How Verbal Orders Cause Medical Errors Compromising Patient Safety

1 in 10 patients around the world receives unintended harm owing to medical errors. This was the revelation made in the 59th Regional Committee for World Health organization’s South-East Asia region. The statistics in the United States are 44,000-98,000 deaths. A new discipline in healthcare called Patient Safety is emerging to address this global issue. It involves reporting, analysis and prevention of medical errors to the maximum possible extent both humanly and by using technology.

Verbal orders given by doctors play a major role in causing major errors in medicine. Though there are strict guidelines given by the World Health Organization banning verbal orders of medical prescription, the practice is rampant and under-reported. This article tries to gain further insight on this subject.

What are the Factors Which Contribute to Verbal Orders of Medical Prescription Compromising Patient Safety?
There are four major root causes which lead to the doctors verbally prescribing the medicines for their patients. They are: human factors, environmental factors, system or process constraints and human resource issues.

Human Factors: Unclear voice and accent of the doctors, their casual attitude towards a serious profession can mislead their subordinates. The nurses might not feel encouraged to clarify their doubts on the type, dosage and method of administration of the prescribed drug from the doctor. The patient is the causality in case of a medical error.

Environmental Factors: The hospital is a very busy place. The background noise can distract the attention of the physicians while they ponder over the right prescription of a drug. The high demand of a medical profession can be stressful and lead to fatigue. These possible occupational hazards can contribute to medical errors.

Constraints of the System: A doctor is required for the expert opinion by health care professionals of various disciplines. This inherently multitasking role of this job might not provide the doctor with the time to read the prescribed drug(s) once again. Sometimes sound alike names of the drug also cause confusion leading to medical errors.

Human Resource Issues: In developed nations there is a scarcity of qualified staff. In developing nations, in spite of the presence of abundant human resources, the infrastructure for providing adequate training and education to the aspiring healthcare professionals is missing. Lack of expertise can cause error in any field. However, in the medical field, it can be a matter of life and death of the patient.

Accepted Standard Scoring of the Hazards Associated with Each of the Causes of Medical Error:

Cause Effect of Failure Probability Severity Hazard Scoring
Human Factors Casual Attitude or Mind Set Frequent Major 12
Environmental Factors Noise, Distraction, Stress and Fatigue Frequent Major 12
Constraints of the System Sound alike names and Language Occasional Major 9
Human Resources Issues Improper Training and Staffing Uncommon Moderate 4

The causes with hazard scoring more than 8 are considered to be high-risk ones requiring commencement of corrective measures on priority basis.

Hazard Scores of the Medical Errors Based on the Probability and Severity:

Probability Catastrophic Major Moderate Minor
Frequent 16 12 8 4
Occasional 12 9 6 3
Uncommon 8 6 4 2
Remote 4 3 2 1

What are the Steps Taken to Stress on the Verbal Order Protocol Compliance?

  • Awareness should be built among the doctors and nurses on the risks of medical errors owing to mis-communications. This can be done through period interactions during policy review sessions on patient safety.
  • The nurses should be encouraged to question the doctors if a wrong drug is prescribed. They should also restrain from taking verbal orders.
  • The workers can be sensitized about the issue by placing posters to spread the message in their work place.
  • It should be made mandatory for the nurses to read back the documented prescription to the doctor. It should be signed by the doctor for confirmation after been reviewed by the druggist.
  • There should be a system in place to continuously monitor the compliance of the protocols on verbal order.
  • Information technology can play a significant role in reducing the challenges of medical professionals while they prescribe drugs.
  • New software products can be developed which can cross check the validity of a drug written by the doctor prior to it being administered to the patient.

Conclusion: The adage “to err is human” cannot be taken as an excuse to allow the happening medical errors. Though there are certain medical errors unavoidable by their very nature, verbal orders can be completely prevented if appropriate steps are taken on time for the cause of patient safety. In the coming days, health care professionals can be definitely expected to address the seriousness of this issue in its right prospective.

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