Work in Partnership With Your Health Professional to Prevent Medical Errors

What Are Medical Errors?

The possibility of a medical error worries many people in today's complex health care system. When health care or services have an unexpected and undesired result, it is called an adverse event. An adverse event may be caused by a medical error when something that was planned as a part of medical care doesn't work out or when the wrong plan was used in the first place. Medical errors can occur anywhere in the health care system: in hospitals, clinics, outpatient surgery centers, health professionals' offices, nursing homes, pharmacies, and patients' homes. Errors can involve medicines, surgery, diagnosis, equipment, or lab reports. They can occur during even the most routine tasks, such as when a hospital patient on a salt-free diet is given the wrong meal.

Most errors result from problems created by today's complex health care system. Errors also occur when health professionals and their patients have problems communicating. For example, one study supported by the U.S. Agency for Healthcare Research and Quality (AHRQ) found that health professionals sometimes do not help their patients make informed decisions. Uninvolved and uninformed patients are less likely to accept their health professional's recommended treatment and less likely to do what they need to do to make the treatment work.¹

Medical errors are one of the nation's leading causes of death and injury. A report by the Institute of Medicine estimates that as many as 44,000 to 98,000 people die in American hospitals each year as the result of medical errors. This means that more people die from medical errors than from motor vehicle accidents, breast cancer, or AIDS.¹

Government agencies, purchasers of group health care, and health professionals are working together to make the United States health care system safer.

There are many things you can do to work in partnership with your health professional to prevent medical errors.

What You Can Do to Prevent Medical Errors

Be involved in your health care. The single most important 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. You and your doctor should agree on exactly what will be done during each step of your care.

Research shows that patients who are more involved with their care tend to get better results. Choose a health professional whom you feel comfortable talking to about your health and treatment. If you don't understand what your doctor has told you, ask again. Your health is too important to worry about being embarrassed if you have to ask again.

Let your doctor know about all medicines and treatments. If you have several doctors, it is important to keep all of them informed about your care.

If you are the caregiver of a child or older adult, be an active member of his or her health care team. Research shows that your participation will help prevent errors and improve results.

The U.S. Agency for Healthcare Research and Quality (AHRQ) suggests these five steps to help prevent medical errors:

1. Speak up if you have questions or concerns.
2. Keep a list of all the medicines you take and bring it with you to every hospital or doctor's visit.
3. Make sure you get the results of any test or procedure that is done.
4. Talk with your doctor and health care team about your choices if you need hospital care.
5. Make sure you understand what will happen if you need surgery.

The following sections will give you specific tips, based on the latest scientific evidence about what works best.

Prevent Medication Errors

Make sure that all of your health professionals know about everything you are taking. This includes prescription and nonprescription medicines as well as dietary supplements such as vitamins and herbs. At least once a year, bring all of your medicines and supplements with you to your health professional. "Brown bagging" your medicines can help you talk to your health professional about them and find out if there are any problems. It can also help your health professional keep your records up to date, which can help you get better quality care.

Make sure your health professional knows about your allergies and about adverse reactions you have had to any medicine. This can help you avoid getting a medicine that might harm you.

When your health professional writes you a prescription, make sure you can read it. If you can't read the handwriting on the prescription, your pharmacist might not be able to, either.

Ask for information about your medicine in terms you can understand. Do this both when your medicines are prescribed and when you receive them. It is okay to ask questions and to expect answers that you can understand. Ask questions such as:

• What is the medicine for?
• How am I supposed to take it and for how long?
• What side effects are likely? What should I do if side effects occur?
• Is this medicine safe to take with the other medicines or dietary supplements I am taking?
• What foods, drinks, or activities should I avoid while taking this medicine?
• What am I supposed to do if I miss a dose?

Take your medicine exactly as your health professional says. Make sure you understand exactly how your health professional wants you to take your medicine. For example, are you supposed to take it for only a short time then stop, or is this medicine you will always need to take.

Stay in touch with your health professional if you are prescribed pain medicine. It is important for your doctor to know how well your new pain medicine is working. If your pain is not controlled by the medicine, do not take it more often or in larger amounts. Talk to your doctor first.

When you pick up your medicines from the pharmacy, ask the pharmacist if this is the medicine that your health professional prescribed. It is important to make sure you have the correct medicine, at the correct dose. If you are refilling an existing prescription, and the size, shape, or color of the pills seems different than before, check to make sure you have received the right medicine. When you get your medicine, read the label, including any warnings. If the medicine looks different than you expected, ask the pharmacist about it.

If you have any questions about the directions on the medicine label, ask for clarification. Medicine labels can be hard to understand. For example, ask if "4 doses daily" means taking a dose every 6 hours around the clock or just during regular waking hours.

Ask your pharmacist for the best device to measure liquid medicines. Also ask for advice if you're not sure how to use the medicine. Research shows that many people do not understand the right way to measure liquid medicines. For example, many people use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people measure the right dose, but being told how to use the device helps even more.

Ask for written information about the side effects your medicines could cause. If you know what might happen, you will be better prepared if it does or if something unexpected happens instead. You can report the problem right away and get help before it gets worse. Written information about medicines can help patients recognize problem side effects and then give that information to their health professional or pharmacist.

If you experience side effects that seem severe or unexpected, report them to your health professional. Many people who experience medicine-related symptoms do not report them to their doctors. Your health professional may be able to adjust the dose of medicine to reduce or eliminate side effects or give you a different medicine that works better for you.

Prevent Medical Errors During Hospital Stays

If you have a choice, choose a hospital at which many patients have 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.

If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have cleansed their hands. Using an alcohol-based hand cleanser is an important way to prevent the spread of infections in the hospital, yet this is not done regularly or thoroughly enough. One study found that when patients checked whether their health care workers cleansed their hands, the workers used an alcohol-based hand cleanser more consistently.

Make sure your health professional checks your identity before giving you any medicines or treatment. Checking your identity can be looking at an ID, such as a wristband, or asking your name.

When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home and give you written instructions. This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors think their patients understand more than they really do about what they should or should not do when they return home.

Prevent Medical Errors During Surgery

If you are having surgery, make sure that you, your health professional, and your surgeon all agree and are clear on exactly what will be done. Doing surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. Wrong-site surgery is completely preventable. Your surgeon or a nurse may mark directly on the site to be operated on before surgery. Consider telling your surgeon it is all right with you for the site of your surgery to be marked in this way if it will help prevent errors.

You can ask your surgeon the following questions about the surgery:

• Exactly what will you be doing?
• About how long will it take?
• What will happen after the surgery?
• How can I expect to feel during recovery?

Before surgery, talk to your health professional and ask questions. Ask your doctor who will manage your care while you are in the hospital. Be sure to tell the nurses, anesthesiologist, and your surgeon if you have ever had a bad reaction to anesthesia. It is also important to tell them about any medicines you are taking.

Other Steps You Can Take to Prevent Medical Errors

• Speak up if you have questions or concerns. You have a right to question anyone who is involved with your care.
• Make sure that someone, such as your personal doctor, is in charge of your care. This is especially important if you have many health problems or are in a hospital.
• Make sure that all health professionals involved in your care have important health information about you. Do not assume that everyone knows everything they need to know.
• Ask a family member or friend to be there with you and to be your advocate. This should be someone who can help get things done and speak up for you if you are not able to do this for yourself. Even if you think you don't need help now, you might need it later. Make sure the person who will make decisions for you if you are not able to (your advocate) knows what you prefer for your care.
• 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 might be better off without it.
• If you have a test, don't assume that no news is good news. Ask when and how you will get the results of tests or procedures. If you do not get them when expected, don't assume that the results are fine. Call your health professional and ask for the results. Also ask what the results mean in relationship to your treatment.
• Learn about your condition and treatment by asking your health professionals and by using other reliable sources. Ask your health professional if your treatment is based on the latest evidence. Many treatment recommendations based on the latest scientific evidence are available on the Web site of the National Guideline Clearinghouse at http://www.guideline.gov. Other good sources include the library, respected Web sites, and support groups.

Get more information. For more information about medical errors, see the U.S. Agency for Healthcare Research and Quality (AHRQ) Web site at http://www.ahrq.gov/qual/errorsix.htm. You can also call the AHRQ Clearinghouse toll-free at 1-800-358-9295 for a federal report on medical errors, publication No. OM00-0004.

The following documents from the AHRQ Web site are especially useful:

• 20 Tips to Help Prevent Medical Errors: Patient Fact Sheet
• 20 Tips to Help Prevent Medical Errors in Children

The U.S. Food and Drug Administration (FDA) also has a helpful article called "Think it Through: A Guide to Managing the Benefits and Risks of Medicines." Call 1-888-878-3256 to get a copy of this article.

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Related Information

• Choosing a Health Care Agent
• Making the Most of Your Appointment
• Making Wise Health Decisions
• Smart Decisions: Know Your Options
• Work Closely With Your Doctor