Mistakes of healthcare workers during antineoplastic infusions: how can we prevent them?

Background. 39 years old Betsy Lehman, which in 1994 took part in a clinical study, died because of the excessive infusion of cyclophosphamide (4 times higher dose). The mistake was revealed only in 10 weeks after the patient’s death. Now there is a Betsy Lehman Center of Patient Safety and Decrease of Medical Errors. According to the definition, medication error is an unintended failure in the drug treatment process that leads to, or has the potential to lead to the harm of the patient. In turn, wrong usage of the drug is an intentional misuse not in accordance with the instruction for medical usage (including, with some illegal aims). According to the statistics, only in USA medical errors harm 44,000-98,000 patients annually and cause the death of 7,000 patients. Objective. To define the main concepts of medical errors and methods of their avoidance. Materials and methods. Analysis of literature data on this topic. Results and discussion. Categories of medical mistakes include the mistakes of prescribing, of dispensing, of preparation, of administration and of monitoring. Retrospective analysis of the correctness of drug administration had revealed that the risk factors of mistakes included patient’s age <15 y. o. or >64 y. o., and a big quantity of administered drugs. Nurses with different professional experience equally often made mistakes; mistakes were more often during night shifts. Medical mistakes in oncology have some peculiarities. Namely, in oncology the drug dose often depends on the body surface and other factors; exceeded dose is accompanied by the high toxicity, and the insufficient dose – by the severe decrease of treatment effectiveness; anticancer treatment is accompanied by the administration of the big amount of additional drugs (antiemetics, hemopoesis stimulators, glucocorticoids, etc.). Analysis of chemotherapy of 1311 adult patients, which underwent the treatment in the university clinics of Valencia (Spain), revealed the mistakes in 17.2 % of cases. Mistakes in drug prescription were the most often (75.7 %). Similar French study revealed the mistakes in 5.2 % of cases, the majority of them (91 %) were also the mistakes in prescription (wrong choice of treatment regimen, incomplete prescriptions, inadequate doses). Such mistakes have not only medical, but also the social and economic consequences, including the increase of treatment cost. Meta-analysis of R. Ashokkumar et al. (2018) revealed that the frequency of medical errors in oncology, according to the different studies, was about 0.004-41.6 %. There is one more problem: because of the fear of punishment healthcare workers hide their errors, that’s why the small amount of errors may not be the real favorable parameter, but just a result of incomplete notification. Factors of medical mistakes appearance are divided into 3 groups: due to healthcare workers (training level, knowledge, physical and emotional condition), due to clinics administration (presence of treatment standards, communication quality, registration and analysis of error cases) and social (staff workload, time limitations, workplace organization, payment). With the aim of prevention of medical errors in oncology we must implement the treatment standards and local protocols, control technics of preparation and administration of anticancer drugs, widen the network of clinical pharmacists, use external drug compounding, thoroughly manage the medical documents, introduce electronic control systems and improve the communication between medical workers. Talking about legal aspects, concept of medical error does not have any legal consolidation. Literature includes about 70 its definitions. In case of a complaint of patient or his/her relatives healthcare workers will be asked such questions: whether the diagnostics of the patient was complete, whether the diagnosis was correct and timely made, what are the causes of the unfavorable outcomes, is there any direct causative link between healthcare workers’ actions and these outcomes, whether there was any standards’ violations. In general, vague criteria of standardization of medical care decrease the level of legal protection of both patients and healthcare workers. Conclusions. 1. Medical errors are quite often, but their exact incidence can’t be established. 2. Medical errors in oncology have some peculiarities because of the peculiarities of tumor treatment. 3. With the aim of prevention of medical errors in oncology we must implement the treatment standards and local protocols, control technics of preparation and administration of anticancer drugs, widen the network of clinical pharmacists, use external drug compounding, thoroughly manage the medical documents, introduce electronic control systems and improve the communication.

A plea for extension of the anatomical nomenclature: Vessels

This article is the fourth and last part of a series aimed at extending and correcting the anatomical nomenclature. Because of the rapid development of internet and the use of electronic formats in communication in anatomy, embryology, histology, medical education and clinical medicine, an appropriate, precise and concise anatomical nomenclature is required. Such tool enables to avoid any potential confusion and possible scientific/medical mistakes. The up-to-date official anatomical terminology, Terminologia Anatomica, is available longer than 20 years and needs to be refined and extended. The authors have collected and listed 210 terms and completed them with definitions and/or explanations. We aimed to start a discussion about their potential incorporation into the new revised version of the Terminologia Anatomica. This article is primarily focused on the vessels of the human body (arteries, veins and lymphatic system).

Medical mistakes in the dental practice: a view from the inside

The purpose of the study was revealing the subjective opinion of doctors of various dental medical specialties about the experience of making medical mistakes. Methods: a single semi-structured interview method, qualitative deductive content analysis of the content of recorded interviews for encoding and categorizing text units using the OpenCode 4.02 program. Results: it was found that all respondents associated the concept of "medical mistake" with incorrect actions or inaction of the doctor, which led to negative consequences in the treatment of the patient. Thirty percent of respondents admitted to making manipulative and diagnostic mistakes in their dental practice. Analysis and ranking of factors indicated by dentists to commit a medical mistake showed that these are 1) objective factors of a subjective nature related to the personal characteristics of the doctor: insufficient knowledge and lack of experience, fatigue, arrogance; 2) objective factors related to the shortcomings of the organization of dental care in a medical institution; 3) objective factors of a subjective nature related to individual characteristics of patients. Conclusions: Continuous improvement of the training system for future dentists, residents, and doctors based on modern achievements in the field of dentistry, as well as the widespread use of simulation technologies for practicing manipulative skills, and the introduction of the "standardized patient" method for developing communication skills in order to effectively interact with patients are preventive measures aimed at preventing medical mistakes in dental practice. Awareness of the factors of medical mistakes and their analysis at the personal level will minimize their number and, consequently, improve the quality of dental care provided to the population.

Medical negligence and likely developments in Oman

Medical mistakes can never be eliminated but they can be minimised. From the world of aviation, it is clear that simulation training can have dramatic beneficial effects. Such training, however, is compulsory. In contrast, in the world of medicine there are few countries which have adopted a comparable approach. Unless continued medical registration is directly linked to satisfactory performance in simulated exercises and real events, it is unlikely that significant reductions will be achieved. This review will concentrate on the situation where mistakes and their mismanagement have direct and adverse consequences for patients. It will not be concerned with the recognised complications of procedures and treatments, with the exceptions of poor communication where patients have entered into treatments unaware of the associated risks.