20 Tips to Help Prevent Medical Errors

Adapted from a Patient Fact Sheet. AHRQ Publication No. 02-P034, September 2002. Agency for Healthcare Research and Quality, Rockville, MD. www.ahrq.gov. Click here to print or download the pdf file.

Medical errors are one of the leading causes of death and injury. Rates of medication errors and adverse drug events for hospitalized children were comparable to rates for hospitalized adults in a 2001 study in the Journal of the American Medical Association. However, the rate for potential adverse drug events was three times higher in children, and substantially higher still for babies in neonatal intensive care units. Studies of medical errors outside the hospital are just getting underway.

This fact sheet is intended to help parents help their children avoid medical errors. It is good advice for any patient and their partner or advocate.

What are Medical Errors?

Medical errors happen 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. A 1999 report by the Institute of Medicine estimates that as many as 44,000 to 98,000 people die in U.S. hospitals each year as the result of medical errors.

Medical errors can occur anywhere in the health care system: Hospitals, Clinics, Outpatient Surgery Centers, Doctors’ Offices, Pharmacies, and Patients’ Homes.

Errors can involve Medicines, Surgery, Diagnosis, Equipment, and Lab Reports.

Most errors result from problems created by today’s complex health care system. But errors also happen when doctors and their patients have problems communicating. For example, a study supported by the Agency for Healthcare Research and Quality (AHRQ) found that doctors often do not do enough to help their patients make informed decisions. Uninvolved and uninformed patients are less likely to accept the doctor’s choice of treatment and less likely to do what they need to do to make the treatment work.

What Can You Do?

Be Involved in Your Child’s Health Care

1. The single most important way you can help to prevent errors is to be an active member of your child’s health care team. That means taking part in every decision about your child’s health care. Research shows that parents who are more involved with their child’s care tend to get better results. Some specific tips, based on the latest scientific evidence about what works best, follow.

Medicines

2. Make sure that all of your child’s doctors know about everything your child is taking and his or her weight. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.

At least once a year, bring all of your child’s medicines and supplements with you to the doctor. “Brown bagging” your child’s medicines can help you and your doctor talk about them and find out if there are any problems. Knowing your child’s medication history and weight can help your doctor keep your child’s records up to date, which can help your child get better quality care.

3. Make sure your child’s doctor knows about any allergies and how your child reacts to medicines. This can help you avoid getting a medicine that can harm your child.

4. When your child’s doctor writes you a prescription, make sure you can read it. If you can’t read the doctor’s handwriting, your pharmacist might not be able to either. Ask the doctor to use block letters to print the name of the drug.

5. When you pick up your child’s medicine from the pharmacy, ask: Is this the medicine that my child’s doctor prescribed? A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.

6. Ask for information about your child’s medicines in terms you can understand--both when the medicines are prescribed and when you receive them at the hospital or pharmacy.

• What is the name of the medicine?
• What is the medicine for?
• Is the dose of this medicine appropriate for my child based on his or her weight?
• How often is my child supposed to take it, and for how long?
• What side effects are likely? What do I do if they occur?
• Is this medicine safe for my child to take with other medicines or dietary supplements?
• What food, drink, or activities should my child avoid while taking this medicine?
• Is the dose of this medicine appropriate for my child based on his or her weight?
• When should I see an improvement?

7. If you have any questions about the directions on your child’s medicine labels, ask. Medicine labels can be hard to understand. For example, ask if “four doses daily” means taking a dose every 6 hours around the clock or just during regular waking hours.

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

9. Ask for written information about the side effects your child’s medicine could cause.
If you know what might happen, you will be better prepared if it does--or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines can help people recognize problem side effects. If your child experiences side effects, alert the doctor and pharmacist right away.

Hospital Stays

10. If you have a choice, choose a hospital at which many children have the procedure or surgery your child needs. 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. Find out how many of the procedures have been performed at the hospital. While your child is in the hospital, make sure he or she is always wearing an identification bracelet.

11. If your child is in the hospital, ask all health care workers who have direct contact with your child whether they have washed their hands.

Handwashing is an important way to prevent the spread of infections in hospitals. Yet, it is not done regularly or thoroughly enough. A study found that when patients checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.

12. When your child is being discharged from the hospital, ask his or her doctor to explain the treatment plan you will use at home.

This includes learning about your child’s medicines and finding out when he or she can get back to regular activities. Research shows that at discharge time, doctors think people understand more than they really do about what they should or should not do when they return home.

Surgery

13. If your child is having surgery, make sure that you, your child’s doctor, and the 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. The good news is that wrong-site surgery is 100 percent preventable. The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery.

Other Steps You Can Take

14. Speak up if you have questions or concerns. You have a right to question anyone who is involved with your child’s care.

15. Make sure that you know who (such as your child’s pediatrician) is in charge of his or her care.

This is especially important if your child has many health problems or is in a hospital.

16. Make sure that all health professionals involved in your child’s care have important health information about him or her.

Do not assume that everyone knows everything they need to. Don’t be afraid to speak up.

17. Ask a family member or friend to be there with you and to be your advocate. Choose someone who can help get things done and speak up for you if you can’t.

18. Ask why each test or procedure is being done. It is a good idea to find out why a test or treatment is needed and how it can help. Your child could be better off without it.

19. If your child has a test, ask when the results will be available. If you don’t hear from the doctor or the lab, call to ask about the test results.

20. Learn about your child’s condition and treatments by asking the doctor and nurse and by using other reliable sources.

Ask your child’s doctor if his or her treatment is based on the latest scientific evidence. For example, treatment recommendations based on the latest scientific evidence are available from the National Guideline Clearinghouse™ or other Web sites such as healthfinder® at http://www.healthfinder.gov.

As printed in the VHL Family Forum 13:1, April 2005. For permission to reprint, please contact VHL Family Alliance, editor@vhl.org. Further information is available from the VHL Family Alliance, info@vhl.org.