Hospital
Errors
Hospital errors incidence
§
250000 Americans
die every year from hospital mistakes. That is one person in
every ten minutes. 1 in ten people are treated in a hospital
every year. Hospital mistakes are the fifth leading cause of
death in U.S.
Dont assume doctors, nurses, aides or surgeons know best.
One
in seven hospital patients suffers at least one hospital mistake
that prolongs his or her stay causes permanent damage, requires
life sustaining treatment or results in death.
Hospital acquired infections
§
In USA infections
acquired after being admitted to a hospital kill more than 30000
patients every year. This is a death toll similar to breast
cancer in USA
Any hospital with high infection rates should be avoided. If you
are in hospital do not touch toilet handles, bathroom fixtures,
door handles or public surfaces. Even doctors working in
hospitals carry a lot of germs in their ties and necklaces.
Hospital acquired infections
Air Conditioning
§
Cooler room tempratures
inhibit growth of bateria.
Avoid hospitals which are not air conditioned.
Hospital floor should be cleaned between patients.
That we do regularly. I have never seen any Sri Lankan hospitals
I have visited or been as a patient doing that.
Medication errors
§
Medication related
fatalities occur due to incorrect prescription or administration
of medication. How many doctors in Sri Lanka type their
prescriptions.
You know how bad doctors handwriting is.
I type all my prescriptions when they take it to a pharmacy.
Anaphylaxis
§
Always tell your doctor about
vitamins, herbs and your intake of alcohol or smoking.
Always tell about
all the medicines you take and the right dosage in milligrams
when you go to the hospital so you would not get the wrong
dosage. Always tell hospital doctor about your allergies.
77 percent of deaths due to anaphylactic shock (serious allergy
happens inside hospitals in USA )
http://www.ncbi.nlm.nih.gov/pubmed/24332862
Advise to the patient
§
Make sure the hospital charts your
weight properly. They may put your weight in pounds and you
might get double the dosage. This has happened to many people.
From the doctor or
pharmacist get a full explanation as to how to take your
medicine, what times any interactions, if safe to drive after
taking it.
Any doubts can be
cleared by this website where you can check if you got the right
drug.
http://www.drugs.com/imprints.php
Avoid errors
§
If you suffer from a disease always
learn about it yourself. If a treatment doesn't seem right you
don't have to take it.
Always remember to thank your providers and hospital workers so
that you would be treated as a person. During shift changes
chances of medical mishaps skyrocket. Have your hospital staff
check your identity to prevent mishaps.
Further Advise
§
If you have catheters, IVs
they may need to be changed to prevent infections. Dont forget
to ask your nurses. When IV fluids run out let them know. If you
cannot move you have to be moved every four hours to prevent bed
sores.
Experience of the doctor
§
If you are going to do the
procedure find out how many of the same procedure they have
performed before. Skill and experience of the hospital and the
doctors matter a lot to your safety. Doctors and hospitals
keeping electronic records have 86 percent fewer communication
errors.
Computerized Records
§
Hosptial using computer
systems kill 20% fewer people because computers can pick up
allergies and drug interactions. It is best to keep your own
records. Avoid weekends for hospital surgeries when medical
errors are more common with lighter staffing.
Surgery
§
Mix up of patients commonly
happen because the patient cannot communicate once anesthetized.
Patient must communicate with all concerned prior to the surgery
to make sure everybody knows about his condition. Have the
surgeon initial the surgical site prior to surgery. Longer you
are in hospital greater the risk of a hospital error.
Beware of side effects
§
Remember that all tests and
treatments have side effects. Sometimes less is more.
A lot of hospital deaths occur with blood clots. Venous
thromboembolism affects a million people in USA annually killing
about 100000 of them.
General Anesthesia kills
§
Obviously more common with
any surgery under general anesthesia or prolonged surgery.
Avoid falls in the hospital. Mostly occur while going to the
bathroom. 30% hospital falls result in seriuos
injury. Most american beds have bed railings.
Risks of General Anesthesia
§
Risk of death in General Anesthesia
alone is 1 in 10000
§
Risk of Liposuction with General
Anesthesia is 1/5000
§
2% of all ICU admissions are due to
complications of GA
Complications of GA
§
Pain
§
Nausea and Vomiting in 30%
§
Damage to teeth 1/4500
§
Sore Throat and Laryngeal Damage
§
Anaphylaxis
§
Cardiovascular collapse
§
Respiratory Depression
§
Aspiration pneumonia
§
Hypothermia
§
Hypoxic brain damage
§
Nerve Injury
§
Awareness during
§
Embolism, air, thrombus,
§
venous or arterial
§
Backache
§
Headache
§
Idiosyncratic Reaction , eg malignant
hyperpyrexia with suxamethonium, Succinyl-choline
§
Iotrogenic problems, pneumothorax
§
Death
Aspiration Pneumonitis
§
Due to lack of gag refelx
§
Can occur with high spinal anesthesia.
§
Cricoid pressure during induction helps
§
Ranitidine or PP inhibitors help. Use of
metoclorpramide help.
Peripheral Nerve Damage
§
Results from nerve compression
§
Commonly ulnar nerve and common
peroneal nerve
§
Rarely Brachial plexus damage
Damage to teeth
§
The most common claim made
against Anesthetist.
§
Upper left incisor is
commonly damaged.
Embolism
§
Rare but can be fatal.
§
Air Embolism common with pelvic
operations.
§
Venous thromboembolism should be prevented
with TEDS and Low Molecular Weight Heparin
Safety of tumescent local anesthesia
§
Doctors in Sri
Lanka have very little experience in Tumescent Anesthesia and
saftey of that technique. This anesthesia was developed by Dr
Jeffrey Klein from California who is a dermatologist and a
founding member of the American Academy of Cosmetic Surgery.
Safety of tumescent Anesthesia in out patient setting
Safety of tumescent liposuction in 15,336 patients.
National survey results.
The safety of liposuction: results of a national survey
Safety of liposuction using exclusively tumescent local
anesthesia in 3,240 consecutive cases
§
The same surgeon performed
liposuction using exclusively TLA in 3,240 procedures.
§
In a series of 3,240 procedures, no
deaths occurred, and no complications requiring hospitalization
were experienced
§
Liposuction using exclusively TLA
is a proven safe procedure provided that the existing guidelines
are meticulously followed.
Dr Jeffrey Klein
This
is Dr Jeff Klein who discovered tumescent anesthesia speaking at
the 2nd Annual World Academy of Cosmetic Surgery in Vienna
on Semptember 4th 2011 posing for a picture with me. I am
holding in my hand special cannula made by Dr Jeffrey Klein for
liposuctions. He is a Dermatologist.