Itzhak Brook MD, MSc. Professor of Pediatrics and Medicine Georgetown University School of Medicine Preventing Errors in Oncology: A Physician’s Perspective as a Cancer of the Neck Patient

Tracheo-esophageal speech with a voice prosthesis

Overview 1 Hospitalization after surgery Physician's errors Nurses errors Preventing errors Advocacy Suggestions for improving care 1. Brook I. Neck Cancer- A Physicians’ Personal Experience. Arch Otolaryngol Head Neck Surg. 2009;135:118.

Hospitalization after Laryngectomy Emotional unpreparedness Pain, weakness & complete dependency Tube feeding Connected to lines Humidified oxygen & suctioning Blood drawn almost daily Unable to talk ( writing only)

Medical errors Occur at all levels-nurses, physician Reluctance to complaint (dependency) Laryngectomees more vulnerable and less able to abort errors because their inability to speak

Physician’s Errors Failure to detect cancer recurrence Early feeding Removal of scar tissue instead of the tumor Forgetting to write down orders

Nurses’ Errors (1) Not responding to calls Forgetting to connect the call button. Not washing hands or using gloves Not placing the oral thermometer in a plastic cover Using an inappropriately sized blood pressure cuff Administer an incorrect dose of a medication

Nurses Errors (2) Administer medications orally instead of an NG tube Administer medications through the NG tube dissolved in hot water (causing esophageal burn) Connecting suction machine to wall without a bottle of water Not rinsing the hydrogen peroxide after cleaning the tracheostomy tube (causing severe irritation)

Preventing medical errors ( 1 ) Better & uniform training. Adhere to established standards Perform regular records review to detect and correct errors Employ only well trained medical staff. Counsel, reprimand, and educate staff who make errors. Dismiss those who continue to make mistakes. Develop & meticulously follow algorithms, set procedures & bedside checklist for all procedures.

Preventing medical errors ( 2 ) Increase supervision & communication between health care providers Educate patients & caregivers about patient condition & treatment plans Encourage patient advocacy (family/friend) to ensure appropriate management Respond to complaints. Admit responsibility when appropriate & discuss these with the family and staff Investigate all errors and take preventive action

Advocacy Choosing the appropriate treatment (laser, conventional surgery) Get a second opinion Look for an expert in your type of surgery Do not confuse friendliness with expertise Ask for the true prognosis

Be Your Own Advocate Decrease chances of medical errors by being informed and not hesitating to challenge & ask for explanations Become an “expert” Have a family or friends with you in the hospital Get a second opinion Educate your medical caregivers about your condition and needs (prior to and after surgery)

Improving surgeons’ attitude after laryngectomy Patient should ask that they be patient, allow more time for communication Explain what will happen Understand the challenges of life as a laryngectomee

Improving surgeons attitude after laryngectomy Need patience and sensitive, allow more time for communication Explain what is happening Understand the tremendous life changing event of becoming a laryngectomee Examine all parts of the body

Patient’s post surgical care can be improved by: Educating patient and family about the short & long term medical & social implications of the procedures Greater personal attention by surgical team (spending more time, provide information) implementing standard techniques of nursing care

Patient’s post surgical care can be improved by (2): Greater vigilance & better communication among staff to avoid medical errors Educate surgeons: proper medical and psychological post surgical care, special needs of patients after major surgery

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