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Patients at risk of post-surgical procedural errors

Sunday, October 7th, 2012

Any surgical and post-operative mistakes can have devastating consequences for patients. While hospitals implement safety protocols and procedures to ensure patient safety, a new report suggests that these processes may not be enough to prevent errors and injury. The study found that surgical patients were exposed to between 4 and 5 procedural mistakes during their post-operation recovery. Half of these errors resulted in medical harm.

While the hospital under review is in London, medical experts compare the hospital to other large research facilities in New York and throughout the United States. The investigation monitored all patients at a “large gastro-intestinal surgery center” over the course of 2 years and found that failures in the processes of care led to surgical and procedural mistakes, in some cases, causing patient injury and medical harm.

Researchers tracked 50 patients who underwent non-emergency surgery on the digestive tract, mostly for cancer between 2008 and 2010. The team uncovered 352 mistakes, 256 which were due to process failures. Some of the procedural errors included:

  • Delays in treatment
  • Failure to deliver medication
  • Failures in communication and assessment
  • Over or under medication
  • Improper delivery of test results
  • Failure to provide patient instructions

Medical professionals in the UK and in the US were shocked by the sheer number of errors in post-op recovery, especially considering the technology and protocols necessary to ensure patient safety. New recommendations include read backs and check backs for accuracy and the general promotion of a culture of safety. Doctors and other health authorities who were not involved in the study see the report as a warning sign that the existing processes and procedures are not enough to keep patients safe.

Source: Reuters, “Study finds errors in post-surgery care are common,” Kerry Grens, Oct. 2, 2012

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