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Itzhak Brook MD, MSc.Professor of Pediatrics and Medicine
Georgetown University School of Medicine
Preventing Errors in Oncology:A Physician’s Perspective as a
Cancer of the Neck Patient
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Tracheo-esophageal speech with a voice prosthesis
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Overview1
• Hospitalization after surgery• Physician's errors• Nurses errors• Preventing errors• Advocacy• Suggestions for improving care
1. Brook I. Neck Cancer- A Physicians’ Personal Experience. Arch Otolaryngol Head Neck Surg. 2009;135:118.
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Hospitalization after Laryngectomy
• Emotional unpreparedness• Pain, weakness & complete
dependency • Tube feeding • Connected to lines• Humidified oxygen & suctioning • Blood drawn almost daily• Unable to talk ( writing only)
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Medical errors
• Occur at all levels-nurses, physician
• Reluctance to complaint (dependency)
• Laryngectomees more vulnerable and less able to abort errors because their inability to speak
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Physician’s Errors• Failure to detect cancer
recurrence• Early feeding• Removal of scar tissue instead
of the tumor• Forgetting to write down orders
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Nurses’ Errors (1)
• Not responding to calls• Forgetting to connect the call button.• Not washing hands or using gloves • Not placing the oral thermometer in
a plastic cover• Using an inappropriately sized blood
pressure cuff • Administer an incorrect dose of a
medication
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Nurses Errors (2)•Administer medications orally instead of an NG tube•Administer medications through the NG tube dissolved in hot water (causing esophageal burn)•Connecting suction machine to wall without a bottle of water•Not rinsing the hydrogen peroxide after cleaning the tracheostomy tube (causing severe irritation)
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Preventing medical errors (1)• Better & uniform training. • Adhere to established standards• Perform regular records review to detect
and correct errors• Employ only well trained medical staff. • Counsel, reprimand, and educate staff who
make errors. Dismiss those who continue to make mistakes.
• Develop & meticulously follow algorithms, set procedures & bedside checklist for all procedures.
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Preventing medical errors (2)• Increase supervision & communication
between health care providers• Educate patients & caregivers about patient
condition & treatment plans • Encourage patient advocacy (family/friend) to
ensure appropriate management• Respond to complaints. Admit responsibility
when appropriate & discuss these with the family and staff
• Investigate all errors and take preventive action
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Advocacy• Choosing the appropriate treatment
(laser, conventional surgery)• Get a second opinion• Look for an expert in your type of
surgery• Do not confuse friendliness with
expertise • Ask for the true prognosis
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Be Your Own Advocate• Decrease chances of medical errors by
being informed and not hesitating to challenge & ask for explanations
• Become an “expert” • Have a family or friends with you in the
hospital• Get a second opinion• Educate your medical caregivers about
your condition and needs (prior to and after surgery)
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Improving surgeons’ attitude after laryngectomy
Patient should ask • that they be patient, allow more
time for communication • Explain what will happen• Understand the challenges of
life as a laryngectomee
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Improving surgeons attitude after laryngectomy
• Need patience and sensitive, allow more time for communication
• Explain what is happening• Understand the tremendous life
changing event of becoming a laryngectomee
• Examine all parts of the body
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Patient’s post surgical care can be improved by:
• Educating patient and family about the short & long term medical & social implications of the procedures
• Greater personal attention by surgical team (spending more time, provide information)
• implementing standard techniques of nursing care
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Patient’s post surgical care can be improved by (2):
• Greater vigilance & better communication among staff to avoid medical errors
• Educate surgeons: proper medical and psychological post surgical care, special needs of patients after major surgery
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Blog site for book: http://dribrook.blogspot.com
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Thanks for your attention!
Any Questions?
Itzhak Brook MD, Professor of Pediatrics and Medicine
Georgetown University School of Medicine
http://dribrook.blogspot.com
Phone: 202-744 8211