Dr. G’s strategies to prevent medical errors

As a medical examiner, I discover during autopsies why some people die unexpectedly. A significant number die from mistakes made in the hospital. A report from the Institute of Medicine (part of the National Academy of Sciences) found that between 44,000 and 98,000 Americans die each year from medical errors made in hospitals. Some errors are hard to prevent, but many can be avoided by alert patients or their families.

Some of the main dangers — and how to prevent them…

DRUG MISTAKES

It is estimated that up to half of adverse drug reactions are caused by errors. Sometimes it’s the patient’s fault, such as neglecting to inform the hospital staff about a known allergy. Sometimes doctors aren’t as careful as they should be. A patient might be given a drug that is inappropriate for his/her condition — or given the right drug but the wrong dose. A “standard” dose isn’t necessarily the right dose.

Example: Older adults metabolize drugs slowly. A dose that’s safe for a 40-year-old might be too high for someone who is 65. A patient’s size also makes a difference. A large man will generally need a larger dose than a petite woman.

My advice: Tell the hospital staff about every supplement and drug that you’re taking, including over-the-counter medications. Better yet, bring a written list to the hospital.

Also, ask your doctor if drug doses should be adjusted for your body weight/metabolism. And confirm that you really need a particular drug. Sedatives, for example, frequently cause side effects, including increasing risk for falls, yet they are commonly prescribed to hospital patients who don’t really need them.

In addition, ask anyone who gives you a medication or intravenous infusion what it is for. This will make him/her think twice before administering it — which helps prevent errors.

INFECTION

This is the leading cause of unexpected hospital deaths. According to the Centers for Disease Control and Prevention (CDC), 1.7 million Americans suffer a health-care-related infection each year. An extremely virulent organism — methicillin-resistant Staphylococcus aureus (MRSA) — kills up to one in five hospital patients who get it.

My advice: Ask about a surgeon’s infection rates. Do this before choosing a surgeon. For “clean” procedures, such as a knee replacement, the infection rate should be 2% or less. Infection is more likely during “dirty” procedures, such as those involving the intestines. You always want the number to be as low as possible — less than 10%. Also…

Don’t let the staff touch you unless you’ve seen them washing their hands before putting on fresh gloves. Everyone should wash his hands as soon as he enters the room. If anyone doesn’t, ask him to do so.

Exercise your lungs. Bacterial pneumonia is common in hospitals. Up to 30% of patients placed on a ventilator develop pneumonia, and up to 50% of these patients die from it. Self-defense: Ask for an incentive spirometer, a tubelike device that increases bronchial pressure. This helps remove the mucus and fluids that bacteria need to proliferate. Also, walk as soon as possible, even if it is uncomfortable.

Avoid urinary catheters. They are the main cause of hospital urinary tract infections. If you can’t walk to the bathroom, ask if you can use a bedpan or wear diapers. Men can request a urinal or condom catheter, which slips over the penis and doesn’t require inserting a tube into the urethra.

DEEP-VEIN THROMBOSIS (DVT)

About 10% of hospital patients who stay in bed for a week and up to one-third of patients in intensive care units (ICUs) develop DVT, a life-threatening condition in which a blood clot in the leg can travel to the lungs and cause a pulmonary embolism (when an artery in the lung becomes blocked).

Immobility is the main cause of DVT. The risk is highest in hospital patients because tissue damage — either from surgery or underlying medical problems — increases the body’s production of clotting factors.

My advice: Before checking into the hospital, tell your doctor that you want to move around as soon as possible after your procedure. Simply flexing your legs and sitting up in bed can help prevent DVT. Walking is better?try to do it once an hour if your condition permits. Even if you’re in an ICU, ask the staff to help you stand up and walk. Also important: Ask for leg-compression devices. Known as “squeezers,” they are pneumatic devices that inflate and deflate at regular intervals to help prevent clotting.

SMOKING

Anyone who smokes should quit for at least six weeks before going into the hospital. Smoking increases the risk for pneumonia. It impairs your ability to breathe on your own after being on a mechanical ventilator during surgery. It also impedes healing.

My advice: If you can’t quit smoking on your own, talk to your doctor about stop-smoking aids, such as nicotine patches, or drugs, such as varenicline (Chantix). People who use these products have about twice the success rate of those who don’t.

FALLS

They’re among the leading causes of unexpected hospital deaths. The risk is higher if you’re taking sedatives, have recently had anesthesia or are taking multiple drugs, including laxatives and diuretics.

My advice: Don’t get out of bed without help even if you think you’re well enough to do so. Wear nonskid slippers when walking around your room or down the halls. Also important: Keep the bed rails raised and the bed low. Make sure the nurse’s call light is within reach. If you need to get up, call the nurse for assistance.

WITHHOLDING INFORMATION

No one likes feeling embarrassed. Men with chest pains, for example, may hesitate to admit that they have taken Viagra — which may be dangerous when combined with nitrate drugs used to treat chest pain.

It is common for alcoholics to say that they don’t drink. This is extremely risky. Alcoholics can die from withdrawal unless they’re given medications to prevent it and are carefully monitored.

My advice: Be sure to tell your doctor everything. Don’t withhold any information about drug use, alcohol abuse, etc.

Beware of New Drugs

The FDA has taken about a ­dozen drugs off the market in just the last 10 years. Medications that appear to be safe during the approval process can later turn out to have dangerous effects.

Example: The antibiotic gatifloxacin (Tequin), originally approved for respiratory infections, was later found to cause dangerous changes in blood sugar levels, resulting in the deaths of some patients. The deaths were especially tragic because most ­patients would have done just as well with older — and safer — drugs.

Most new drugs are tested on only a few thousand patients at most. If a drug causes a deadly reaction in, say, one in 20,000 patients, it might be years before the dangers become apparent.

Avoid any drug until it has been on the market for at least two years. That’s long enough for serious dangers to surface. (Of course, some patients benefit greatly from new, breakthrough drugs, but for most conditions, older drugs with proven safety profiles are equally effective.)