Medical Error and Patient Safety: Human Factors in Medicine
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Summary
A difficult and recalcitrant phenomenon, medical error causes pervasive and expensive problems in terms of patient injury, ineffective treatment, and rising healthcare costs. Simple heightened awareness can help, but it requires organized, effective remedies and countermeasures that are reasonable, acceptable, and adaptable to see a truly significant drop in the intolerable rate of medical mistakes. Only with better understanding, knowledge, and directed techniques can there be rapid and marked improvement in medical error management discipline.
Since medical error is situation specific and involves diverse variables in equipment, environment, and human performance, the correct choice of preventive and corrective techniques is critical. Providing a wealth of useful ideas, concepts, and techniques, Medical Error and Patient Safety: Human Factors in Medicine uses abroad perspective to present more than 500 remedies that can be applied and tailored to your unique circumstances. This detailed review of so many measures enables you to correctly identify needs and undertake appropriate actions to achieve a success that can be measured in avoided injuries, improved healthcare, and reduced cost.
Thought provoking and useful, this book considers the potential for error and the possibility for improvement in every aspect of healthcare. After an introduction to general concepts and approaches, it examines vulnerabilities in medical services, including emergency services, healthcare facilities, and infection control. It covers risks in medical devices and product design; human factors such as fatigue and stress; management errors; errors in communication at all levels of the healthcare hierarchy; as well as mistakes in drug delivery including faulty labels and warnings. The authors also compare and contrast several analytical methods, their interpretation, and their translation into a plan of action.
Table of Contents
Introduction
Common Understanding
Sophisticated Knowledge
Current Urgency
Time to Rebuild
Our Approach
A New Meaning for Error
Multidisciplinary Orientation
General Concepts
Causation
Bias
Performance Criteria
Transparency
Harmonization
Teamwork
Rationalization
Assurance Techniques
Management of Error
Caveats
Medical Services
Theoretical Assumptions
Medication Errors
Infection Control
Emergency Services
Handovers and Interactions
Health Care Facilities
Limitations of Service
Caveats
Medical Devices
Risks
Error Reduction
External Requirements
Communications
Product Design
Critical Comments
Conclusions
Caveats
Analysis
Corrective Action
Preventive Action
System Analysis
Human Error Control
Risk Assessment
Mistaken Beliefs
Observational Demeanor
Correct Terminology
Complete Process
Post Control Measures
Operational Discipline
Error Troubleshooting
Traceability
Industrial Engineering
Quality Assurance
Other Disciplines
Government and Industry Reviews
In-House Teams
Personality Factors
Caveats
Human Factors
Hospital Beds
Fatigue
Defiant Actions
Stress
Situation Awareness
Reduction and Integration
Patient Handling
Drug Altered Behavior
Macroergonomics
Team Training
Human Factors Experts
Cultural Changes
Sentinel Events
Scope of Activities
Caveats
Management Errors
Introduction
Illustrative Error Sources
Transformational Issues
Management Principles
Management Concerns
Caveats
Communications
Interactivity
Acknowledged Problems
Supplemental Techniques
Important Variables
Communicating Consent
Misreading Symptoms
Caveats
Drug Delivery
Containers
Labels
Warnings
Mental Processes
Pill Matching
Instructions
Regulation
Prescription Directions
Security and Counterfeiting
Recalls
Possible Problems
Networking and Privacy Protection
Patient Concerns
Caveats
Appendix
Standards Organizations
Marks of Approval
Selected Standards and Regulations
References and Recommended Reading
Subject Index
Editorial Reviews
“This book authored by George A. Peters and Barbara J. Peters is a useful resource for any patient, attorney or physician who wishes to understand the potential for error as well as improvement in the current state of healthcare in America. This resource identifies the vulnerable areas of our healthcare system as well as the tragic outcomes of such vulnerabilities.
“Not only does this resource cover areas of risk via current medical devices, but it also identifies risks related to human factors, health care management, health care communication among providers, as well as frequent error in medication/drug delivery.
“Finally, these authors present remedies for such errors and objectives for current healthcare patient safety.
“This is an excellent resource for any health care provider, patient or attorney representing the patient’s best interest related to health care in America.
— Janabeth Fleming Taylor, R.N., R.N.C., - ATLA Paralegal of the Year 2002; Attorney's Medical Services, Inc., Corpus Christi, Texas
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