Patient Safety and Medical Errors

Patient Safety is considered to be the most important parameter of quality that every contemporary healthcare system should be aiming at. The terms “Patient Safety” and “Medical Errors” are directly linked to the “Safety Culture and Climate” in every organization. It is widely accepted that medical errors constitute an index of insufficient safety and are defined as any unintentional event that diminishes or could diminish the level of patient safety. This chapter indicates that a beneficial safety culture is essential to enhance and assure patient safety. Furthermore, health care staff with a positive safety culture is more probable to learn openly and successfully from errors and injuries.

Medical Errors

The impact of medical errors on the delivery of health care is massive, and it significantly reduces health care quality. They could be largely attributed to system failures and not human weakness. Therefore improving health care quality and ensuring quality control in health care would mean making systems function in a better manner. In order to achieve this all sections of society as well as industry must be involved. Reporting of medical error needs to be encouraged and this may be ensured if health care professionals as well as administrators and health consumers come forward without fear of being blamed. To get to the root of the problem- literally and metaphorically- a root cause analysis and audit must be carried out whenever feasible. Persons outside the medical care establishment also need to work with medical service providers to set standards of performance, competence and excellence.

Clinical Pathways and the Human Factor

A key approach to improving patient safety is to seek to modify both formal and informal behaviours in response to the extensive reporting of error causes in the literature. This response is primarily in two parts; a) actions to minimise the risk of error or b) actions to control against error. For a) very valuable work has also been undertaken in running human factors courses to demonstrate and try to change poor behaviour via best practice models. In the case of b) much work has been done on increasing control regimes such as checklists and also formal rules in formal procedures. However, these actions tend to be specific to specific health units, are often piecemeal and are not integrated to complement each other. Little work has been done to integrate these formal and informal/social behaviour into clinical pathways or health activities. This chapter reviews current thinking and develops a methodology and proposal for identification and control of human error in clinical pathways based on the research of the two authors.

The Psychological Impact of Medical Error on Patients, Family Members, and Health Professionals

The current chapter examines the psychological implications emerging from medical errors. Whilst the psychological effects have studied, nonetheless the consequent impacts and the underlying psychological causes have not been sufficiently analysed and/ or interpreted. The chapter will add to the literate by using a psychodynamic approach in analysing the psychological impact of medical errors and provide interpretations of the underlying causes. The chapter concludes that medical errors lead to a series of implications. For the patient the quality of interactions with health professionals are directly affected and usually have immediate consequences. The impact of these consequences in the patient is mediated by the patient's personality, history of the individual and the psychoanalytic destiny of the patient. For the patient's relatives medical errors create emotional cracks leading to regression and eventual transference of the medical errors as a “bad” object. For health professionals medical errors impact upon the psychological defence mechanisms of the psychic Ego.

Application of Quality Management in Promoting Patient Safety and Preventing Medical Errors

The combination of healthcare professionals, processes and technologies bring significant benefits for patients. However, it also involves an inevitable risk of adverse events. Patients receiving health care in health institutions have the potential to experience some forms of medical errors. The word medical error commonly encompasses terms such as mistakes, near misses, active and latent errors. This signifies the complexity and multidimensional nature of the error. The consequences can be costly to the patients, the health professionals, the health care institutions, and the entire health care system. The costs may involve human, economic, and social aspects. Thus, ensuring quality health care can contribute to patients' safety by reducing potential medical errors in practice. This chapter aims to introduce a quality management framework for improving the quality and effectiveness of services, reducing medical errors and making the healthcare system safer for patients.

The Role of Forensic Medicine in Medical Errors

This chapter presents the importance of Legal and Forensic Medicine in medical malpractice and explains how autopsies have a crucial role for the evaluation and the prevention of medical errors. Health systems vary from country to country; however, experts are indispensable in each system. In fact, experts' opinions are asked for resolution of specific court cases. Standard of care is often assessed by expert medical witnesses who testify for one of the litigants. The physician who acts as an expert witness is one of the most important figures in malpractice litigation. Therefore, a doctor who is an expert witness has to have certain training and qualifications and to act under common recommendations. The ideal medical expert seems to be the forensic doctor. In the future, a harmonization of practices could be applied in medical liability cases and the guidelines provided by the medico-legal community could constitute a stable base for their evaluation.

The Second Victim Phenomenon

Medical error happens when an action within the medical field is not fulfilled as planned, or the plan is performed incorrectly. Patient and family are the first victim of an adverse event. The damage in a patient's health, leads in a distressing situation not only for the patient, but also for the clinician who is responsible for this outcome. The term “second victim” refers to the trauma that a health professional sustains due to a serious adverse event in the healthcare system. After a medical error the caregivers are experiencing the aftermath in their personal and professional life. They feel isolated and abandoned, and some of them are coming up against the law with penal and disciplinary ramifications as a consequence of the blame culture in the health care system. Some health professionals experienced the consequences of an unfortunate incident even if it did not lead in harm to the patient's health.

The Perspectives of Medical Errors in the Health Care Industry

This chapter presents the overview of medical errors; drug prescription errors and prescribing; the overview of medical error disclosure; medical errors and telemedicine; medical errors and medical education; the overview of nursing medication errors; and the aspects of medical errors in the health care industry. Reducing medical errors, increasing patient safety, and improving the quality of health care are the major goals in the health care industry. Medical errors are caused by mistakes in drug prescription, dosing, and medical administration in inpatient and outpatient settings. Heath care-related guidelines, institutional safety practices, and modern health care technologies must be applied in hospitals, clinics, and medical offices to reduce the occurrence of medical errors. The chapter argues that understanding the perspectives of medical errors has the potential to enhance health care performance and reach strategic goals in the health care industry.