preventing errors in oncology: a physician’s perspective as a cancer of the neck patient
DESCRIPTION
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. Tracheo-esophageal speech with a voice prosthesis. Overview 1. Hospitalization after surgery - PowerPoint PPT PresentationTRANSCRIPT
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
Tracheo-esophageal speech with a voice prosthesis
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.
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)
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
Physician’s Errors• Failure to detect cancer
recurrence• Early feeding• Removal of scar tissue instead
of the tumor• Forgetting to write down orders
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
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)
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.
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
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
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)
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
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
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
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
Blog site for book: http://dribrook.blogspot.com
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