Medical Errors in Nursing: Preventing Patient Falls and Infections

This is the third and final part in our series on medical errors in nursing. The first two parts covered medication and documentation errors-two common error types that can negatively impact patient care and outcomes, and pose liability risks for nurses, doctors, and other healthcare professionals.

In this final part we'll examine infections and patient falls, taking a closer look at the causes of those errors, from human factors like fatigue and stress, to environmental factors, to inadequate information management systems. We'll also look at the importance of education and training in preventing medical errors. Finally, we'll consider the secondary and tertiary victims of medical errors-healthcare workers and the healthcare organization as a whole, respectively.

First, let's take a closer look at healthcare-associated infections (HAIs) and what nurses can to do prevent them.

Patient Infections: A Troubling Ongoing Problem in Healthcare

Infections can happen anywhere in the healthcare system-from hospitals to outpatient clinics, to nursing homes and hospices. The problem of HAIs is enormous. In acute care hospitals alone there were an estimated 721,800 infections in 2011, according to the Centers for Disease Control's (CDC) HAI Prevalence Survey.1

The majority of infection types were:

Additional Causes of Medical Errors in Nursing

Distraction: A nurse may forget to follow protocols regarding infection control if she/he is juggling too many things or is interrupted.

Environment : Issues like lack of proper lighting and spaces that are too hot/cold can cause distractions that lead to errors.

Fatigue : A nurse who is chronically overworked can make errors out of exhaustion, which can cause memory lapses and brain fog.

Lack of knowledge/understanding : A nurse who doesn't understand how a device or piece of equipment works can make errors that lead to infections, patient falls, and other problems.

Incomplete patient information : A lack of information about a patient, such as which medications they are taking, can lead to errors. If a nurse doesn't know a patient has been given a medication that causes drowsiness or dizziness, for example, she may not monitor the patient appropriately, which could lead to a patient fall.

Systemic problems : Under-funded medical care, inefficiencies, doctors and other healthcare workers that are overwhelmed, lack of integrated technology-all of these systemic problems can contribute to nursing errors.

How Infections Spread

In the U.S., the primary modes of infection transmission include:

How Nurses Can Help Prevent Infections

Nurses are on the frontlines of healthcare-that means diligent daily infection control practices are absolutely essential for preventing the spread of infections.

Here are basic infection prevention strategies for nurses to follow:

Special Note about Catheters : Improper sterilization of urinary catheters is a leading cause of infections in hospitals. Nurses should only use catheters when necessary. They must appropriately insert and clean catheters according to protocols, remove them in a timely manner, and avoid using catheters long term unless medically necessary. Nurses who aren't being provided with the proper resources to prevent the spread of infection should report it immediately.

Preventing Patient Falls

Falls are a serious risk for vulnerable patients. Patient falls that result in a serious injury are among the top 10 sentinel events reported to the Joint Commission's Sentinel Event Database every year.2

Hundreds of thousands of patients fall every year in hospitals, and 30 to 50% of these falls result in an injury. In a study cited by the Joint Commission, a fall-related injury added 6.3 days to a patient's hospital stay. The average cost for a fall was $14,000.


It's clear that patient falls are far too common. It's not just the elderly who are at risk. Medical conditions, disabilities, medications, surgery procedures, and diagnostic tests can leave a patient of any age and physical ability weakened, confused, and disoriented, putting them at greater risk of a fall.

Nurses can and should take all of the following measures to protect their patients from falls:

Secondary and Tertiary Victims of Medical Errors

The first victim of a medical error is the victim and their family. Healthcare providers are the secondary victims, and the organization-whether it's a small outpatient clinic, a large hospital, or a nursing home-is the tertiary victim.

Everyone suffers from medical errors. The healthcare provider's reputation and job could be at stake-especially in cases where a patient is severely injured, disabled, or dies as a result of the error. A caregiver involved in a serious medical error may suffer prolonged psychological or physiological problems as a result, including anxiety, depression, shame, self-doubt, sleep disturbances, and post-traumatic stress disorder, in addition to legal actions against them, termination, and/or revocation of their licenses.

The organization suffers from medical errors in terms of lost trust by the public in the facility and possible legal actions against it.

The potentially enormous consequences of medical errors highlight the need for organization, communication, support for healthcare workers, and adequate funding of healthcare facilities.

Nurse educators can play a role in the prevention of medical errors by ensuring nurses receive continuing education about medical errors, and steps to prevent them through live courses, healthcare education videos, and other mediums. When nurses have all the resources they need at their disposal, they can focus on what matters: delivering quality patient care.

Sources:

  1. http://www.cdc.gov/HAI/surveillance/

  2. http://www.jointcommission.org/assets/1/18/SEA_55.pdf