Don't forget to tap a major safety resource: your patients
From the June ACP Observer, copyright © 2003 by the American
College of Physicians.
By Bonnie Darves
SAN DIEGO—As efforts to improve patient safety continue to heat up,
many physicians overlook a major safety-improvement resource: their own
patients.
The need to boost patients' vigilance against potential errors is
particularly critical in ambulatory settings, where poor communication "is
a major cause of 'latent errors,'" said Robert C. Gong, ACP Member, who
gave a presentation at Annual Session on patients' role in patient safety.
As an example of how latent errors occur, Dr. Gong said that studies
have estimated that one-third of patients don't understand what their
doctors tell them to do.
The results can be catastrophic. Dr. Gong cited the example of a
patient who, during a follow-up visit for psoriasis, was given
prescriptions for two creams: one for the face and one for the body.
During the visit, the doctor discussed the difference between the two
medications, but he wrote only "use as directed" on the prescriptions.
The patient used the creams incorrectly, putting the wrong lotion on
his face for several weeks. By the time the error was discovered, the
patient had already incurred scarring.
Dr. Gong says that patients can be a valuable tool when it comes to
avoiding errors.
Had the patient been more direct about making sure he understood the
difference between the medications—by asking the pharmacist for detailed
instructions, for example, or by calling the physician when he first began
experiencing problems—the adverse outcome might have been prevented.
"We need to educate our patients to take that proactive role and call
us," said Dr. Gong, an internist with Siena Hills Primary Care in
Henderson, Nev. "Error prevention doesn't have to involve a lot of
high-tech areas, but rather a lot of mundane tasks that we do every day."
Some patients are already active "directors" of their own care and can
pick up on potential errors, he said. Other patients, however, are passive
"receivers" of information their physicians deliver.
You have to educate them to verify medication prescriptions and doses,
voice concerns about their health or your treatments, and double check
your recommendations before they leave the exam room.
Dr. Gong also said patients can do more to ensure their own safety by
taking the following steps:
- Provide complete information about the medications they're taking,
including over-the-counter and herbal preparations.
- Remind their physician of any allergies and adverse reactions
they've had to medications in the past.
- Make sure they read the prescription before taking it to the
pharmacy.
- Ask for complete information about medications and potential side
effects in terms they can understand.
Dr. Gong also urged physicians to work to dispel the "no news is good
news" myth when it comes to test results. Because some test results ends
up in the wrong charts, he said, patients need to understand that they
should always ask about results if they haven't received verbal or written
notification of tests and other procedures.
Bonnie Darves is a freelance writer in Lake Oswego, Ore.
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How to report errors and near misses
You can report medication errors in confidence to the medication errors
reporting program operated jointly by the
United States Pharmacopeia and the
Institute for Safe Medication Practices. To phone in a report (you can
do so anonymously), call 1-800-23-ERROR.
Both organizations review all reports. They also share the reports'
contents with the FDA and the manufacturers of medications that have been
involved in prescription errors or "near misses."
The USP and ISMP Web sites, along with the new
patient-safety section on
ACP's Web site, also give physicians tips and resources on reducing
prescribing errors.
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