We go to the hospital for care and recovery. Certainly no one wants to get sicker in the hospital, but it happens more often than most people realize. There are dangers in hospitals, and other healthcare facilities, that can cause serious harm, even death. Each year ECRI* compiles of a list of top health technology hazards. This post covers items 6-10 — read my recent post for the first 5 health hazards.
6. Infusion pump medication errors due to confusion.
Infusion pumps must be programmed for each patient, but the process is error prone and staff can make mistakes that cause patient harm. For instance, staff can confuse intended flow rate with dose rate, causing patients to receive too little or too much medication – a potentially dangerous error. Unfortunately, these programming errors are fairly common. Even worse, the use of “smart pumps”, which are designed with dose error reduction systems, doesn’t eliminate the problem.
Why are these errors occurring?
The design, layout and required programming sequence on pumps contributes to these errors. Additionally, there is usually a lack of procedures to verify programming accuracy.
How can facilities reduce infusion pump errors?
Auto-programming infusion pumps can eliminate manual-entry errors. Additionally, configuring the medication records so they are consistent with the programming sequences will reduce errors. Lastly, facilities should set up systems to verify dosage programming.
7. Missed bedside alarms can lead to patient harm.
There’s a lot of beeping and chirping on in-patient floors. Many patients have bedside equipment monitors with alarms to indicate a change in patient health or equipment malfunction. Because of the widespread use of monitors, there is an overload of alarms, which can lead to staff missing or ignoring alarms – a phenomenon referred to as alarm fatigue. (For more information on alarm fatigue, read my blog post: The Dangers of Missed Bedside Alarms.) When staff don’t recognize and respond to the alarms, the consequences can be dire – including serious patient harm, even death.
What can facilities do to reduce missed alarms?
Staff should customize each patient’s alarms based on the particular needs of a care area and the condition of the patient. Combined with staff education, alarm customization policies can help reduce the risks.
What can you do?
Patients and family members can help. If the patient is too sick to monitor and report alarms, then I strongly suggest that a family member, or other trusted adult, stay with the patient at all times.
Patients and families — especially families of critically ill patients — should ask the medical staff:
- What monitors are in use and why
- What the alarms sound like for each piece of equipment
- Which alarms are urgent and demand immediate attention
If an urgent alarm sounds, a family member (or the patient if condition allows) should immediately seek help from the nurses on duty by locating a nurse in the hall or at the nurse’s station.
8. Patient injury from overhead patient lift systems.
Many patients are unable to move on their own, requiring help from staff, who cannot safely lift patients. Therefore, staff use overhead patient lift systems to lift and transfer patients, such as when moving a patient from the bed to a wheelchair. During use, staff puts the patient in a sling that is suspended from the mechanism. Although these systems are designed to improve safety, they can also cause significant injury if they are designed, installed, used, or maintained improperly. Lift components can fall from above, or fail while in use, potentially harming patients, staff and visitors.
How can facilities improve the safety of overhead lifts?
Facilities can reduce the risk of injuries by:
- Using qualified personnel to install the system
- Thoroughly testing a system after installation
- Assessing the condition of the lift before and during each use
- Performing regular preventive maintenance
9. Equipment damage and fires from improper cleaning of electrical components.
Rigorous cleaning is vital in hospitals and other care facilities. Not only do hospital surfaces need cleaning, staff must clean and disinfect electrical equipment as well. Without proper cleaning, devices can cross-contaminate patients and others. However, improper cleaning of electrical equipment can lead to malfunction, damage, or fire. How? Damage occurs when cleaning staff repeatedly use wipes dripping with excess fluid or spray liquids directly onto powered devices and equipment.
How can facilities maintain cleaning standards while reducing risk of damage?
It’s clear cut – cleaning staff should follow proper techniques when cleaning electrical equipment, including:
- Following manufacturer instructions
- Avoid spraying fluids directly onto the equipment
- Using appropriate cloths, wipes, and sponges, while squeezing out excess liquid before use
10. Flawed battery charging systems and practices.
It’s annoying when your phone battery dies. It’s life-threatening when medical equipment keeping a patient alive fails due to battery issues. Some medical devices rely on rechargeable batteries to temporarily provide power. So, when batteries aren’t sufficiently charged, devices can fail if there are no alternative sources of power or back-up devices available. This can impact ventilators, defibrillators, and other life-sustaining or life-saving devices.
How does this happen?
Sometimes staff members don’t properly charge or maintain batteries. But often the fault lies with the equipment – a device’s battery status indicator may not be sufficiently accurate or clear. Or a battery charger may malfunction. Finally, the battery itself may be defective.
What can facilities do to keep equipment running?
It’s essential for facilities to follow appropriate battery use and maintenance practices. Equally important, but often overlooked: evaluating battery systems before purchase to ensure that devices will operate as expected when running on rechargeable battery power.
What can you do about all these dangers in hospitals?
As with the hazards outlined in last week’s post, there is little you can do as a patient or family member to prevent exposure to these dangers in hospitals, with the exception of missed alarms. (As outlined above, patients and family members can help reduce the risk of missed alarms.)
Even though there is little that patients and families can do to reduce their own risk of these 10 hazards, it is worth your time and energy to evaluate a hospital before you (or a loved one) are admitted. Of course, in emergencies you won’t have time for research. But, if you research the hospitals in your area, you will at least have an idea about how hospitals rank for safety issues, which will come in handy if an emergency arises while you are close to home.
Research your hospital options.
Although no hospital is 100% hazard free, some hospitals are better than others at reducing risks for patients. To reduce your exposure to dangers in hospitals, research hospitals to learn how they rate for infection control and other safety measures. However, beware that you will not find information related to the 10 hazards identified by ECRI. Of course, there is no way of knowing if hospitals who rank well on safety related issues are also on top of these 10 issues. But it’s always a good idea to use hospitals who have good safety records and robust safety programs and policies.
To research hospitals in your area, visit the Zaggo Resource Center for information and links to hospital ratings sites. However, it’s important to realize that there is no standard methodology used by hospital ratings sites, so the information may contain flawed data. Use the information with caution. Read the August 2019 NEJM article on “rating the raters” for more information.
Additionally, read these blog posts to learn more about choosing a hospital:
- How to Choose a Hospital.
- Wondering How to Choose the “Best” Hospital? Find out How Doctors Would Choose a Hospital for Their Own Care.
- What’s Your Hospital’s Safety Record? Is Your Hospital Safe?
- Is Your Hospital Safe? Are Programs in Place to Avoid Dangerous “Never Events”?
*ECRI Institute is a nonprofit organization dedicated to bringing the discipline of applied scientific research to discover which medical procedures, devices, drugs, and processes are best, all to enable the improvement of patient care.
NOTE: I updated this post on 8-20-19.