Medical Errors: Data on the Invisible Epidemic Joe Graedon, MS, & Terry Graedon, PhD Joe Graedon, MS, & Terry Graedon, PhD OCHU/CUPE 6/4/12

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3 of These Each Day

Deaths & Mortality U.S. CDC Data TOTAL U.S. DEATHS 2,437,163 TOTAL U.S. DEATHS 2,437,163 Heart Disease 599,413 Heart Disease 599,413 Cancer567,628 Cancer567,628 Lower Resp. Dis.137,353 Lower Resp. Dis.137,353 Stroke 128,842 Stroke 128,842 Accidents 118,021 Accidents 118,021 Alzheimer’s 79,003 Alzheimer’s 79,003 Data posted as of March, 2012

Health Care Harm Infections (HAIs)> 100,000 (CDC) Infections (HAIs)> 100,000 (CDC) Fatal ADEs (hosp) 106,000 Fatal ADEs (hosp) 106,000 (Lazarou, JAMA, 1998) (Lazarou, JAMA, 1998) Fatal ADEs (nursing) 93,000 Fatal ADEs (nursing) 93,000 (Handler, Ann. Longterm Care, 2010) (Handler, Ann. Longterm Care, 2010) Fatal ADEs (OP) 198,815 Fatal ADEs (OP) 198,815 (Bootman, Am. J. Health-Syst. Pharm., 1997) (Bootman, Am. J. Health-Syst. Pharm., 1997)

Health Care Harm Lethal VTEs 119,000 Lethal VTEs 119,000 Range: 100,000 to 300,000 Range: 100,000 to 300,000 (Raskob, Am. J. Prev. Med. 2010; Heit, Blood, 2005) (Raskob, Am. J. Prev. Med. 2010; Heit, Blood, 2005) Unnecessary surgery 12,000 Unnecessary surgery 12,000 (Starfield, JAMA, 2000) (Starfield, JAMA, 2000) Surgical complications32,591 Surgical complications32,591 (Zhan, JAMA, 2003) (Zhan, JAMA, 2003) Excessive radiation 29,500 Excessive radiation 29,500 (Berrington de Gonzalez Arch. Intern.Med., 2009) (Berrington de Gonzalez Arch. Intern.Med., 2009)

Health Care Harm Pressure ulcers (bed sores)60,000 Pressure ulcers (bed sores)60,000 (Allman, N. Engl. J. Med. 1989) (Allman, N. Engl. J. Med. 1989) Misdiagnosis 132,500 Misdiagnosis 132,500 Range: 40,000 to 225,000 Range: 40,000 to 225,000 (Newman-Toker, JAMA, 2009; Shojania, JAMA, 2003; (Newman-Toker, JAMA, 2009; Shojania, JAMA, 2003; Wachter, Arch. Intern. Med., 2009) Wachter, Arch. Intern. Med., 2009) TOTAL: 883,406

Common Diagnostic Mistakes Blood Clot in Lungs or Legs Blood Clot in Lungs or Legs Adverse Drug Event Adverse Drug Event Cancer Cancer Acute Coronary Syndrome Acute Coronary Syndrome Stroke Stroke Congestive Heart Failure Congestive Heart Failure

Canadian Data “There is limited knowledge about the incidence of adverse events and health care error in Canadian health care, and little knowledge about current initiatives to improve patient safety.” Baker & Norton, Patient Safety and Health Care Error in the Canadian Health Care System. Health Canada 2001

Health Care Harm in Canada ADEs 32,921 ADEs 32,921 (Canadian Adverse Reaction Newsletter, 2011) May represent only 1 to 10% of actual ADEs Chart Review: Chart Review: 11% had injuries resulting in death, disability, + hosp 11% had injuries resulting in death, disability, + hosp 20% of these events were lethal; 37% highly preventable 20% of these events were lethal; 37% highly preventable (Baker & Norton, CMAJ, 2004) Diagnostic Errors15% of preventable deaths Diagnostic Errors15% of preventable deaths (Croskerry, CMAJ, 2010)

Numbed by Numbers “Statistics are people with the tears wiped away.” Irving Selikoff, MD

Helen Graedon Born September 27, 1904 Died December 14, 1996 School teacher Civil rights advocate Peace activist & poster artist World citizen

Drug Interaction Demerol-Selegiline interaction = Demerol-Selegiline interaction = serotonin syndrome serotonin syndrome Muscle spasms Muscle spasms Emotional distress Emotional distress Nurse denied connection with drug Nurse denied connection with drug Legs tied down Legs tied down Bar on side of bed down Bar on side of bed down Attempt to walk--walker not close by Attempt to walk--walker not close by Fall Fall Death due to retroperitoneal bleeding Death due to retroperitoneal bleeding

Prescribers’ Knowledge About Interactions 14 drug pairs sent in questionnaire 14 drug pairs sent in questionnaire < 50% identified unsafe combos < 50% identified unsafe combos Tagamet (cimetidine) & Coumadin Tagamet (cimetidine) & Coumadin Conclusion: “knowledge poor” Conclusion: “knowledge poor” “Alert Fatigue” > Computer Overrides “Alert Fatigue” > Computer Overrides 14 drug pairs sent in questionnaire 14 drug pairs sent in questionnaire < 50% identified unsafe combos < 50% identified unsafe combos Tagamet (cimetidine) & Coumadin Tagamet (cimetidine) & Coumadin Conclusion: “knowledge poor” Conclusion: “knowledge poor” “Alert Fatigue” > Computer Overrides “Alert Fatigue” > Computer Overrides Drug Safety June, 2008 A Postal Survey of US Prescribers

What caused this woman’s death?

Justice Ginsburg?

Questions to Ask about your Prescription Other ways to treat this problem? Other ways to treat this problem? Evidence-based effectiveness? Evidence-based effectiveness? Most common/serious side effects Most common/serious side effects Symptoms requiring action Symptoms requiring action How can I contact you? How can I contact you? How to take this medicine How to take this medicine How to stop this medicine How to stop this medicine Other ways to treat this problem? Other ways to treat this problem? Evidence-based effectiveness? Evidence-based effectiveness? Most common/serious side effects Most common/serious side effects Symptoms requiring action Symptoms requiring action How can I contact you? How can I contact you? How to take this medicine How to take this medicine How to stop this medicine How to stop this medicine

Reducing Misdiagnosis Teach back (verify my 1º concerns) Teach back (verify my 1º concerns) Confidence in diagnosis? Confidence in diagnosis? Other tests that might clarify Qs? Other tests that might clarify Qs? Symptoms that don’t fit! Symptoms that don’t fit! What else could it be? What else could it be? “Gimme my damned data!” “Gimme my damned data!” Follow-up plan & contact info Follow-up plan & contact info Teach back (verify my 1º concerns) Teach back (verify my 1º concerns) Confidence in diagnosis? Confidence in diagnosis? Other tests that might clarify Qs? Other tests that might clarify Qs? Symptoms that don’t fit! Symptoms that don’t fit! What else could it be? What else could it be? “Gimme my damned data!” “Gimme my damned data!” Follow-up plan & contact info Follow-up plan & contact info

Take an advocate! Check every drug Be assertive In doubt? Say NO! Condition H (Help!) Hazardous handoffs Avoiding Hospital Errors Expect Mistakes!

Communication & Teamwork Prevents Problems We need better data! We need better data! Mandatory reporting Mandatory reporting Let patients (& families) help Let patients (& families) help Informed Informed Respected Respected Empowered Empowered