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Approaches for Reducing Medical Errors
In retrospect, it is apparent that the healthcare setting is shifting from the traditional practice to evidence based practice which is characterized by safety and quality of care. As such, the paradigm of evidence based practice seems to identify the twenty-first century healthcare profession as an evolved version of the historical practice. Despite the observed changes in professionalism and conceptionalization of practice, an array of clinical issues that compromise patients’ safety and treatment outcomes continue to be witnessed. One of the most common clinical issues that I have witnessed both in clinical placement and laboratory simulations is the issue of medical errors. It is quite surprising that this clinical issue has become highly pronounced across the continuum of care setting, ranging from medical diagnosis to nursing interventions. According to Grober and Bohnen (2005), medical errors have become a significant challenge in public health and their threat to patient’s safety raises concern. From a theoretical perspective, medical error bears different definitions. Currently, there is no standardized nomenclature for medical error’s definition. However, some few studies have investigated ‘medical error’ directly and proposed universally acceptable definitions of this phenomenon. In general, medical error can be defined as any action that can result to adverse patient outcomes (Hofer & Hayward 2000). Based on the principle of evidence based practice, medical error has an immense relevance to contemporary nursing practice. The clinical rationale for this perspective is based on the fact that nurses are at the central point of patients’ care. They are required to carry out nursing interventions in the course of care where their actions are defined by various clinical and nursing standards. As such, nurses play an integral role in determining patient outcomes. This demonstrates how medical errors impact the nursing practice, more than any other field in healthcare setting.
Over the decades, the issue of medical errors has been studied extensively to understand its underlying aspects. Foremost, it impact on patient safety has attracted an extensive clinical inquiry. In one prospective study which was carried out by Ker et al. (2010), about 850, 000 medical errors occur in the United Kingdom, annually, accounting for a cost of over £2 billion. These findings were based on the 2000 study that sought to investigate the extent of the issue and its cost impact to the UK healthcare system. Elsewhere in the United States, the 2000 Institute of Medicine’s report revealed that medical errors account for approximately 98,000 deaths that could be prevented. They also result into about 1 million excess injuries to patients, annually. These findings were consistent with those of Weingart et al. (2000) that investigated the epidemiological trends of medical error within the US healthcare system. Following these findings, Hofer and Hayward (2001) carried out a prospective study in seven medical centers within the Department of Veteran Affairs and reported that one in every 10,000 patients died as a result of failure to by healthcare personnel to provide optimal care. Overall, a recent study has revealed that medical error causes over 250,000 deaths in the US, annually. As such, it is apparent that medical error ranks third among the leading causes of death in the country with 9.5% share (Makary & Michael 2016).
Additionally, forms of errors have been studied and documented in which prescribing errors, diagnostic errors and surgical errors have been reported as the most common forms of errors. Eldar (2002) notes failure to the right drug at the right time as one of causes of medical errors. He provides example with prescribing antipsychotics for delusions or valproate to a pregnant woman, all of which lead to adverse patient outcomes. On the other hand, surgical errors have been found to be responsible for surgical complications. Healey et al. (2002) investigated surgical complication rates for cardio-thoracic surgery, general surgery, trauma, and vascular surgery in a University teaching hospital and found out that approximately 50% of adverse events were preventable.
Causes of medical errors have also been studied extensively in an effort to develop appropriate mitigation measures, especially through evidence based practice and healthcare management. Overall, Palmieri et al. (2008) note practitioners’ incompetence, poor practice guidelines, inconsistent processes, and system failures as the main causes of medical errors. Regarding process design, poor communication among healthcare teams has been identified as the leading cause of medical errors. According to the 2007 report by the Joint Commission on Quality and Safety, over 50% of adverse events were found to be caused by poor communication between healthcare teams, and healthcare personnel and patients or family members. However, leadership was also found to underlie inadequate communication in hospitals. On the other hand, competency of healthcare providers, especially based on education and training are other causes of medical errors. Neale, Woloshynowych and Vincent (2001) identified variations in experience and training among healthcare personnel as a significant cause of medical errors. In another case study which was analyzed by Henneman (2007), medical errors are enhanced by the failure to acknowledge their consequences by healthcare professionals. Recently, Phillips and Barker (2010) released their findings on the effect of residency in teaching hospitals based on a systematic review of literature and concluded that the July influx of new residents coincides with an significant increase of medical errors. Finally, human factors such as sleep deprivation and fatigue among healthcare providers contribute to medical errors. Sleep deprivation has been identified as a key contributory factor to medical errors. For instance, poor performance by surgeons has been found to have significant correlation with night shifts (Ker et al. 2010). These findings were consistent with those obtained by Barger et al. (2006) who investigated the effect of shift extension on medical errors, attentional failures and adverse events. They concluded that shift extension among medical interns was associated with a two to three-fold increase of preventable medical errors.
Nursing leadership has significant impact on the prevention of medical errors. In practice, nursing interventions play instrumental roles in determining patient outcomes. This implies that effective nursing leadership can influence patient safety, especially with regard to the prevention of medical errors. However, nursing leadership has always been experiencing challenges. This aspect is attributable to the fact that most nurses are not willing to take leadership roles as part of their career. According to the 2010 Institute of Medicine’s report, a majority of nurses in the US healthcare system do not have interest in taking leadership responsibilities (IOM 2010). As such, leadership barriers in nursing practice seem to have immense consequences, including medical errors arising from nursing care. This is why IOM (2010) recommends changes in nursing leadership, in order to ensure that nurses are competent to take leadership roles.
Ideally, transformative leadership, also referred to as servant leadership may address an array of clinical issues within the healthcare system. For instance, transformative leadership is characterized by a collective decision making process on leadership. As such, it can change the way nurses operate and ensure appropriate measures for improving patient safety through reducing medical errors. Second, transformative leadership ensures cooperation by employees to set objectives. In this context, nurses’ motivation and job satisfaction can ensure that they execute their caring duties in diligence and passion. This way, chances of medical errors can be minimized. On the other hand, transformative leadership enhances teamwork. As such, all members of the team work towards a common objective in the interest of the team. This implies that the adoption of this leadership strategy can enhance nurse-nurse relations and coordination in the course of duty. In this context, adequate nurse-nurse coordination provides an opportunity for identifying medical errors in a timely manner before they lead to adverse events. Additionally, transformative leadership can influence the way nurses exercise their authority at the workplace. Break in the chain of command has always been a significant issue in nursing practice. For instance, delegation of duties to the nursing staff by nurse administrators faces a challenge where nurses are resistant to leadership. This implies that nursing processes are not executed, appropriately, and this may result into poor patient outcomes. Therefore, transformative leadership ensures efficient and effective delegation of duties, as well as, fostering a sense of responsibility. Finally, transformative leadership is associated with effective communication among employees. As such, it can address the issue of poor communication among nursing staff, which has been identified as one of the main causes of medical errors.
From the perspective of evidence based nursing practice, medical errors can be prevented through various approaches. Currently, there are two main medical error prevention models; Root Cause Analysis (RCA) and Healthcare Failure Mode and Effects Analysis (HFMEA). HFMEA provides a systematic approach for identifying process failures before their occurrence, as well as clinical risk management approaches (DeRosier et al. 2002). On the other hand, RCA provides a systematic approach for investigating the underlying factors leading to an adverse event (Pietra et al. 2005).
Conclusively, medical errors have emerged as one of the main clinical issues impacting on patient safety and healthcare practice, in general. The fact that medical errors account for 9.5% of all deaths in the US suggest the need for mitigation measures. Overall, medical errors have a significant impact on the nursing practice. Therefore, appropriate measures, including training and changes in nursing leadership seem necessary. In this context, transformative is ideal in reducing medical errors among nurses. The managerial rationale is based on the fact that transformative leadership enhances teamwork, delegation of duties, communication, and efficient implementation of change strategies. This implies that its adoption in the nursing profession can reduce medical errors by nurses.