ViewpointPatient safety and patient error
Section snippets
Patient errors
What does it mean to say that patients make errors, and why does this concept matter? We used the framework developed by James Reason, who defined errors as actions not completed as intended (errors of execution) or as actions proceeding as intended but failing to achieve the outcome intended because the plan was wrong (errors of planning, also called mistakes). Errors can be attributable to systems, people, or settings. Systems theory suggests that most errors result from the convergence of
The context of patient errors
Patient error should be understood with respect to the personhood and social roles of patients. As people, patients should be free to make decisions, consciously or otherwise, and to retain the moral agency to err. Another important context is the variety of roles of patients, which help to define their capacity and opportunity to make or avoid errors. As consumers and coproducers of care,14 competent patients have their own experiential and embodied knowledge. Indeed, modern consumerism,
Mechanisms and types of error
Most patient errors result from their own behaviour.18 The table shows examples of errors attributable to patients in the planning or execution of actions necessary for their own health care. Patients often consciously neglect their needs and responsibilities in their own health care—whether through choice, or because of competing priorities and constraints.19 Patients can also forget to take treatment, or may not have appropriate resources to access it.20 Although some errors might originate
Promotion of patients' safety
In speculatively opening a debate on the issue of patient error, we have identified a need for empirical work on patients' contribution to error and for development of a taxonomy of error, perhaps by using formal consensus-building methods (Reason J, University of Manchester personal communication). This theoretical foundation should facilitate the construction of priorities for action to support patient safety. For health-care providers, continuing actions to promote patient safety might be
Conclusion
Patient error can be overlooked by a narrow focus on the complex conditions under which health-care professionals contribute to system errors and medical errors. Patient errors are an important part of the patient-safety puzzle, and will probably increase in frequency.1 Patients' errors not only endanger their own health but also adversely affect family, friends, and communities. It would be impossible to avert all these consequences, or to forestall all of the antecedents of patient errors,
References (27)
- et al.
Patient non-compliance: deviance or reasoned decision-making
Soc Sci Med
(1992) - et al.
To err is human: building a safer health system
(2000) Common errors by patients in the management of diabetes
N Y State J Med
(1953)Iatrogenic disease: a hazard of multiple drug therapy
Roy Soc Health J
(1976)- et al.
Sources of error in delayed payment of physician claims
Fam Med
(2003) Tapping and resolving consumer concerns about health care
Am J Law Med
(2000)World Alliance for Patient Safety: Forward Programme 2005
(2004)Human Error
(2002)The Institute of Medicine report on medical errors - could it do harm?
N Engl J Med
(2000)- et al.
Measuring errors and adverse events in health care
J Gen Intern Med
(2003)
Perceived causes of family physician errors
J Fam Pract
Errors in general practice: development of an error classification and pilot study of a method for detecting errors
Qual Saf Health Care
Should we consider non-compliance a medical error?
Qual Saf Health Care
Cited by (32)
Evaluation of patients’ engagement in radiation therapy safety
2016, Cancer/RadiotherapieCitation Excerpt :Positionning errors account for 55% of these events and 22% are identification errors. Patients themselves can also be the sources of errors or behave in a manner threatening their own safety, or the safety of other patients [7]. Patients can also express a need to get more involved in their own treatment.
Topics in drug therapy
2012, Clinical Pharmacology: Eleventh EditionPatient participation to patient safety in radiotherapy: A reality to be developed
2012, Bulletin du CancerCan or must the patient participate to risk management in radiotherapy?
2011, Cancer/RadiotherapieRisk assessment in radiation therapy
2010, Bulletin du CancerRefocusing the lens: Patient safety in ambulatory chronic disease care
2009, Joint Commission Journal on Quality and Patient SafetyCitation Excerpt :This case involves problems with the health system, including poor access to/knowledge of after-hours medical advice, and with communication, because a bothersome symptom—insomnia—was not discussed in recent visits. Importantly, this example illustrates how patient and caregiver errors, in this case taking someone else’s medication, can lead to harm.7,16 Mrs. Khas rheumatoid arthritis, for which she is treated with methotrexate and etanercept.