Medical Malpractice
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November 30th, 2004

"Hospital learns from medical mistakes"

Dana-Farber Cancer Institute in Boston has spent the last decade reforming its hospital to ensure patient safety comes first. While a hospital is supposed to put patient safety first, reports in recent years have shown how many problems exist in the nation''s 6,000 hospitals. In 1999, a report forced hospitals to acknowledge there were 98,000 people dying every year because of medical mistakes like accidental overdoses, infections and other caregiver errors.

At Dana-Farber, when a doctor mistakenly prescribed four times the intended dose of breast cancer medication to two women and none of the nearly 25 medical staff involved in the care noticed until weeks, it left one patient dead and another suffering irreversible heart damage.

At that point, major changes were made, making the hospital one of the most safety conscious hospitals in the nation today. New nursing precautions to prevent careless nursing malpractice errors have been implemented, like making sure the patient''s name and birthday is verified, regardless of how well the nurse knows the patient, treatment instructions are reviewed on a computer and the drug concentration is checked before the pharmacist is informed the patient shows no signs of side effects from previous treatments.

The hospital is equipped with a state-of-the-art internal error tracking system, collecting verbal and written reports from staff on all lapses, as well as allowing doctors and nurses to spend more time with patients and a full disclosure policy. The hospital is only one of a few hospitals that have set up forma committees of patients to advise on everything from furniture to suggestions on improving care.

While Dana-Farber''s efforts have not been cheap, costing at least $11 million in upfront investments, excluding extensive training programs and the hiring of physician assistants and other employees to give doctors more time to meet with patients, in 10 years there have been no medication errors causing permanent injury to outpatients.

Most hospitals don''t even know how many medication errors they are making, and the $2 million it would cost for fully computerized drug ordering systems, currently in just about 10 percent of hospitals, are not made part of the budget. Considering total national costs because of medical mistakes are estimated to be between $17 million and $29 billion per year, in addition to lost lives and permanently injured patients, patient safety advocates believe medication errors must be made a priority if positive changes are going to be made.