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The spouse of a patient allergic to Heparin stops a nurse from flushing a catheter with the anticoagulant, possibly avoiding a serious or fatal reaction. The allergy had not been entered in the patient's chart.
A parent prevents a surgeon from removing a child's tonsils and adenoids. The child was to have had a polyp excised, but the surgeon's office had placed an incorrect reservation on the operating room schedule.
A patient's husband asks a nurse if the band around his wife's arm should be so tight. Two hours earlier, another nurse had forgotten to remove the tourniquet when inserting an IV.
Hundreds of such reports were submitted to the Pennsylvania Patient Safety Reporting System over a six-month period. “Patients and family members who speak up about patient-care issues have not only identified medical errors but have also prevented errors and injuries,” according to the Pennsylvania Patient Safety Authority, which created the reporting system.
Campaigns now exist to recruit patients and family members as watchdogs to ensure safe care. In 2000, the federal Agency for Healthcare Research and Quality (AHRQ) created a fact sheet for consumers called “20 Tips to Help Prevent Medical Errors”, and the private Joint Commission, which accredits hospitals, in 2002 launched its Speak Up initiative to encourage patients to be vigilant. But some experts think such campaigns ask too much of sick patients and stressed family members and might actually do more harm than good. And patients are not always willing.
Both the AHRQ and Joint Commission urge patients to ask health care providers if they have washed their hands, and the Joint Commission suggests asking if they should be wearing gloves. Hospital-acquired infections are a major problem in health care, and hand washing is the primary preventive. Yet studies show that nurses, physicians and other health care workers wash their hands far less frequently than is recommended. Patients are also encouraged to confirm their identity with surgeons before an operation, along with the body part being operated on.
While surveys show that patients are often willing to ask for more information, they are less inclined to engage in behaviors they perceive as challenging doctors and nurses. For example, people in one survey were quite willing to ask for an explanation of something they didn't understand or to ask the reason for a hospital procedure, but they were much less willing to ask health care providers about washed hands or whether they had the right patient before a procedure. Researchers recommend educating physicians and nurses about the value of patient participation so they will accept questions and concerns raised by patients and encourage patients to speak up. Researchers also recommend that patients themselves be educated about the value of their contributions.
But some experts don't believe this kind of patient participation is worthy of long-term investment and instead should be seen as a sporadic, unexpected source of help in reducing medical errors. According to Melinda Lyons, an engineer specializing in the study of human capabilities in Great Britain, all patients are not equally suited to the role of safety watchdog because of their varying ages, cultures, backgrounds, personalities, levels of intelligence and languages.
In addition, it's unreasonable to burden patients suffering from fatigue, stress, pain or discomfort with additional responsibilities when any other industry would consider someone suffering from even one of those factors “too high risk to be trusted with any critical decisions,” said Lyons.
Lyons also worried that clinicians and hospitals, in an effort to save time and costs, could try to inappropriately shift the safety burden to patients and that clinicians could be lulled into a false sense of security if they view patients as a reliable backup to catch errors.
In fact, the Pennsylvania Patient Safety Reporting System received many reports of health care providers accepting a patient's word too hastily. In one case, an anesthesiologist asked a patient if she was having surgery on her left shoulder, to which the patient replied, “Yes.” After the anesthesiologist administered a local anesthetic to that shoulder, the nurse informed the anesthesiologist that it was the right shoulder being operated on.
That error, and others like it, could have been prevented if the entire team had marked the surgical site beforehand, a standard practice in some hospitals.
— Barbara Mantel
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