美摔之: 医护素质

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Medical errors third-leading cause of death in America​

Emily Jerry was two years old when she lost her life after a pharmacy technician filled her intravenous bag with more than 20 times the recommended dose of sodium chloride.
Emily Jerry was two years old when she lost her life after a pharmacy technician filled her intravenous bag with more than 20 times the recommended dose of sodium chloride.
Courtesy of Chris Jerry
“My little angel” is how Christopher Jerry describes his daughter Emily.
At just a year and a half, Emily was diagnosed with a massive abdominal tumor and endured numerous surgeries and rigorous chemotherapy before finally being declared cancer-free. But just to be sure, doctors encouraged Chris and his wife to continue with Emily’s last scheduled chemotherapy session, a three-day treatment that would begin on her second birthday.

On the morning of her final day of treatment, a pharmacy technician prepared the intravenous bag, filling it with more than 20 times the recommended dose of sodium chloride. Within hours Emily was on life support and declared brain dead.
Three days later she was gone.
Sadly, Emily’s case is not unique. According to a recent study by Johns Hopkins, more than 250,000 people in the United States die every year because of medical mistakes, making it the third leading cause of death after heart disease and cancer.
Other studies report much higher figures, claiming the number of deaths from medical error to be as high as 440,000. The reason for the discrepancy is that physicians, funeral directors, coroners and medical examiners rarely note on death certificates the human errors and system failures involved. Yet death certificates are what the Centers for Disease Control and Prevention rely on to post statistics for deaths nationwide.
The authors of the Johns Hopkins study, led by Dr. Martin Makary of the Johns Hopkins University School of Medicine, have appealed to the CDC to change the way in which it collects data from death certificates. To date, no changes have been made, Makary said.

‘The system is to blame’​

Makary defines a death due to medical error as one that is caused by inadequately skilled staff, error in judgment or care, a system defect or a preventable adverse effect. This includes computer breakdowns, mix-ups with the doses or types of medications administered to patients and surgical complications that go undiagnosed.
“Currently the CDC uses a deaths collection system that only tallies causes of death occurring from diseases, morbid conditions, and injuries,” Makary stated in a letter urging the CDC to change the way it collects the nation’s vital health statistics.
“It’s the system more than the individuals that is to blame,” Makary said. The U.S. patient-care study, which was released in 2016, explored death-rate data for eight consecutive years. The researchers discovered that based on a total of 35,416,020 hospitalizations, there was a pooled incidence rate of 251,454 deaths per year — or about 9.5 percent of all deaths — that stemmed from medical error.
Now, two years later, Makary said he hasn’t seen the needle move much.
“Medical-care workers are dedicated, caring people,” said Chris Jerry, “but they’re human. And human beings make mistakes.” According to him, the day Emily was given her fatal dose, the hospital pharmacy was short-staffed, the pharmacy computer was not properly working, and there was a backlog of physician orders.
Afterward Chris said he discovered that pharmacy technicians, rather than well-trained and educated pharmacists, are compounding nearly all of the IV medications for patients. And many states have no requirements, or proof of competency, for these pharmacy technicians.
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Medical errors, one of the leading causes of death
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To seek greater safeguards for patients, Chris founded the Emily Jerry Foundation in 2008. EJF focuses primarily on medication safety and better training for pharmacy technicians, as well as backup procedures that will improve the health-care system. Last year he unveiled the Emily Jerry Foundation’s National Pharmacy Technician Initiative, an interactive scorecard to make the public aware of unsafe pharmacy practices in the United States. He also travels throughout the country, speaking out about key patient safety-related issues and best practices proven to minimize the “human error” component of medicine.

Any new tools ‘will be a game changer’​

Pascal Metrics, based in Washington, D.C., designs ways to increase patient safety and improve clinical reliability at health organizations.
Pascal’s chief medical information officer, Dr. David Classen, is also associate professor of medicine at the University of Utah and an active consultant in infectious diseases at the University of Utah School of Medicine in Salt Lake City. He admits there are problems: “The system of care is fragmented,” he said. “Any tools that enable patients to manage their health-care needs will be a game changer.”
To improve the safety of medication use, Classen developed and implemented a computerized physician order-entry program at LDS Hospital in Salt Lake City. “Harnessing health information technology through the use of electronic health records of hospitalized and ambulatory patients is essential,” he said.
Many hospitals, for their part, are seeking to keep pace with increasingly available technology to improve patient safety. Kim Lanyon, a senior ICU nurse at Danbury Hospital in Connecticut, said all electronic records there are double-checked, and fail-safe devices are in place.”
At Mount Sinai Hospital in New York City, Dr. Vicki LoPatchin oversees a Good Catch Award, given to medical personnel who identify potential or existing errors related to their patients’ care. Similarly, most physicians’ offices now keep records electronically, as well as recording conversations among doctors, nurses and their patients in order to make certain there is clarity and that no mistakes result.
Even so, Makary said ordinary complications can occur, especially from unneeded medical care. According to him, “Twenty percent of all medical procedures may be unnecessary.” He faults also the overprescription of medication following surgery, particularly opioids.
Doctors, he said, have been encouraged by drug companies, sometimes through cash payments, to “promote” their products, as revealed by the website Dollars for Docs.

What patients can do to protect themselves​

According to Dr. John James, a patient-safety advocate and author of A Sea of Broken Hearts: Patient Rights in a Dangerous, Profit-Driven Health Care System, patients need to take charge. “There needs to be a balance between the provider community and the patients. It is not an even relationship at all.”
In 2002 James lost his 19-year-old son after he collapsed while running. He had been diagnosed with a heart arrhythmia by a cardiologist a few weeks prior and was released from the hospital with instructions not to drive for 24 hours.
“His death certificate said he died of a heart arrhythmia,” he said, but my son really died as a result of “uninformed, careless, and unethical care by cardiologists.” He explained: “If you have a patient with heart arrhythmias of a certain level and low potassium, you need to replace the potassium, and they did not. And they didn’t tell him he shouldn’t go back to running.” Communication errors, he said, are “unfortunately very common.”
In 2014 James retired early to devote his life to improving patient safety. His mission: to teach people how to be empowered patients. He has created a patient bill of rights, which he’s been pushing to become federal law. Yet so far he said his letters to the Centers for Medicare & Medicaid Services have gone unanswered.
“Makary has a lot of courage,” James said. “A lot of the retired doctors will tell you it’s a mess and it’s terrible. But for a young physician to come out and say what he did, that’s pretty bold. Makary is a brave guy.”
James’ site, Patient Safety America, lists the three levels in which patients can protect themselves. These include being a wise consumer of health care by demanding quality, cost-effective care for yourself and those you love; by participating in patient-safety leadership through boards, panels and commissions that implement policy and laws; and by pushing for laws that favor safer care, transparency and accountability.
Too often, the health-care system silences people around a problem.

Dr. Martin Makary
surgical oncologist and chief of the Johns Hopkins Islet Transplant Center
Here are some other ways patients can be vigilant right now:
Ask questions. Gain as much insight as you can from your health-care provider. Ask about the benefits, side effects and disadvantages of a recommended medication or procedure. Use social media to learn more about the patient’s own condition, as well as those medications and procedures for which they were prescribed.
Seek a second opinion. If the situation warrants or if uncertainties exist, get a second opinion from another doctor: A good doctor will welcome confirmation of his diagnosis and resist any efforts to discourage the patient from learning more — or what Makary calls, “attempts to gag the patient.”
“Too often,” he said, “the health-care system silences people around a problem.” Why? Many doctors are reluctant to speculate, but some admit the answers range from simple ego to losing a patient to another doctor they trust more.
Bring along an advocate. Sometimes it’s hard to process all the information by yourself. Bring a family member or a friend to your appointment — someone who can understand the information and suggestions given and ask questions.
Ilene Corina, president and founder of the Pulse Center for Patient Safety Education & Advocacy, based in Wantagh, New York, urges both the patient and their advocate to be “respectful but assertive” in seeking answers to the questions they may have. In some cases, she recommends a “designated medication manager” to be a safety check on the advice the care provider gives.
 

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医疗失误成为美国第三大死因​

艾米丽·杰瑞 (Emily Jerry) 两岁时,一名药剂师在她的静脉输液袋中注入了超过推荐剂量 20 倍的氯化钠,她因此丧生。
艾米丽·杰瑞 (Emily Jerry) 两岁时,一名药剂师在她的静脉输液袋中注入了超过推荐剂量 20 倍的氯化钠,她因此丧生。
克里斯·杰瑞 (Chris Jerry) 提供
“我的小天使”是克里斯托弗·杰瑞 (Christopher Jerry) 对女儿艾米丽 (Emily) 的描述。
在仅仅一年半的时间里,艾米丽被诊断出患有巨大的腹部肿瘤,经历了无数次手术和严格的化疗,最终被宣布无癌。但可以肯定的是,医生鼓励克里斯和他的妻子继续艾米丽最后一次安排的化疗,为期三天的治疗将从她的第二个生日开始。

在她接受治疗的最后一天早上,一名药学技术人员准备了静脉输液袋,里面装满了推荐剂量 20 倍以上的氯化钠。几小时内,艾米丽就靠着生命维持装置,并宣布脑死亡。
三天后,她不见了。
可悲的是,艾米丽的情况并不是独一无二的。根据约翰霍普金斯大学最近的一项研究,美国每年有超过 250,000 人因医疗失误而死亡,使其成为继心脏病和癌症之后的第三大死因。
其他研究报告的数字要高得多,声称因医疗失误造成的死亡人数高达 440,000 人。造成这种差异的原因是医生、殡仪馆承办人、验尸官和法医很少在死亡证明上注明所涉及的人为错误和系统故障。然而,死亡证明是疾病控制和预防中心发布全国死亡统计数据的依据。
由约翰霍普金斯大学医学院的 Martin Makary 博士领导的约翰霍普金斯大学研究的作者呼吁疾病预防控制中心改变它从死亡证明中收集数据的方式。Makary 说,迄今为止,还没有做出任何改变。

'系统是罪魁祸首'​

Makary 将医疗错误导致的死亡定义为由技术人员不足、判断或护理错误、系统缺陷或可预防的不利影响引起的死亡。这包括计算机故障、与给患者服用的药物剂量或类型混淆以及未确诊的手术并发症。
“目前,CDC 使用的死亡收集系统只统计疾病、病态和伤害导致的死亡原因,”马卡里在一封信中,敦促 CDC改变其收集国家重要健康统计数据的方式。
“应该责备的是系统而不是个人,”马卡里说。2016 年发布的美国患者护理研究连续八年探索死亡率数据。研究人员发现,根据总共 35,416,020 次住院治疗,每年有 251,454 人死于医疗错误,约占所有死亡人数的 9.5%,这是由于医疗失误造成的。
现在,两年后,马卡里说他没有看到针移动太多。
“医护人员是敬业、有爱心的人,”克里斯杰瑞说,“但他们也是人。人类也会犯错。” 据他介绍,艾米丽接受致命剂量的那一天,医院药房人手不足,药房计算机无法正常工作,医生订单积压。
之后克里斯说他发现药房技术人员,而不是训练有素和受过良好教育的药剂师,正在为患者配制几乎所有的静脉注射药物。许多州对这些药学技术人员没有要求或能力证明。
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医疗错误,这是导致死亡的主要原因之一
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为了为患者寻求更大的保障,Chris于 2008 年创立了Emily Jerry Foundation。EJF主要关注药物安全和对药学技术人员的更好培训,以及作为将改善医疗保健系统的备用程序。去年,他公布了艾米丽杰瑞基金会的国家药学技术员计划,一种交互式记分卡,旨在让公众了解美国不安全的药房做法。他还周游全国,谈论与患者安全相关的关键问题和最佳实践,这些实践已证明可以最大限度地减少医学中的“人为错误”部分。

任何新工具“都将改变游戏规则”​

Pascal Metrics 总部位于华盛顿特区,致力于设计提高患者安全性和医疗机构临床可靠性的方法。
Pascal 的首席医疗信息官 David Classen 博士也是犹他大学医学副教授,也是盐湖城犹他大学医学院传染病领域的活跃顾问。他承认存在问题:“护理系统是支离破碎的,”他说。“任何使患者能够管理其医疗保健需求的工具都将改变游戏规则。”
为了提高药物使用的安全性,Classen 在盐湖城 LDS 医院开发并实施了一个计算机化的医嘱录入程序。“通过使用住院和非卧床患者的电子健康记录来利用健康信息技术至关重要,”他说。
就其本身而言,许多医院正在寻求跟上日益可用的技术以提高患者安全性。康涅狄格州丹伯里医院的高级重症监护病房护士金·拉尼恩说,那里的所有电子记录都经过双重检查,并配备了故障安全装置。”
在纽约市的西奈山医院,Vicki LoPatchin 博士负责监督 Good Catch 奖,该奖授予发现与患者护理相关的潜在或现有错误的医务人员。同样,大多数医生办公室现在都以电子方式保存记录,并记录医生、护士和他们的病人之间的对话,以确保清晰,不会导致错误。
即便如此,Makary 说普通的并发症也可能发生,尤其是不必要的医疗护理。据他说,“所有医疗程序中有 20% 可能是不必要的。” 他还指责手术后药物处方过多,尤其是阿片类药物。
他说,正如网站Dollars for Docs所透露的那样,医生一直受到制药公司的鼓励,有时通过现金支付来“推广”他们的产品。

患者可以做些什么来保护自己​

患者安全倡导者、《心碎之海:危险的、以利润为导向的医疗保健系统中的患者权利》的作者约翰·詹姆斯博士认为,患者需要承担责任。“需要在提供者社区和患者之间取得平衡。这根本不是一种平等的关系。”
2002 年,詹姆斯在跑步时摔倒,失去了 19 岁的儿子。几周前,一位心脏病专家诊断出他患有心律失常,并被告知在 24 小时内不得开车出院。
“他的死亡证明上说他死于心律失常,”他说,但我儿子确实是死于“心脏病专家的不知情、粗心和不道德的护理”。他解释说:“如果你的病人有一定程度的心律失常和低钾,你需要补钾,而他们没有。他们没有告诉他他不应该回去跑步。” 他说,“不幸的是,沟通错误非常普遍”。
2014 年,詹姆斯提前退休,致力于改善患者安全。他的使命:教人们如何赋予患者权力。他制定了一项患者权利法案,并一直在推动该法案成为联邦法律。然而,到目前为止,他说他给医疗保险和医疗补助服务中心的信没有得到答复。
“马卡里有很大的勇气,”詹姆斯说。“很多退休的医生会告诉你这是一团糟,而且很糟糕。但是对于一个年轻的医生来说,他的所作所为是相当大胆的。马卡里是个勇敢的人。”
James 的网站Patient Safety America列出了患者可以保护自己的三个级别。这些包括通过为您自己和您所爱的人要求高质量、具有成本效益的护理而成为一个明智的医疗保健消费者;通过执行政策和法律的董事会、小组和委员会参与患者安全领导;并推动制定有利于更安全护理、透明度和问责制的法律。
很多时候,医疗保健系统让人们对一个问题保持沉默。

Martin Makary
外科肿瘤学家和约翰霍普金斯岛移植中心主任
以下是患者现在可以保持警惕的其他一些方法:
提出问题。从您的医疗保健提供者那里获得尽可能多的洞察力。询问推荐的药物或程序的好处、副作用和缺点。使用社交媒体了解更多关于患者自身状况的信息,以及为他们开出的药物和程序。
寻求第二意见。如果情况需要或存在不确定性,请从另一位医生那里获得第二意见:一位好医生会欢迎对他的诊断进行确认,并抵制任何阻止患者了解更多信息的努力——或者 Makary 所说的“试图堵住患者的嘴”。 ”
“很多时候,”他说,“医疗保健系统让人们对一个问题保持沉默。” 为什么?许多医生不愿推测,但有些人承认答案范围从简单的自我到失去一个病人到另一个他们更信任的医生。
带上辩护人。有时很难自己处理所有信息。带一位家人或朋友参加您的预约——他们可以理解所提供的信息和建议并提出问题。
Ilene Corina 是位于纽约 Wantagh 的 Pulse Center for Patient Safety Education & Advocacy 的总裁兼创始人,她敦促患者和他们的倡导者在寻求他们可能遇到的问题的答案时“尊重但自信”。在某些情况下,她建议“指定的药物经理”对护理提供者提供的建议进行安全检查。
 

贵圈

Attacks on me, frankly, are attacks on science :)
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FDA/CDC/NIH到现在, 不能在疫苗注射流程中加入一秒钟的一个简单动作. 看来是有原因的.

从上到下, 美国的医疗体系在全面腐烂
 

RareEarth

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FDA/CDC/NIH到现在, 不能在疫苗注射流程中加入一秒钟的一个简单动作. 看来是有原因的. 从上到下, 美国的医疗体系在全面腐烂

岂止医疗体系,奥斯卡颁奖晚会现在都常出事故。随着美国的去工业化,美国精神被文科生导向了。这届美国人民不行了。
 

rottenmelon

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成也工业化 拜也工业化
以前美国还连年打仗能撑一撑 现在连将军都变性了 没啥盼头了
 
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