Thursday, September 01, 2005
Checklist for patients to prevent errors

By Dr. Anthony Policastro Nanticoke Memorial Hospital

On Tuesday, Aug. 23, the World Health Organization made a public announcement of an international effort to prevent medical errors. They will do it by promoting a series of safety standards.

Those standards will be checklist items that patients can expect when they receive medical care. The list will be similar to the checklist used by pilots in the cockpit. The idea is to double-check everything that might cause a common error. I have previously written about some of these. However, since they will now be more common, I would like to cover them all.

They take the form of things that patients should expect when they go to a hospital. They also take the form of things patients should check for when they go to a hospital and the form of questions patients should ask when they go to a hospital.

The first of these has to do with confirming your identity. Hospitals see many patients. Some of them have similar names. Some of them are of similar age. There needs to be a method to make sure that they are positively identified. Hospitals have been asked to come up with two specific forms of identification for every thing that they do to a patient.

This would mean that identification is checked before each blood test. This would mean identification is checked before each X-ray. This would mean identification is checked before each medication is given.

Most hospitals have selected the patient name plus one other identifier. The other identifier might be the birth date. It might be the chart number. It might be a photograph. Whatever is used, you should expect it to be checked each time you have something done. You might be asked about it. Your identification tag might be looked at to check it. There might be a bar code system of identification. Whatever method is used should be consistent throughout the hospital.

The next expectation that you should have is that all care givers will wash their hands before they examine you or treat you. If there is a sink in your room, you could observe this directly. There are sometimes hand sanitizers in the room that might be used. If you have any doubts about it, you should ask about it before the treatment is given.

A third recommendation has to do with marking in indelible ink the site of any procedure. At one time, this was done only for procedures in the operating room. Now the expectation should be that it is done for any procedure. For example, a broken bone in the ER should be marked before a cast is applied.

When you get a prescription for a medication you should expect that you can read the name of the drug clearly. If you cannot read it, the pharmacist might not be able to read it either. Many drugs have similar names. The prescription needs to be clear. If it is not, you should ask for a rewrite before you leave the office. This will actually save the physician time because he/she will not then receive a call from a confused pharmacist later.

Not all the requirements are for health care personnel. The patient should also have certain things that they do.

One of these is to make sure you tell the physician all products that you take. Over the counter medications may contain something that will affect what the physician prescribes. Herbal remedies can have a lot of drug interactions. The same thing is true of vitamins and other supplements. Certain drugs should not be used with alcohol. Even the use of illegal drugs is important to know about so you do not get a similar drug from the physician and result in an overdose. Another thing to make sure of is to explain about any allergies that you might have. For example latex allergies are common in patients who have allergies to fruits like avocados.

One other thing you can make sure of is that notes from other places make it to the medical record in your primary care physician's office. If you have a lab test done, make sure the result gets to your physician. That is true even if it was ordered by a consultant or at an ED visit. The same is true for X-ray results and other studies. Similarly, there should be notes from a consulting physician in your primary care physician's record when you see such an individual.

As you can see these patient safety items involve both medical personnel and the patient. Your medical experiences should be interactive in nature. Improving patient safety is really a two-way street.

Just like the pilot and the co-pilot both check each item in the cockpit checklist, you and the medical personnel who treat you should both go through the medical checklist to ensure your safety.

Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.