June 13, 2014

Reducing Medical Errors in Diabetes Care Needed

The public believes that our medical system can and should be improved. Even I believe this, but the larger problem of diabetes care requires our attention. With the number of people diagnosed daily, even many of them are not finding out how to care for themselves adequately.

Errors in diabetes care become a common cause of complications that can result of disability and even death, according to this article in Diabetes in Control. Yet, the diabetes errors being reported are likely much lower than the actual number. At least the report from the Institute of Medicine (IOM) catapulted the issue onto the front pages of magazines and newspapers in the United States.

The challenge before us now in not documenting how bad the number of errors have been, but to focus on how best to help those who are in fact providing care to patients with diabetes. Not only is this task more difficult, but also more important. How this is done will be what we need to improve care. The following discussion may help us highlight some of the common misconceptions:

#1. It is the belief that there is always someone to be held accountable for the error and remove them from the system. However, most of the important medical errors are multifactorial and are the result of numerous small oversights, any one of which, if corrected, might have prevented or reversed the error.

#2. The "system" is providing obstacles that result in blame falling on the individual at the point of care. However, these problems often have more to do with the system of care itself. This system or “culture of safety” is defective and needs to be improved or at the minimum corrected from the top-down. A culture of safety should be defined as any situation requiring providers to work together as a cohesive unit on behalf of patients; safety.

#3. It is the belief that correcting all errors in the main objective. Wrong! Many errors do not harm anyone and often are spotted by the people who make them. These often are the result of taking shortcuts. These errors are usually corrected when the work is reviewed. It is sound strategy to set up procedures for providers to routinely check both their work and others. In this way, the vast majority of errors can be caught and corrected without harming patients.

#4. It is often believed that the nurses are the cause of many errors. Not correct! It is the hospitals that have reduced the nurse-patient ratio and added stress to the nursing staff. By employing non-nurse technicians, the error rate is increasing and the nurses and doctors cannot keep the stress at even a manageable level. Many errors are repeated again and again because they are not reported or shared with others. The Institute for Safe Medication Practices is one place to report errors anonymously. This will share the errors with hundreds of thousands of medical professionals and help them prevent these errors.

For patients with diabetes, frequent glucose monitoring, wound care, and the clinical needs of those with orthostatic hypotension, renal disease, and retinopathy can lead to increased nursing requirements. We can do a great deal to champion the need for more nurses at the bedsides of patients.

Electronic Medical Records (EMRs) can prevent errors from poor handwriting, but they also open the door for new types of errors. These errors are checking off the wrong dose, directions, or even the wrong drug. Some errors can be stopped if providers would routinely run a drug-interaction check on prescriptions before giving them to the patients. With EMRs, this can be done almost instantly.

If hospitals and doctors are to improve safety for diabetic patients, here are a few starters:
#1. Offer more education that is patient-centered, requiring the patients to demonstrate what they know.

#2. Increase awareness of the need for adequate resources, particularly sufficient time for doctors to thoroughly evaluate clinical problems.

#3. Form ad-hoc teams of doctors and nurses to work together more cohesively in the care of diabetic patients.

#4. Change the paradigm so that providers think less about who is to blame and more about how to prevent catastrophes caused by the system in which they work.

#5. Change the tort system so that hospitals and providers can focus on making the system better and not on avoiding frivolous and illogical lawsuits. And

#6. Make the system of care as focused on quality as it is on cost containment.

Each of these issues can play an important role in the improvement of the system of care and in the protection of the diabetic patients from the consequences of medical errors. To this, add patient education to help them prevent errors at home that may well prevent the need for hospitalization.

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