Higher error in certain groups? II

Ross Koppel rkoppel at SAS.UPENN.EDU
Sun Oct 5 17:16:09 UTC 2014


No one could possibly know for the reasons previously noted.   BUT:     
One almost universal indicator, however, is available:  Pharmacists in 
teaching hospitals routinely stop/refuse about 4% to 5% of all orders 
(made by young docs).


Ross Koppel, Ph.D. FACMI
Sociology Dept and Sch. of Medicine
Senior Fellow, LDI, Wharton
University of Pennsylvania, Phila, PA 19104-6299
215 576 8221 C: 215 518 0134

On 10/2/2014 7:37 PM, Robert Bell wrote:
> What is the error rate from the pharmacy on the finally ordered 
> medications in your teaching hospital. Has that been studied?
>
> Robert
>
> Sent from my iPad
>
> On Sep 30, 2014, at 9:10 PM, Ross Koppel <rkoppel at SAS.UPENN.EDU 
> <mailto:rkoppel at SAS.UPENN.EDU>> wrote:
>
>> Follow up to previous email
>>
>> I forgot to mention why the orders were stopped  (and remember this 
>> is a teaching hospital):
>>
>> pharmacists called the young docs
>> senior docs or colleagues questioned them
>> nurses questioned them
>> they thought about it some more
>> they got a lab or other result that suggested another 
>> approach/idea/drug.   (Note about this one:  We hypothesized that 
>> older/more experienced docs would not be so quick to order if they 
>> knew a lab result was coming.  We've never fully studied that hy, but 
>> every more experienced doc we discussed it with loved the hy).
>>
>> Note:  We did not count orders stopped within one minute or so.  That 
>> was the fat finger grace period.
>>
>> Ross Koppel, Ph.D. FACMI
>> Sociology Dept and Sch. of Medicine
>> Senior Fellow, LDI, Wharton
>> University of Pennsylvania, Phila, PA 19104-6299
>> 215 576 8221 C: 215 518 0134
>> On 9/30/2014 5:20 PM, Robert Bell wrote:
>>> Following up on Ross' comments, coud I ask members of the list, what 
>>> are the top three things each would like to see happen to 
>>> significantly reduce the deaths and injury that occur with medical 
>>> errors (including diagnostic). I have the idea that having a 
>>> priority ranked shopping list of the agreed upon things to start 
>>> doing would advance the discussion from where it currently rests.
>>>
>>> Most seem to agree that we are not making much progress. How can we 
>>> change this?
>>>
>>> Robert Bell, M.D.
>>>
>>>
>>>
>>>
>>> ------------------------------------------------------------------------
>>> *From: * Ross Koppel <rkoppel at SAS.UPENN.EDU 
>>> <mailto:rkoppel at SAS.UPENN.EDU>>;
>>> *To: * <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
>>> <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>;
>>> *Subject: * Re: [IMPROVEDX] Higher error in certain groups?
>>> *Sent: * Tue, Sep 30, 2014 1:03:15 AM
>>>
>>> Rob,     You are making two points....and I'm not sure either 
>>> disagrees with anything I said.
>>>
>>> 1. We need the numbers.  All agree.  I would add that:
>>>
>>>     We are probably missing 98% of medication errors.
>>>     We have excellent data on wrong site surgery and wrong patient 
>>> surgery
>>>     We have terrible data on wrong patient errors involving 
>>> meds....for prescribing, dispensing and administration
>>>     We have bad data on Dx errors.... but at least one can get a 
>>> sort of handle on them if one follows the trajectory of the patient 
>>> over a long time.
>>> But, yes, we need the numbers and they are hard to get.
>>>
>>> 2. Your observations of errors you notice with any of your contacts 
>>> with the medical profession:  I argue that the errors you observe -- 
>>> while apparently quite high -- are much lower than what the average 
>>> patient undergoes.  On the most trivial level, you are literate and 
>>> you speak English.  On a higher level, they know you're a doc and 
>>> don't want to screw up.  Most patients, even if we gave them a 
>>> digital recorder, would be unable to identify the vast majority of 
>>> errors to which they are subjected.
>>>
>>> Heck, I wrote one of the major papers on workarounds to barcode 
>>> medication admin. Last month I was in the hospital ED for a bad dog 
>>> attack.  They gave me the wrist band of a Mr. Thomas Keller, born 
>>> 1977  (may have been 1971.... I can't remember).
>>>
>>> If you are saying you see many errors all the time:  Then yes, 
>>> absolutely.  If you are saying Docs face more errors than the avg 
>>> patient, then I disagree.
>>>
>>> NOTE:  Many, Many errors are caught and stopped before they harm 
>>> patients.  And much of the harm that does get through is low level.
>>>
>>> Ross
>>>
>>> Ross Koppel, Ph.D. FACMI
>>> Sociology Dept and Sch. of Medicine
>>> Senior Fellow, LDI, Wharton
>>> University of Pennsylvania, Phila, PA 19104-6299
>>> 215 576 8221 C: 215 518 0134
>>> On 9/29/2014 8:10 PM, Robert Bell wrote:
>>>> Ross, that has not been my general experience over 40 years. But I 
>>>> have no way of proving it.
>>>>
>>>> There is hardly a contact that I have with the medical profession 
>>>> that is not associated with some big or small problem, be it the 
>>>> wrong doctor's name on a urine specimen, lack of communication in a 
>>>> doctor's office (telling the staff you are there in the waiting 
>>>> room) being given someone else's paperwork for labwork, having 
>>>> crossed leads on an EKG read by the physician as normal, surgery 
>>>> that has unexpected negative results, or missed serious diagnoses, 
>>>> etc. And yes, many good things have happened.
>>>>
>>>> Prior to a talk I gave to staff at a local hospital, I collected my 
>>>> own errors in every day life that I made. My definition of an error 
>>>> was something that truly annoyed me. Like leaving my car keys in 
>>>> the house when jumping into the car in the garage, or doing four 
>>>> shopping tasks but forgetting the fifth. I seem to remember that on 
>>>> one day I had 8, and the next day 6 such events.
>>>>
>>>> Keeping a list of errors, both small and large, that happen with 
>>>> each personal medical contact might be valuable!
>>>>
>>>> That is why the 440,000 figure for annual deaths, for me, could 
>>>> well be correct.
>>>>
>>>> But in all of this Ross, we need good figures, not guesses.
>>>>
>>>> How do we get that information? Can we move very far forward 
>>>> without it?
>>>>
>>>> Rob Bell, M.D.
>>>>
>>>> Sent from my iPad
>>>>
>>>> On Sep 29, 2014, at 5:40 AM, Ross Koppel <rkoppel at SAS.UPENN.EDU 
>>>> <mailto:rkoppel at SAS.UPENN.EDU>> wrote:
>>>>
>>>>> My guess is that health care professionals get better and safer 
>>>>> care than most patients, /in general/.  The perceived "higher 
>>>>> rates" of errors are a reflection of health care professionals 
>>>>> ability to notice errors that occur to many patients.
>>>>>
>>>>>
>>>>> Ross Koppel, Ph.D. FACMI
>>>>> Sociology Dept and Sch. of Medicine
>>>>> Senior Fellow, LDI, Wharton
>>>>> University of Pennsylvania, Phila, PA 19104-6299
>>>>> 215 576 8221 C: 215 518 0134
>>>>> On 9/28/2014 6:07 PM, Hoffer, Edward P.,M.D. wrote:
>>>>>> Anecdotes abound - doctors and nurses caring for health care professionals, particularly those they know and/or who work at their institution, often cut corners or avoid unpleasant procedures. While this is intended as kindness, it often means appropriate care is withheld.
>>>>>>
>>>>>> Whether anecdotes truly reflect reality, I have no way of knowing.
>>>>>>
>>>>>> Ed
>>>>>>
>>>>>> Edward P Hoffer MD, FACP
>>>>>>
>>>>>> ________________________________________
>>>>>> From: Teresa Graedon [terry.graedon at GMAIL.COM  <mailto:terry.graedon at GMAIL.COM>]
>>>>>> Sent: Sunday, September 28, 2014 9:30 AM
>>>>>> To:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG  <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>>>>>> Subject: Re: [IMPROVEDX] Higher error in certain groups?
>>>>>>
>>>>>> Robert,
>>>>>>
>>>>>> That is an interesting idea. How would it work?
>>>>>>
>>>>>> I suspect that HCPs are simply more likely to detect errors than less (health-care-) educated patients. I'd be interested in data, though, or a plan to gather the evidence.
>>>>>>
>>>>>> Terry Graedon, PhD
>>>>>> The People's Pharmacy
>>>>>>
>>>>>> On Sep 26, 2014, at 10:46 PM, Robert Bell<rmsbell at ESEDONA.NET  <mailto:rmsbell at ESEDONA.NET>> wrote:
>>>>>>
>>>>>>> I have the idea that HCPs, particularly physicians, are more like to be exposed to errors in medicine when they are patients.
>>>>>>>
>>>>>>> Is there any truth to this and, also are there other groups of patients that are more likely to be involved in errors when patients?
>>>>>>>
>>>>>>> Rob Bell, M.D.
>>>>>>>
>>>>>>> Sent from my iPad
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