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When caregivers care less than they should

October 7, 2008
Adirondack Daily Enterprise

In the end, I suppose, it all comes down to where the "buck stops," so when your doctor has decided that hospitalization is essential for you or your child, he or she is exactly where it stops.

Therefore, when something goes wrong, be it an licensed practical nurse, registered nurse, or perhaps even an intern who might be the perpetrator, the attending physician or physicians become the target of retribution. This is the color of legal responsibility in our business oriented, free enterprise society. Leave that responsibility to underlings and you suffer the consequences when the roof falls in.

I don't care to discuss the ethical aspects of this point of view at this juncture; perhaps I'll take it up at some future opportunity. My present attention will be devoted to a more personal and frightening aspect involved in the loss of control of a situation by those responsible - the common error of providing the wrong drug or an erroneous dose, so prevalent in our modern overburdened hospital environments.

Would you believe that a study conducted by Dr. Glenn S. Takada and colleagues at the University of Southern California calculated an estimate of 11.1 adverse drug events occurring for every 100 children in 12 freestanding children's hospitals?

Published in the April issue of Pediatrics, the article also worked out their calculations to indicate that this represented 15.7 events per 1,000 patient-days and 1.23 adverse drug events for every 1,000 medication doses.

It's quite likely that this article might have been buried in the medical literature had it not been for the chance recent occurrence involving Dennis Quaid's twins, in which an adult dose of heparin was given to his newborn twins along with another infant.

Okay, I must admit that the usual outcome of similar errors is either of minimal consequence or readily reversible. Dr. Takata, himself, admitted that the resultant harm was mostly "mild, temporary." Nevertheless, 22 percent of errors were called preventable, 17.8 percent could have been identified earlier, and 16.8 percent could have been handled more effectively.

Luck prevailed this time, but only one serious, life-threatening case need occur, especially if the child or adult loved one happens to be yours; then the situation takes on a whole different aspect. Patients die or become disabled, and doctors get sued.

This report by Dr. Takata's group included a second consideration involving ways to prevent such dangerous occurrences from happening in the first place by utilizing a "modified trigger tool" technique. Once again, I prefer to leave this concept for possible future consideration. My main application with respect to this serious revelation shall remain delineated as such, a revelation, rather than as an attempt to provide a solution.

In the end, even the authors confessed that there is no "gold standard" for adverse drug events for comparison, and that their use of the trigger tool as well as their classification of an event as preventable was inevitably "subjective and susceptible to certain biases."

Be it as it may, the upshot of this revelation was characterized by the authors as a way of providing the groundwork for developing strategies that might help avoid such occurrences in the future.

My own experience with respect to the development of such prevention strategies is a decidedly mixed bag. Creating artificial tools in order to assist a varied group of individuals, at least when applied in the earliest stages of a problem situation, might very well provide an equitable response.

On the other hand, the most serious consequences for which such strategies have application are usually, in effect, exactly those that do not fit into the pattern ascribed by the artificial tool. That is why I chose to avoid trying to analyze prevention strategies at this juncture.

My purpose, then, in presenting this scary hospital circumstance - which many readers will quickly find as a parallel to another set of circumstances involving spread of infection in a hospital environment - is to bring to your attention the fact that what happens to your child or other loved ones, be it in school, at work, or even in the supposedly safest place of all populated by supposedly caring, devoted individuals known as a hospital, the onus is on you to provide your own individually designed "trigger tool."

Marvin Ackerman is a retired physician living in Queensbury.



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