failure to provide prophylactic treatment
· Inadequate monitoring or follow -up of treatment
· Treatment
· 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
·
4/ infection error
Types of infection error like Viruses, bacteria, parasites,
fungus, and prions are different types of pathogens that cause
infections.
How to prevent infection:
· Wash your hands often, especially before and after preparing
food, going to the bathroom, and after other dirty tasks.
1. Have a specially trained and dedicated infection control staff
1. Regularly educate all surgeons and staff on infection control
measures
1. Vaccinate and treat personnel for exposure to infection at all
times
1. Implement computer-assisted decision support and reminders
that help doctors know when and how much antibiotic or other
medication to give
nosocomial infection
1. Staphylococcus aureus
1. Escherichia coli

7. 1. Candida
1. Methicillin
Causes by
3. Urinary catheters (urinary tract infections)
3. Surgical procedures (surgical site infections)
3. Central vinos catheters (blood sternum infection)
3. Mechanical ventilation (pneumonia)
How to prevent nosocomial infections
0. Frequent hand hygiene is the most important preventative
measure to limit the spread of pathogens.
0. Compliance with isolation precautions
0. Proper use of personal protective equipment
0. Avoidance of unnecessary use of indwelling devices, and
remove them as soon as advisable.
0. Practicing proper aseptic and/or sterile techniques during
insertion and maintenance of devices.
4. Routine disinfection of surfaces, patient equipment, and
medical devices
4. Appropriate waste management
5/ blood transfusion
blood transfusion mistakes occur when
1. incorrect blood is given to a patient. For instance, a blood
sample may be mislabeled.
1. incorrect patient name may be marked on a blood sample,
1. blood sample is marked with the incorrect blood type (O-
negative, etc.).
1. too much blood given to patient
1. blood is stored at incorrect temperatures
How prevent blood transfusion error
1. training of medical staff, including nurses and technicians.

8. 1. Mack sour that the correct blood group to correct
RULES AND PROGRAMS FOLLOWED IN THE HOSPITAL
TO REDUCE MEDICAL ERRORS IN SAUDI ARABIA
The Minister of Health, Dr. Abdullah bin Abdulaziz Al-
Rabiah is following with great interest the work of the technical
committees that were recently established within each health
facility to detect the medical error as soon as it occurs without
the need for a complaint and linking the procedures for
practicing the health service according to a mechanism that is
followed up electronically, which is known as the “electronic
dashboard” system. Dashboard in hospitals, which enhances the
level of health service and contributes to reducing medical
errors.
The Ministry of Health has set procedures to reduce medical
errors, including:
1- Requiring all health personnel to register professionally with
the Saudi Commission for Health Specialties.
2- Continuing medical education for all health personnel, as a
condition for re-registration.
3- Requiring all health personnel to train in clinical skills
4- Implementing a program to monitor and measure severe
events.
5- Implementing a performance measurement program.
6- Implementation of the clinical review program.
7- Adopting treatment protocols and establishing the rules of
evidence-based medicine.
8- Creation of quality committees in the ministry and
directorates of health affairs. 9- Implementing the performance
indicators measurement program.
10- Creating committees to examine and approve the
qualifications and experience of doctors.
11- Supporting infection control programs in hospitals and
developing the skills of workers.

9. 12- Strengthening health awareness programs inside and outside
hospitals.
13- Developing an evaluation program for clinical and non-
clinical departments in hospitals by experts in the same field.
14- Improving nursing skills and requesting nursing
competencies from developed countries.
15- Introducing a bridging program for all technicians.
16- Introducing patient satisfaction measurement programs.
17- Medical file repair program.
18- Establishment of medical performance review committees.
Many medical errors are not reported by healthcare
professionals due to fear of retribution and may be concealed by
patients and their families in the sense that reporting them may
be pointless. As long as there is no system in place to report and
address medical errors, these conditions will not improve.
The Saudi Center for Accreditation of Health Facilities is now
developing a system according to which it will receive and
study the current cases of serious accidents that occur in
approved facilities, serious medical errors and serious accidents
to be reported.
The Ministry of Health has identified the following events that
need to be reported:
1- Diagnostic or therapeutic procedure for the wrong patient
2- Performing surgery in the wrong place
3- Serious damage caused by blood transfusion
4- Suicide in the hypnosis department
5- Forgetting surgical tools and pads
6- Wrong medication that leads to death or serious
complications
7- Handing over a newborn to non-parents
8- Baby kidnapping
9- Maternal mortality
10- An unexpected death
11- Unexpected loss of a party or function of a member

10. 12- Air embolism of a blood vessel
Starting in January 2016, hospitals accredited by the Saudi
Center for Accreditation of Health Institutions must report all
serious accidents by filling in and submitting the Serious
Accident Reporting Form on the electronic portal of the Saudi
Center for Accreditation of Health Facilities. This is within (5)
working days from the internal notification of the serious
accident (the date on which the hospital administration was
notified of the accident). This must be followed by a Root
Cause Analysis (RCA) and a risk reduction action plan within
(30) business days from the date of notification of the serious
accident. A root cause analysis is a formal process of
investigations aimed at identifying the root causes of adverse
adverse events.
The Saudi Center for Accreditation of Health Facilities
encouraged all health facilities as well as the beneficiaries
From its services, patients and reviewers are required to report
serious medical errors to which they were a party, and support
everything that would achieve this.
The policy followed by the Saudi Center related to reporting
serious medical errors states that we are a mandatory report to
all approved health facilities and a voluntary initiative for non-
accredited health facilities.
And those that connect to the council by other means (informed
means - the patient - a relative)
The most prominent benefits of reporting serious medical
errors:
1. Know the medical errors that occur in hospitals
The various medical centers and how their causes were, and
what are the results of the radical analysis of them and the
corrective plan that was implemented, the Saudi Center for
Accreditation of Health Facilities and all other health facilities
greatly helps in learning the lessons learned from those

11. mistakes in order to help avoid them in the future.
2. Reporting Medical Errors A practical guide provided by
health facilities to the public who benefit from their services as
an indication of their
Its commitment to the required transparency in recognizing
deficiencies when they occur.
3. Reporting medical errors helps health facilities through the
advisory services provided by the Saudi Center for
Accreditation of Health Institutions related to the fundamental
analysis of the error and the development of the corrective plan.
4. Reporting Medical Errors The Saudi Center for Accreditation
of Health Facilities assists in carrying out practical research
aimed at determining the rates and types of medical errors and
methods of combating them, and disseminating the results of
those studies to all sectors of the health community in the
Kingdom.
5. Reporting medical errors is evidence of the approved health
facilities' commitment to the policy of maintenance and follow -
up accreditation by the Saudi Center for Accreditation of Health
Facilities.

12. COMMON CAUSES OF MEDICAL ERRORS :
Factors associated with health care professionals:
· Lack of therapeutic training
· Inadequate drug knowledge and experience
· Inadequate knowledge of the patient
· Inadequate perception of risk
· Overworked or fatigued health care professionals
· Physical and emotional health issues
· Poor communication between health care professional and
with patients are the most common causes of medical errors.
Whether verbal or written, these issues can arise in a medical
practice or a healthcare system and can occur between a
physician, nurse, healthcare team member, or patient. Poor
communication often results in medical errors
Factors associated with patients
· Patient characteristics (e.g., personality, insufficient patient
education and language barriers)
· inappropriate patient identification
· failure to obtain consent
· insufficient patient education.
· Complexity of clinical case, including multiple health
conditions, polypharmacy and high-risk medications.
Factors associated with the work environment
· Workload and time pressures
· Distractions and interruptions (by both primary care staff and
patients)
· Lack of standardized protocols and procedures
· Insufficient resources n Issues with the physical work
environment (e.g., lighting, temperature and ventilation)
· Inadequate staffing alone does not lead to medical errors but
can put healthcare workers in situations where they are more
likely to make a mistake.
Factors associated with medicines
· Naming of medicines
· Labelling and packaging

13. Factors associated with tasks
· Repetitive systems for ordering, processing and authorization
· Patient monitoring (dependent on practice, patient, other
health care settings, prescriber)
Factors associated with computerized information systems
· Difficult processes for generating first prescriptions (e.g. drug
pick lists, default dose regimens and missed alerts)
· Difficult processes for generating correct repeat prescriptions
· Lack of accuracy of patient records
· Inadequate design that allows for human
· Technical failures can include complications or failures with
medical devices, implants, grafts, or pieces of equipment.
Advice Help To Prevent Medical Errors
Medical errors can occur anywhere in the health care system:
hospitals, clinics, surgery centers, doctors' offices, nursing
homes, pharmacies, and patients' homes. Errors can involve
medicines, surgery, diagnosis, equipment, or lab reports. These
tips tell what you can do to get safer care.
How to Reduce or Prevent Medical Errors in health care system
:
Following steps are important in reducing or preventing medical
errors:
· Make a center for patient safety within the agency for health
care research and quality:
· Make national goals for patient safety
· Follow the progress in the meeting for the recognized goals
· Form mandatory reporting systems regarding collection and
interpretation of medical mistakes
· Make the standards and expectations for improvement in
safety high via the actions and support of oversight
organizations
· Make safety systems inside the healthcare organizations via
the use of safe practices at the delivery level

14. · Make an accurate patient’s identification
· Increase the effectiveness of communication among the
patients and the providers
· Timely reporting of important tests
· Label all the medications
· Transfer accurately the medication information to nurses
· Fulfill the hand hygiene guidelines and thus decrease the risk
of infection
· Make a universal agenda for preventing wrong site, wrong
patient and wrong procedure and follow it .
· Complete the pre-procedure verification
· Ensure the safe place for medication preparation
· Reduce interruptions during drug administration
· Use calculator to calculate the exact dose
· Separate and label of drugs with similar names, colors or
sounds
· Check whether medication is given to proper patient
· Nursing education regarding calculation of dose
· Delivery of drugs from pharmacy to ward under supervision of
staff nurse
· Double checking of medications via two separate nurses
· Follow the rule of right i.e. right patient, right drug, right
dose, right route and right time
· Head nurse must report the medication error when it occurs
· Nurses must have access to patient’s information
· Increase the patient-nurse ratio in each shift
· Attendance of educational programs
· Make and follow medication administration policy
Advice Help To Prevent Medical Errors For patient :
The best way you can help to prevent errors is to be an active
member of your health care team. That means taking part in
every decision about your health care. Research shows that
patients who are more involved with their care tend to get better
results.
1. Make sure that all of your doctors know about every medicine

15. you are taking.
2. Bring all of your medicines and supplements to your doctor
visits.
3. Make sure your doctor knows about any allergies and adverse
reactions you have had to medicines.
When your doctor writes a prescription for you, make sure you
can read it.
4. Ask for information about your medicines in terms you can
understand—both when your medicines are prescribed and when
you get them:
o What is the medicine for?
o How am I supposed to take it and for how long?
o What side effects are likely? What do I do if they occur?
o Is this medicine safe to take with other medicines or dietary
supplements I am taking?
o What food, drink, or activities should I avoid while taking
this medicine?
5. When you pick up your medicine from the pharmacy, ask: Is
this the medicine that my doctor prescribed?
6. If you have any questions about the directions on your
medicine labels, ask.
7. Ask your pharmacist for the best device to measure your
liquid medicine.
8. Ask for written information about the side effects your
medicine could cause.
1. If you are in a hospital, consider asking all health care
workers who will touch you whether they have washed their
hands.
1. When you are being discharged from the hospital, ask your
doctor to explain the treatment plan you will follow at home.

16. 1. If you are having surgery, make sure that you, your doctor,
and your surgeon all agree on exactly what will be done.
Having surgery at the wrong site (for example, operating on the
left knee instead of the right) is rare. But even once is too often.
The good news is that wrong-site surgery is 100 percent
preventable. Surgeons are expected to sign their initials directly
on the site to be operated on before the surgery.
1. If you have a choice, choose a hospital where many patients
have had the procedure or surgery you need.
Research shows that patients tend to have better results when
they are treated in hospitals that have a great deal of experience
with their condition.
1. Speak up if you have questions or concerns.
You have a right to question anyone who is involved with your
care.
1. Make sure that someone, such as your primary care doctor,
coordinates your care.
This is especially important if you have many health problems
or are in the hospital.
1. Make sure that all your doctors have your important health
information.
Do not assume that everyone has all the information they need.
1. Ask a family member or friend to go to appointments with
you.
Even if you do not need help now, you might need it later.
1. Know that "more" is not always better.
It is a good idea to find out why a test or treatment is needed
and how it can help you. You could be better off without it.
1. If you have a test, do not assume that no news is good news.
Ask how and when you will get the results.
20- Learn about your condition and treatments by asking your
doctor and nurse and by using other reliable sources.

17. Conclusion
Medical errors are one of the most important quality problems
in health care today. All providers know medical errors create a
serious public health problem that poses a substantial threat to
patient safety. Part of the solution is to maintain a culture that
works toward recognizing safety challenges and implementing
viable solutions rather than harboring a culture of blame,
shame, and punishment. Healthcare organizations need to
establish a culture of safety that focuses on system improvement
by viewing medical errors as challenges that must be overcome.
All individuals on the healthcare team must play a role in
making the provision of healthcare safer for patients and
healthcare workers.
Often it is difficult to recognize one’s mistake, but it is
necessary to face the situation and try to learn from it so that
future errors can be prevented. Identifying the risk factors for
medical errors is crucial first step towards its prevention and is
important goal of quality care assurance.

18. References
1) Jay Kalra. (2011). Medical Errors and Patient Safety :
Strategies to Reduce and Disclose Medical Errors and
Improve Patient Safety. De Gruyter.
2) Hulbert JR. Dictionaries: British and American. London:
Andre Deutsch 1955; 68– 77.
3) Oxford English dictionary [online]. Available
at http://ezproxy.ouls.ox.ac.uk:2118/entrance.dtl (last accessed
2 February 2009).
4) https://www.kennedyjohnson.com/medical-
malpractice/hospital-errors/types-of-surgical-errors/
5) Anderson,D. J.Podgorny, K..,et al (2014) Strategies to
prevent surgical site infections in Acute care Hospital: 2014
Update . (2014) . infection control and Hospital Epidemiology ,
35(6) ; 605627 DOI;
6) https://psnet.ahrq.gov/primer/wrong-site-wrong-procedure-
and-wrong-patient-surgery
7) Ministry of health ; link
https://www.moh.gov.sa/Ministry/MediaCenter/News/Pages/NE
WS-2010-6-14-002.aspx
8) https://www.ivyleaguenurse.com/courses/prevention-of-
medical-errors/
9) Hurwitz, B., & Sheikh, A. (Eds.). (2011). Health care errors
and patient safety. John Wiley & Sons.
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