Nursing Notes

November 25, 2010

Despite Efforts, Study Finds No Decline in Medical Errors

When I first saw this article, I thought, “Yea! Someone is paying attention to what nurses are saying, finally!”  However, after reading the entire article, I was appalled to see that nursing was not mentioned one time.  The only medical personnel talked about were physicians and how overworked they are.

So, let’s look at this problem from another standpoint, please.  If you are sick enough to be hospitalized (and that means really, really sick), you will find yourself on a unit that is understaffed and overworked–no doubt about that.  You will share your RN with 6-7-8 other patients who are as sick or sicker than you.  You will be lucky to see your nurse for 15 minutes in the 8 hour shift when the RN does your assessment for the shift.  You will see the RN next whenever it is time for medications, but there will be little time for interaction other than about medications.  You will spend most of the day alone in your room watching television or sleeping because there is no one available to spend time helping you deal with your illness.  Your nurse will be available by call button, maybe.  Usually the call light will get you the aide.

If a nurse is caring for too many sick patients, there is no time to get to know the patient at all.  First, the lengths of stay have become so short that you hardly have time to learn everyone’s name.  Then, there is so much to do to take care of such a load of patients that you simply don’t have time to spend at the bedside.  Then, of course, there is the never ending charting to be done–everything you have done during your shift must be charted.  Your assessments must be charted; calls to physicians must be charted.  All orders need to be checked for correctness and carried out, then noted.  Don’t forget that while you are doing all of this, you will be discharging some patients and admitting others.  The beds MUST stay full!

I can certainly see why mistakes happen–honest mistakes that are made because you simply don’t have a minute to stop and think about what you are doing; because you have a list of 20 other things that are timed to be done at the same time and if not done then will be an error against you.

This is not whinning.  This is what happens for just about any nurse who works the floor today.  We are all clamouring for patient-to-nurse ratios so we can give safe patient care, not so we can have it easy.  We don’t do easy.

Please read this article and see if you feel as upset about it as I do.  This is from, and only part of it is below, so you will have to click over to read the rest.  I recommend that you do.  Maybe you could leave them a comment, too, while you are there.


But experts say some safety initiatives may take time to bring results

By Maureen Salamon
HealthDay Reporter

HealthDay/ScoutNews LLC

WEDNESDAY, Nov. 24 (HealthDay News) — Despite intensive efforts to improve patient safety, a six-year study at 10 North Carolina hospitals showed no decline in so-called patient “harms,” which included medical errors and unavoidable mistakes.

Sorting through patients’ medical records from more than 2,300 randomly selected hospital admissions, teams of reviewers found 588 instances of patient harm, which included events such as hospital-acquired infections, surgical errors and medication dosage mistakes.

While most harms were minor and temporary, 50 were life-threatening, 17 resulted in permanent problems and 14 people died, said the researchers, who selected North Carolina hospitals because the state has shown a strong commitment to patient safety. The admissions records spanned the period from January 2002 to December 2007.

Study author Dr. Christopher Landrigan said the results likely reflect what’s happening nationwide. A 1999 Institute of Medicine report publicizing high medical error rates spurred many U.S. hospitals to implement safety-promoting changes, but no uniform set of guidelines exists to direct facilities which changes to tackle, he said.

“What has been done right is that regulatory agencies have begun prioritizing patient safety,” said Landrigan, an assistant professor of pediatrics and medicine at Harvard Medical School. “But these efforts have largely been a patchwork of unconnected efforts and so far have not been as strong as they can be.”

Slightly more than half of the errors were avoidable, Landrigan said. They were detected by investigators who scanned patients’ charts for “trigger” events that suggested mistakes had occurred, such as a prescription for an anti-opioid drug that could remedy a morphine overdose.

The study, published in the Nov. 25 issue of the New England Journal of Medicine, is important because health-care professionals “really haven’t had a good sense of what’s going on with safety over time,” said Dr. David Bates, a professor of health policy and management at the Harvard School of Public Health, where he co-directs the program in clinical effectiveness.

“It’s very useful to have robust estimates of the frequency of harm over time in a relatively large sample,” said Bates, who also serves as medical director of clinical and quality analysis for Partners Healthcare System in Massachusetts and is associate editor of the Journal of Patient Safety….[read more]

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