High-Risk Incident


Medicine has always been a very specific area of social service and errors made by doctors can lead to irretrievable outcomes. In 1999, the Institute of Medicine has reported that from 44,000 to 98,000 people die each year because of medical errors that could have been avoided (Wachter, 2012). Over the last decade, the levels of mortality from medical errors have increased. Estimated medical rating company, held by Health Grades in 2004 showed that more than 190 thousand people died because of medical errors. Hearst Newspapers noted in 2009 that the number of deaths because of medical errors has already reached 200,000.

Unfortunately, in many countries, health workers tend to hide information about their mistakes. It happens because this information has traditionally been used for punishment. Open discussion of medical errors in order to detect and eliminate their causes can only be possible through a change in the culture of professional activity and greater openness towards patients (James, 2013).

The threats of medical maltreatment and the increasing number of high-risk incidents have made doctors and patients reconsider the principal approach to patient safety. Trust and collaboration, computerization of diagnosis results and disease history have made possible to create more transparent system of health service delivery. Although the cases of medical negligence are still frequent, the process of treatment has become open for discussion and analysis.

The paper focuses on the problem of the high-risk incidence prevention and the perception of the modern approach to patient safety and reveals the necessity of active patient participation in the processes of diagnosis, treatment and post-recovery stage.

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Types of Errors

Medical mistake is often understood as actions (inaction) of a doctor, having at its core the imperfection of modern medical science, objective working conditions, lack of skills, or inability to use the available knowledge. Mistakes can be classified as errors in cases of intended medical maltreatment, negligence or guilt evidence.

In modern understanding of patients safety, there is a common approach to the classification of medical mistakes in accordance with the possible preventable and non-preventable adverse events. The term preventable adverse event is preferred to error in the patients safety field as it includes cases when a mistake takes place and has undesired consequences. Medical errors do not necessary lead to adverse events but can have signs of evil will (Wachter, 2012). Another term for medical error is a high-risk incident. This term implies the responsibility both from the doctor and the patient. Recovery is a joint purpose of a responsible collaboration of the patient and the doctor. Trust and positive attitude can greatly contribute to the process of treatment, and the term error implies guilt from one of the parts.

It is necessary to distinguish between intentional illegal acts of health workers and cases of harm to the patient in the absence of guilt. In the first case, the offense or maltreatment entails criminal, disciplinary or civil liability. In the second case, the responsibility is missed. Legal responsibility does not occur if the medical staff did not foresee and could not have foreseen that their actions would cause harm to the health of the patient. However, the practice of unpunished medical errors does not mean entitlement to damage health (Wachter, 2012). Medicine is obliged to assist the patient in all cases, guided by aspiration for a favorable outcome, not hiding behind the concept of high-risk incident, and trying to eliminate it in every individual case.

Medical errors and high-risk incidents can be divided into the following types:

1. Refusal of a medical worker to provide assistance to a patient.

2. Errors in diagnosis of disease identification.

3. Inadequate medical care.

4. Violation of the rights of patients.

5. Errors in examinations of temporary disability.

6. Failure of sanitary and epidemic regime.

7. Inappropriate storage and use of medicines.

8. Violation of safety techniques.

9. Abnormalities in the process of patients transportation (Wachter, 2012).

Among the reasons for the increasing number of high-risk incidents are new health care standards, including invasive technologies, and the lack of highly qualified medical personnel. The amount of medical information is so great that it cannot be metabolized by one person. The number of known diseases exceeds 10 thousand, and there are over 100 thousand symptoms and syndromes.

Review of the Professional Literature

In order to determine negligence, the U.S. Supreme Court requires the expert to justify its features such as a significant lack of knowledge, care, special indifference to patient safety due to ignorance in choosing the means of diagnosis and treatment or lack of professional equipment. Commentary to the American Criminal Code and guidance on criminal law define criminal negligence as a situation of ignoring the substantial undue risk of which the subject could be unaware, although he/she should have known. Criminal negligence or recklessness is defined as a situation of ignoring the substantial undue risk, when the subject knew about it, consciously ignored and continued dangerous behavior (Davis, 2012).

In several states in the USA, physicians have to take part in training courses to reduce the high-risk of incidents when they want to obtain a license. Alternative ideology of corporatism and defensive medicine is the desire of the medical community to explore and explain to the population that an unfavorable outcome is possible even in cases with a perfect doctor and ideal conditions, as well as to other work in the spirit of cooperation with the patient (Ohrn, 2011).

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Safety and quality are essential components of care that are determined by many factors, including the level of modern medical technology and the skills of health workers.

In many developed countries, the practice of professional liability insurance is widely used for presentation of civil lawsuits to doctors with the requirements of monetary compensation for damages. Naturally, general practitioner is unable to pay compensation, reaching sufficiently large amounts. Therefore, developed countries widely use various insurance medical malpractices (Ohrn, 2011).

Increased spending on medical insurance of professional responsibility entailed the rise in health care and the development of so-called defensive medicine. To avoid prosecution in the case of failure, the doctors began to abandon the use of techniques associated with a significant risk, even in cases where such a risk was necessary. At the same time, they began to abuse the purpose of expensive procedures and tests to protect themselves from accusations of a lack of care to the patient (Davis, 2012).

The question of who will pay compensation becomes more and more urgent. It can be health care provider or insurance company, the social insurance funds or compensation for damages to patients, funded by contributions from physicians and (or) of the patients, or the state.

The debate about compensation for damages is always associated with a fairly complicated and lengthy procedure of the trial and emotional stress both to the patient (plaintiff) and the medical officer (defendant). The provision of legal and forensic assessment of adverse outcomes of care shows that in 33-58% of cases of dissatisfaction with the patient medical care, the subsequent examination of medical care is assessed as adequate (Davis, 2012). At the same time, many of these incidents could have been avoided, freeing staff of health facilities from unproductive conflict resolution in court, and forensic experts from complex, costly procedures.

Patient Safety Action Plan

In order to avoid the high-risk incidents, the patient should develop his/her own Patient Safety Action Plan that will define the results of his/her treatment. This plan should not only fulfill treatment goals, but also create trustworthy relationships of a patient with nurses and doctors. Patient Safety Action Plan should be based on the following points:

1. Consulting in several healthcare organizations. This approach presupposes a full consultation and diagnostics to define the disease and its treatment. A patient should be ready to any examining and diagnostics. If a patient doubts the reputation of the healthcare organization or a doctor, he/she should not give up and consult and seek consultation elsewhere. If a patient doubts in his/her diagnosis he or she can always approve or deny it at another doctor.

2. Providing an open communication. In order to obtain qualitative treatment and avoid the high-risk incidents, a patient should be open and sincere in answering the questions even if these questions may sound not ethical. Communication is one of the ways to find a common language with nurses. The patient should not be scared of any kind of questions as they are put in order to help him/her.

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3. Readiness to new programs of treatment. The patient should not be scared of new programs of treatment as they can be more efficient and quick in curing (James, 2013).

4. Providing nurses with information about their state and recovery process. Nurses should know everything about patients state and recovery process as this information will benefit the treatment process. Besides, it will create a good understanding and trust between doctor and patient. Insufficient information can provoke misunderstanding and high-risk incidents. Providing nurses with information about patient's state and recovery process will help to avoid medical errors as a patient should also be an active participant of a treatment process (James, 2013).

5. Development of ethical relationships. Patients should be polite and ethical when communicating with nurses thus creating a friendly atmosphere and decreasing tension between them.

6. Avoiding high-risk incidents. There are some universal steps and strategies which can help to avoid high-risk incidents. Patients should be active and interested in the treatment outcome and try to understand all that relates to their health. Only conscious, informed decisions yield good results. Patients should name the doctor all medications and dietary supplements, which the patient is taking. It will help to avoid the wrong prescription. Some drugs do not mix with each other and may reduce or increase the effects of other medicines (Wachter, 2012).

7. Financial availability of medical service is one more problem which affects the outcome of treatment. Sometimes people can get bankrupt trying to get the necessary medical aid. Patients should remember that appointment of additional tests or drugs does not mean that they are really needed. When a patient is prescribed some medicine he or she should ask the doctor how it will affect the treatment. It is necessary to take analyses in different independent laboratories when there is a threat of serious disease. Patients should gather information about their illness and its treatment methods. They should consult independent specialists, speak out the problem to the relatives and use other available sources.

8. Avoiding of self-treatment. Self-treatment is not a recommended way of treatment. The patient should always consult with a doctor in order to avoid high-risk incidents.

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