According to an alarming study, medication errors and unwanted side effects occur in 1 out of 2 surgical procedures.
The research was conducted by experts at the Harvard Medical School of Boston, who reviewed 277 surgeries which had taken place at the prestigious Massachusetts General Hospital (MGH) between November 2013 and June 2014.
The study’s aim was to quantify the prevalence and distribution of drug administration mistakes associated with surgical procedures, so that the clinic could take steps for reducing such incidents in the future.
As the lead researchers explained, this was the first time that an analysis was carried out on a large scale, in order to assess what occurs before, during and after surgery, when it comes to providing patients with their required treatment.
Previous studies had been much less objective, focusing on self-reported data provided by medical practitioners, who had identified very few errors during such procedures.
By comparison, in this case, medical charts were reviewed, covering periods of time when the subjects were in the pre-operative area, in the operating room and in the recovery room or intensive care unit.
The findings resulting from this assessment were published on October 25 in the journal Anesthesiology.
It was determined that 124 out of those 277 medical procedures involved at least one medication error or adverse drug event. In total, 3,675 drugs had been administered during these interventions, and on 193 instances medical staff took questionable steps, instead of ensuring the patient’s safety at all times.
Two thirds of these mistakes were considered to be “serious”, 2% as “life-threatening” (although no deaths were reported), and the rest were rated as “significant”. More than one third of them eventually caused harm to the patient, such as post-surgery infections or changes in vital signs, the study has revealed.
For example, researchers identified cases when drugs had been labelled incorrectly, when the recommended dosage wasn’t respected, or when records regarding medication administration weren’t kept accurately.
Moreover, study authors also discovered several incidents when medical staff failed to make the proper adjustments when the patient’s vital signs were perturbed during operation.
Even more strikingly, it appears that just 20% of the errors were unavoidable, such as adverse reactions caused by previously unreported drug allergies.
On the other hand, approximately 80% of the mistakes committed by medical staff could have been prevented, and tended to be more frequent during longer operations, according to the study authors.
No matter how disconcerting the results may be, researchers haven’t found them particularly surprising, although they admit there is plenty of room for improvement.
In fact, they warn that the situation might actually be much worse in other hospitals, since the institution included in the study is actually an elite medical center.
“It’s very likely that this issue is even more problematic, given that Mass General is a national leader in patient safety, and has gone out of his way to study this issue in order to improve outcomes”, explained study author Dr. Karen Nanji, assistant professor of anesthesia at Harvard Medical School.
As Nanji explained, surgical operations sometimes require quick decision making, and taking action without extremely careful consideration, because time is of the essence in such cases.
As a result, the hospital’s strict safety guidelines are sometimes breached, and few prescriptions are double-checked, which can have life-threatening, even deadly consequences.
The importance of this study lies in raising awareness regarding such incidents, so that hospitals can prevent them from occurring, by monitoring such procedures more carefully, with the help of automatic systems.
In such matters of life and death, no human errors can be qualified as acceptable, and ensuring the patient’s safety and recovery is of paramount importance.
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