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Friday, December 5, 2014

To Err is Human: To Correct an Err is Humane

Simple Changes to Correct Medical Errors

Ebola paranoia has nestled into the collective conscious of the western world. This is especially poignant when one begins to digest the rash of medical precautionary measures which nudged Ebola into the 24 hour news cycle. Some of the critique levied onto the medical facilities and their staff is justified and not without merit. That notwithstanding, the medical field as a business entity has addressed these types of procedural pitfalls both preemptively and forensically. One of the ways they do this is by way of certification through The Joint Commission.

ALERT: for those of you directly or tangentially within the medical field you might want to jump ahead; you're already mind-numbingly familiar with The Joint Commission. For those of you who are not as well acquainted with The Joint Commission, then it is prudent to go over what this accrediting organization does.

The Joint Commission is a not-for-profit and independent organization which accredits and certifies over 20 thousand health care organizations and medical programs throughout the United States. In order to receive and remain a Joint Commission certified health care facility, a series of guidelines, procedures, protocols, clinical pathways and best practices, that the commission set forward, need to be followed and upheld. Far more than just a nitpicking watchdog The Joint Commission also establishes longterm goals which aid the health care facilities in committing to a shared vision of business practice.

Central to The Joint Commission's longterm goals and visions is the concept of safety. This is an umbrella concept which entails things like, avoiding patients falling, mental or physical injury and medication errors . Although an emphasis is given to patient safety, the safety of the health care workers is also enumerated. In light of the procedural and mechanical errors made by health care workers treating Ebola patients, the necessity of adhering to the standards and goals set forth by The Joint Commission is of even greater importance.

What is often overlooked or simply never given credence are the more basic ways in which medical errors could be curtailed. Here follows a few straightforward suggestions for tinkering with the medical field in order to reduce hospital and medical errors.

Too many names for the same thing

A convention which arose in Europe was the adoption of universal names of medical terms based on Latin and Greek. Undoubtedly, this was done in conclave to better accommodate medical teaching in the handful of prestigious Universities on the continent.

Employing colloquial terminology was useful dealing with non-medical people but grossly inadequate when discussing it with other medical people across Europe. As is often the case, man's hubris deconstructed a standardization which was meant to quell egos. The result is that a whole jumbled medical lexicon has evolved which is unnecessarily confusing and rife with synonyms. Here are a few examples.

When referring to kidneys they are either renal(Latin) or nephritic(Greek). Kidney stones are renal calculi (pebbles in Latin). If one has bladder stones then these become cystoliths (stones in Latin). One can run into a Sesame Street like word game when referring to the head: skull, capit (Latin), cranium (Latin) or the cephalic (Greek) region.

Convert to the metric system already

The consistent use of standardized measurements is one of the cornerstones of scientific research and discovery. It allows for peer review of experiments by facilitating another pillar of scientific research: replication. The vast majority of scientific research conducting the US is done utilizing one standardized set of measurement; the metric system.

The metric system was first established in France around 1799, the same year Napoleon Bonaparte the reigns of power that war torn country. Although not confirmed, this adoption might have been hastened throughout the European continent because of Napoleon's eagerness to codify and govern more efficiently. Despite the official sanctioning of the metric system in the US by the end of the American Civil War in 1866, an colloquial adoption of the metric system still hasn't materialized.

One way to reduce medical errors would be a formal transition within American medical treatment. Calculations of weight, height, length, temperature, depth and volume are routinely done in the US customary units which have to be converted to be applied to metric calibrations.

Lab values and scales all need a make over: 0-10

As anyone who is in the medical field can attest to; lab values and scales are the bread and butter of recognizing either a pathology or a return to normalcy. Knowing your blood sugar level helps to prevent the adverse effects of either hyper- or hypoglycemia or whether or not the fever with a spike in white blood cells means an infection throughout the body.

Daily lab values are essential in caring and treating patients; especially when administering or adjusting medications. Sadly, there hasn't been a push towards standardization of lab values and scales. Some are done parts per million or parts per thousand. Others are based on increments of decimals attached to single digits like 1.3-1.7. Still others are based on an arbitrary finite set like 80-100 or 45-60.

An overdue simplification of labs and scales based on sets of 10 could reduce the feral nature of establishing an interval scale. Something like 0-10 or 0-100 would bolster medical accuracy substantially.

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