Medical Errors




Oneof the chilling reality and that is often overlooked in annualmortality statistics is that, preventable medical errors lead to morethan 440,000 deaths per year. This put medical errors the thirdlargest cause of death in the US, third to cancer and heart disease(Cheragi, Manoocheri, Mohammadnejad &amp Ehsani, 2013).Additionally, these medical errors lead to over 10,000 seriouscomplications and cost the nation more than one trillion US dollarseach year (Cheragi, Manoocheri, Mohammadnejad &amp Ehsani, 2013).The Leapfrog Group (Leapfrog) Hospital scores that grade US generalhospitals from “A” to “F” has revealed a worrying trend thatthere is a slight improvement amongst health facilities in reducingthe errors and that more than one in seven hospitals score lowest inreducing medical errors (Aronson, 2009). The trend is worryingbearing in mind that all medical errors are preventable. Medicalerrors exist when a planned sequence of activities, either physicalor mental, do not achieve intended outcome a mistake or unintendedhealthcare event that may lead to patient injury and sometimes death. Medical errors may be as a result of human attributes such as nursefatigue or lack of appropriate skills, or as a result of machinefailure (Cheragi, Manoocheri, Mohammadnejad &amp Ehsani, 2013).Despite the cause, medical errors are preventable recognizing thecause is necessary to help the health institution develop appropriatestrategies to prevent their occurrence.

Errorsare an integral part of human life however, errors that cost anation a population equivalent to Hawaii’s population, and takingup significant amounts of resources is a costly error and should beprevented. One strategy of preventing medical errors knows the cause,which can be attained through classification of the errors. Thoughsome medical mistakes arise from machines, a majority from thenatural process of behavioral and cognitive adaptation that developthe correct behavioral skills. Human performances are categorizedinto skill-based, knowledge-based and rule-based performances(Aronson, 2009). Skill based performances involve patterns ofactions and thoughts that are governed by stored programmedinstruction that are performed unconsciously.The knowledge basedperformance are used in new situations encountered in practice andrequire conscious analytic processing based on stored knowledge andinformation. The rule based performances involve familiar problemsthat are governed by rules and preconditions. These performances areattributed to the medical errors that are attributed to humanperformances these errors may be the results of inept knowledge andskills by the medical practitioner, failure to follow the correctmethodologies of treatments to the letter or the use inappropriatehealthcare practices. These are the knowledge-based error,Rule-based errors and skill-based errors (Aronson, 2009).

Theskill-based errors are as a result of unconscious aberrations in anormal medical routine that have been naturally automated by medicalpractitioners. Skill-based errors are categorized into slips andlapses, where slips are the observable, external failures in thephysical execution of an intended plan. Slips arise from attention orperception, where the medical practitioner prepares the intended planfor execution but due to lack of attention, the automatic taskcreates an opportunity for error. For instance, a nurse maycalculate the weight-based dose of an esmolol for a patient withacute arrhythmias but inadvertently injects the patients with theuncalculated concentrated esmolol instead of the ready to use thedrug, causing patient’s hypoxic brain or even death. Medicalpractitioners involved in medical slips often recall paying absoluteattention to all details including the concentration of the drug,only to realize that they erred during drug administration. On theother hand, lapses are less visible to outside observers and occurmainly due to failures of memory. They involving forgetting andcontribute t the error of omission of critical medical practice,leading to medical errors (Aronson, 2009).

Inrule-based medical errors, there is an acknowledgment of the medicalissue to be addressed but departs from skill based performance toissue an alternative medication leading to medical errors. Theculpable medical practitioner departs from the established heuristicsand selects the wrong path of treatment leading to errors. Thepractitioner may apply a good rule but in a wrong situation, applythe good rule in the correct situation but misses some importantcontraindications to the rule (Cheragi, Manoocheri, Mohammadnejad &ampEhsani, 2013).

Finally,the knowledge-based performances arise when the skill-based andrule-based performance cannot apply in a situation. These situationsrequire the medical practitioner to understand the situation beforedeliberating on the best medical practice to utilize. Knowledge-basedmedical errors arise due to the incompleteness and flaw of the mentalmode of the medical practitioner, the lack of experience in asituation, and the lack of special training on cognitive theoriesamong clinicians making cognitive skills in medical practice beclosely knit (Olds &amp Clarke, 2010).

Thereare many factors that lead to cognitive and performance based medicalerrors, but the leading cause is fatigue among the medicalpractitioners. It is a known fact that more than sixty percent ofmedical errors are as a result of fatigue by caregivers. Fatigueaffects memory leading to concentration challenges hence theskill-based errors. Additionally, fatigue may cause hunger, stressand illness thus impairing clinician’s productivity thereby causingmedical errors. Long working hours may also cause clinician’sphysical injuries that also contribute to medical errors (Cheragi,Manoocheri, Mohammadnejad &amp Ehsani, 2013).

Nursesare among the twenty-two million Americans that work in shifts, withtheir work schedules covering the 24/7 medical requirements ofpatients. The nurses enjoy relatively lesser off-hours as comparedto other professions since most of their off-time is consumed duringpatients’ hand-over to incoming caregivers. At times, they arecalled from their off-time to assist in patient’s care when thepatients’ number overwhelms the on-shift nurses such as duringemergencies.According to the Center for Disease Control, lack ofsufficient rest leads to fatigue and other shift work sleep Disordersthat affects the quality of work done, impairs safety and contributesto the chronic disease of the workers. Thus, the issue of work hoursin healthcare has attracted quite an attention, with researchfocusing on impacts of long working hours on nurses quality work(Aronson, 2009).

Inresearch conducted by Olds and Clarke (2010), it was discovered thatnurses who were working for more than forty hours (normal time plusovertime) had an increased likelihood of experiencing needle stickinjuries as compared to patients that worked for shorter hours. Moreworrying was the discovery that these nurses that worked for morethan forty hours were witnessing more medical errors in theirpractice as compared to nurses that worked for lesser hours (Olds&ampClarke, 2010). Another research by Rogers (2008), found thatindividuals that work at night and rotating shifts rarely obtainoptimal amounts of sleep since they obtain one to four hours lesssleep than when working during the day. This loss of sleepaccumulates by the end of the workweek and may be significant enoughto impair decision-making initiatives, integrating information,planning and execution of desired plans. Thus, the research found outthat it was common for nurses to sleep when working in nightshifts,or make skill-based, knowledge-based or even rule-based errors intheir medical practices. The trend is astonishing bearing in mindthat a majority of the medical facilities encourage their staff towork extra hours to compensate for patients’ influx andinsufficient staff (Rogers, 2008).

Reducing through Fatigue Management

Thoughit may be impossible to eliminate all medical errors, takingnecessary measures to reduce the number of working hours in a span oftwenty-four hours and within a week is an important step towardsreducing medical errors. A nursing task force formed in 2008 aimed atestablishing appropriate guidelines that may be adopted by hospitalsto manage staff fatigue, thereby reduce the number of medical errorsin the various medical facilities. The task force, which was intendedfor all frontline clinicians such as nurses, pharmacists, andrespiratory therapists, reduced the clinicians working shifts fromsixteen hours to twelve and a half hours within twenty-four hours(Cheragi, Manoocheri, Mohammadnejad &amp Ehsani, 2013). Thedirective significantly reduced the number of human cognitive medicalerrors among the early adopters. Later, an eight-hour shift wasintroduced, heralding even more positive changes in reducing medicalerrors. As such, reducing the number of working shifts pertwenty-four hours is an effective way of reducing cognitive andperformance based medical errors. Thus are medical facilities shouldmove towards reducing the number of working shifts through strategiessuch as employing more staff to share the working hours rather thancompelling the staff to work for extra hours. Employing more staffwill ensure that few staff members are on their leave and may berecalled in case of emergencies rather than relying on nurses who arealready tired and headed to their off (Cheragi, Manoocheri,Mohammadnejad &amp Ehsani, 2013).

However,it may not be possible to attain these significant policy changesunless they are made at a national level. The government must realizethe increased challenges that come with increased working hours amongmedical practitioners and push for all facilities to adopt shortclinical shifts. Less clinical shifts will ensure that the clinicianis energetic and can make appropriate medical decisions or followrequired medical processes without medical lapses or slips, therebyreduce medical errors.Other appropriate methods that can be usedto reduce the cognitive and performance based medical errors includetraining clinicians about the cognitive theories thereby shiftingfrom the current cross-knitted medical practice (Olds &amp Clarke,2010).

Fromthe above, medical errors are the preventable and unintended medicalpractices that do not lead to the planned outcome since the plan didnot proceed as intended or the plan was inadequate. Medical errorsare the third leading cause of death after heart diseases andcancers, contributing to more than 440,000 deaths and 10,000 medicalcomplications per year. A majority of these errors are as a result ofhuman cognitive and performance inadequacies and are categorized intorule-based, knowledge-based and skill-based errors. One of theaptest strategies of reducing these errors is by reducing stafffatigue through reducing the number of shifts per week and number ofworking hours per daily shifts. Reducing working hours reducefatigue, stress, and work-related injuries thereby reduce thecognitive-based medical injuries.


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Cheragi,M.,Manoocheri, H., Mohammadnejad, E., &amp Ehsani, S. (2013). Types andcauses of medication errors from nurse`s viewpoint. IranJournal of nursing Midwifery Research. Vol. 18(3).

Olds,D., &amp Clarke, P., (2010).The Effect of Work Hours on AdverseEvents and Errors in Health Care. Journalof Safety Research.Vol. 41(1),pp153–162

Rogers,E., (2008). Sleepinesson Nurse Performance and Patient Safety. In HughesR., PatientSafety and Quality: An Evidence-Based Handbook for Nurses.Rockville: U.S. Department of Health and Human Services