Discuss strategies that can be employed to help reduce medication errors… With biological emergencies, they tend to have preexisting treatment pathways based on best practice and EBM which would, I would think, actually reduce the risk of an adverse event caused by human error – also remember over half the recoded adverse events were unforeseen Furthermore, excess folic acid downregulates the absorption of natural folate further fomenting the problems. Just “looking at the cause”? They went from 100,000 to 200,000 and now as high as 400,000. I knew that 250k number was wrong. More realistically, if these figures- either woo-meisters; or more SB ones- were true, wouldn’t most people have experience with a family member or friend being a victim? The nurse described a list of post-operative medications which most importantly contained an antibiotic. Michael Muffin. Preventing medical errors must be a high priority for any healthcare provider. You see? Anytime anyone starting throwing around big numbers of anything, the first thing I do is look at the number and see if it even passes the “sniff test.” Just like anti-vaxers claiming that Big Pharma is conducting a global conspiracy to silence criticism of vaccines (and hide the injuries), I just do the math & come to well north of 100 Billion dollars (using the figure of 1 million people, pay 100K per year to keep silent), which is nearly 3 times the total global revenue of vaccines. He has books he wants to sell. It isn’t easy to break out the numbers, but my recollection is that the total number of deaths by medical error was around 40,000 annually, or an average of 8 per hospital spread over 5000 hospitals. Mind blown. You are wasting your own time, and likely you are a waste of carbon. My goodness, that certainly touched a nerve. — Mark Hoofnagle (@MarkHoofnagle) February 1, 2019. We can do better. He is a surgical oncologist at Johns Hopkins and author of Unaccountable, a book about transparency in healthcare. There happens to be interesting research on the cannabinoid system. And here I thought it was just a product of way too many bong hits. “Adverse effects of medical treatment (AEMT) were classified into six categories: (1) adverse drug events, (2) surgical and perioperative adverse events, (3) misadventure (events likely to represent medical error, such as accidental laceration or incorrect dosage), (4) adverse events associated with medical management, (5) adverse events associated with medical or surgical devices, and (6) other.” As for this article, just breaking down the number of deaths in the US & looking at causes – the “medical error” number just smelled bad right from the beginning. There’s obviously a lack of accounting precision in that claim: iatrogenic harm occurs statistically at a given rate for every medical act. F68.10 It is often someone else’s job to report errors. Finally, the authors analyzed the cause-of-death chains for all deaths from 1980 to 2014 to determine how frequently AEMT was (1) anywhere within a death certificate’s cause-of-death chain (ie, not underlying cause) and (2) which other contributing causes were most frequently found in the causal chain when AEMT was certified as the underlying cause. Ohh, there is asprin but it is not so safe, after all. How did we get here? So let’s say that this study’s estimates of how many people die from AEMTs and, in particular, from medical misadventure, are better estimates than the “third leading cause of death” studies. Finally some common sense in that “debate”. Assessing medical errors and assessing iatrogenic harm should not be subservient to whether or not people have realized or imagined that their medical care has gone astray. DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. If you want more detail about the database, the paper in which it was reported is open access, but here’s a bit about the data sources: The GBD study combines multiple data types to assemble a comprehensive cause of death database. Learning Objectives: Following completion of this activity, participants will be able to: Share globally relevant medication errors reported to ISMP between October 2018 to September 2019. Sources of data included VR and VA data; cancer registries; surveillance data for maternal mortality, injuries, and child death; census and survey data for maternal mortality and injuries; and police records for interpersonal violence and transport injuries. — I was admonished for suggesting it because it would be ‘unethical’ to test an experimental treatment while withdrawing the ‘standard of care’ (which has been totally ineffective in those cases, anyways). It’s also in line with my assertions that one major issue with previous studies is that the unspoken underlying assumption behind them is that that if a patient had an AEMT during his hospital course it was the AEMT that killed him. – if the medical management had been correct (non-erroneous), the adverse event would not have occurred. Did you look at the charts? These numbers are enormous, and yes, even one preventable death is one to many. Two points: 1. it shows that research on that system, while stifled for various reasons, is still going on. Of course they will put out false misleading studies. If this dire trend continues it won’t be long before 3 out of every 2 deaths will be due to medical error. Of course, The US will stand in the way; It all started over textiles,anyways, when DuPont patented how to make shit out of oil. Seriously? Does anyone listen to CUp Cakes and take them seriously? It’s almost like checklists and infection prevention protocols and all the other stuff have actually had a positive impact on patient outcomes. And therein lies the problem here. To answer your musings on AI – haven’t you seen the Terminator movies or 2001 A Space Odyssey? https://www.cannalawblog.com/the-world-health-organization-steps-up-on-cannabis/. Evidently you are incapable of seeing the evidence all around you. Recent studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States (U.S)., making medical errors the third leading cause of death. Second of all, notice that for all age ranges save one, how small a fraction of the total AEMTs were deemed to have been due to misadventure representing probable medical error. The study was published two weeks ago in JAMA Network Open; it’s by Sunshine et al. For 5,180 deaths in the most recent year, that means 108,780 deaths had an AEMT as a contributing or primary cause that year, which is in line with the IOM estimates. As for the studies finding up to 400,000 deaths a year due to medical errors, they are, as Monty Python would say, right out. Mortality associated with AEMT as either an underlying or contributing cause appeared in 2.8% of all deaths. In 1999-2000, “To Err is Human” estimated that 44,000 to 98,000 deaths per year were due to medical error. O.K. In addition, it is probable that a significant number of deaths involving AEMT are not captured because of incomplete reporting. I didn’t find any, but I did see several “patient fell out of bed”, which seems common in elderly patients who are disoriented. Do medical errors really kill a quarter of a million people a year in the US? It won’t be robot surgeons. @F68.10 What I am trying to say is that cannabis as a drug would have known side effects. There are also issues with GBD methodology that might not accurately capture every AEMT: …the GBD study’s cause classification system that assigns each death to only a single underlying cause means that some events associated with AEMT may be grouped elsewhere. @Aarno: Did I claim that cannabis cures everything? Six new surveillance country-years, 106 new census or survey country-years, and 528 new cancer-registry country-years were also added. https://t.co/XtkP2CX2gY, — David Gorski, MD, PhD (@gorskon) February 1, 2019. How did we get here? Most people do not experience harm from doctors because they do not overuse their services, nor do they seek to blame doctors for everything. Well, you have to listen to the whole 10 hours before you judge. a category (3) event? Renate, he doesn’t care about the answer to his question, unless the answer is “Buy his book on AI.”. Major events causing death are actually rare, and they are a very big deal – police involved, coroners court, TV coverage big. This database is described thusly in the paper: The 2016 GBD study is a multinational collaborative project with an aim of providing regular and consistent estimates of health loss worldwide. Oh Tommy, that’s IMAX grade projection right there. Roughly 5,200 deaths a year from AEMT and 108,000 deaths in which an AEMT was contributory are too many. Like, do more people who come in with snake bites or serious infections have more adverse events than people who come in from traffic accidents? In that case, it was grass vs. no grass. Each death was categorized as resulting from a single underlying cause. Well, maybe not a full-spectrum, smoked joint — but I fully expect that those in the psych ward will be allowed to vape their CBD at least as freely as the cheap bastards give one smoke breaks every hour but only supply their shitty smokes that inmates make with the rolling machine all day. It is estimated that from 5 to 50% of all medical errors in primary care are administrative errors. Roughly 5,200 deaths a year from AEMT and 108,000 deaths in which an AEMT was contributory are too many. It wasn’t a major part of the story, just a figure mentioned as though it were fact included as background. Medical developpements often mean, people who would have died from some condition in the past, might be saved by medicine that has been developped. Mark was referring to the use of the Institute for Healthcare Improvement’s Global Trigger Tool, which is arguably way too sensitive. Medical errors is one of them. Medical Staff. Adverse effects of medical treatment (AEMT) were classified into six categories: (1) adverse drug events, (2) surgical and perioperative adverse events, (3) misadventure (events likely to represent medical error, such as accidental laceration or incorrect dosage), (4) adverse events associated with medical management, (5) adverse events associated with medical or surgical devices, and (6) other. What did Polly have,on offer? As with the more gen… That basically means any adverse event, whether it was due to a medical error or not. If it was sorting grass vs. no grass, it was doing exactly what it was supposed to do: sorting the most relevant information out of the data. So let’s say that this study’s estimates of how many people die from AEMTs and, in particular, from medical misadventure, are better estimates than the “third leading cause of death” studies. Mistakes will be made. The study is not bulletproof, of course. We should do better. First, it uses a database designed to estimate the prevalence of different causes of death, rather than for insurance billing. … how? Roughly 5,200 deaths a year from AEMT and 108,000 deaths in which an AEMT was contributory are too many. Schadenfreude. Programmers do strange things. I was more thinking that people are more likely to have an unexpected reaction to antibiotics or snake antivenom than they are to sutures and X-rays. Post was not sent - check your email addresses! The attempt to quantify how many deaths are attributable to medical error began in earnest in 2000 with the Institute of Medicine’s To Err Is Human, which estimated that the death rate due to medical error was 44,000 to 96,000, roughly one to two times the death rate from automobiles. They are PROS at that. I don’t think so. And I’d be very upset if someone put amoxicillin in my cake. (2019 edition), Curewell: IV hydration woo on my local news station, Ranjana Srivastava: When cancer patients want quackery, Association of Adverse Effects of Medical Treatment With Mortality in the United States: A Secondary Analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study, https://spectrum.ieee.org/biomedical/devices/making-medical-ai-trustworthy-and-transparent, https://m.acog.org/Patients/FAQs/Nutrition-During-Pregnancy#much, Antivaxxers, COVID-19 vaccines, and “fetal cells”: Everything old is new again, Vaccines cause female infertility: Another antivax lie resurrected and repackaged for COVID-19, Quacks misuse Koch’s postulates to deny that SARS-CoV-2 causes COVID-19, Paul Thomas: An antivax pediatrician de-licensed (for now), Dunking on a 7′ hoop, or: Refuting Dr. Vinay Prasad’s attack on medical skepticism, Scientists and physicians versus the central conspiracy theory of science denial, Antivaxxers, COVID-19 vaccines, and "fetal cells": Everything old is new again - RESPECTFUL INSOLENCE, The antivaccine disinformation war against COVID-19 vaccines continues apace. And that the women most likely to be impacted by this are the poorest, who can’t afford a diet rich in leafy greens? Move to Colorado or Oregon or Washington and enjoy your weed, just stop putting a health halo on it. Is literally shortening life spans for most — It is like a Kurt Vonnegut tale where it is the great equalizer, the Handicapper General, of quality of life and life expectancy; Those with poor nutrition sometimes benefit from it but those with good nutrition otherwise see there lives depricated. The most recent multi-part update of Death by Medicine ( see PRN.fm) is subtitled : “needed Now More than Ever”- so I assume that they think that this is a good thing! Please provide evidence for why Orac’s claims are wrong. A while back on these forums, I discussed clinical trials of CBD for seizures and epilepsy. Methods for GBD 2016 have been reported in full elsewhere. For instance, the person inflicting the harm and the person that will provide subsequent care are two different persons and hence will fail to realize or report that an adverse event took place. 2. All you’d done is make a feeble attempt at name calling. It means that research is going on. On this we agree. Of course not, one death from medical error is too many. MD is the Rodda patient safety research fellow at Johns Hopkins and is focused on health services research. PDF download: MLN Connects for Thursday, December 6, 2018 – CMS. Briefly, data were obtained from deidentified death records from the National Center for Health Statistics; records included information on sex, age, state of residence at time of death, and underlying cause of death. But nevertheless, there will be harm to some. Ohh, JustaTech; I guess I see where you’re coming from:: the WHO’s assessment of CBD could have the most immediate impact. Basically, you’re endorsing cruelty to poor women based on absolutely no evidence of harm to you at all. @F68.10 It is not good that your molecule has receptor in many tissues. Basically, when it comes to these estimates, it seems as though everyone is in a race to see who can blame the most deaths on medical errors. Not surprisingly, its estimates are many-fold lower than the Hopkins study. Such groupings are dependent on which ICD code was assigned as the underlying cause. Also not surprisingly, it got basically no press coverage. Adverse events related to medical or surgical devices and other AEMT were nearly absent in the 1990s but have been responsible for a stable proportion of overall AEMT since the switch to ICD-10 coding of death certificates. . Also remember that the term includes unforeseen complications, so if I give penicillin to someone who has never had it, and they have an allergic reaction to it, that is an adverse event, even if I did everything absolutely correctly. But with CBD, you seem to be advocating that it be locked away BECAUSE it is safe and effective. In Kuwait, there is a paucity literature detailing the causes, forms, and risks of medical errors in their state-funded healthcare facilities. Readers of this blog may recall that the U.S. Drug Enforcement Administration (DEA) has taken the position that the U.S. would “not be able to keep obligations under the [Single Convention] if CBD were decontrolled under the CSA”. A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical errors. Even when no medical errors are responsible for the choices made. Medication errors can occur at any time between when a clinician prescribes a medication and a patient receives the drug. Medical errors are estimated to cause 250,000 deaths per year in the US. Sorry, your blog cannot share posts by email. This organism is so simple that it is prey to every predator since it cannot shelter or feed itself. It is now incumbent upon governments of the USA and other nations to eliminate the barriers to research on cannabis and allow its free commerce across state lines and international frontiers.”, https://www.wikileaf.com/thestash/world-health-organization-cannabis/. Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. It is becomeing more clear with each of your posts. It’s just that the sector is so bloody big, with so many clinicians and patients. Methods for GBD 2016 have been reported in full elsewhere. Bongs aren’t nearly massive enough. Remember, too, that this is a study of all AEMTs, but the authors did try to estimate what proportion of these AEMTs were due to medical error, or, as they put it, “misadventure.” Take a look at this graph, Figure 3 from the paper: First of all, notice how, not unexpectedly, AEMTs increase with patient age. It may also cover hospital-based infections caused by medical interventions (ventilator pneumonia, catheter bladder infections, central-line infections). I think it’s time it made the move to ewe tube. I think the only ones that really are so cynical, are the quacks. Causes were classified according to the International Classification of Diseases, Ninth Revision (ICD-9), for deaths prior to 1999 and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) for subsequent deaths. — Mark Hoofnagle (@MarkHoofnagle) February 1, 2019. They’re devoid of meaning. It never survives to maturity and therefore never reproduces. Not exactly what it was asked to do. The Food and Drug Administration (FDA) ultimately fell in line with the DEA’s interpretation, scheduled Epidiolex (an approved CBD drug), and recently issued a public statement warning that it is unlawful “to introduce food containing added CBD … into interstate commerce.”. He admits losing speaking gigs and book deals. Each show includes a section on “health and healing” where the woo-meister recites studies showing how foods and supplements cure various ills- well really, the studies say no such things- more along the lines that people who eat more fruits and vegetables may have less cancer- but he distorts them to fit his own schtick, selling supplements and powdered fruits and vegetables. They are tiny ( lusciously filled with pastry crème) efficient harbingers of destruction** That’s why it’s so insidious. We should do better. For example, although incorrect dosage of a drug is mentioned in category (3), giving a drug that is inappropriate for the patient, so that the patient suffers an adverse drug event, e.g. He falls, hits his head so hard he’s allegedly diagnosed with traumatic brain injury but it’s the vaxxeens man! Maybe you do surgeries without making a prior diagnosis where you live. Adverse effects of medical treatment (AEMT) were classified into six categories: (1) adverse drug events, (2) surgical and perioperative adverse events, (3) misadventure (events likely to represent medical error, such as accidental laceration or incorrect dosage), (4) adverse events associated with medical management, (5) adverse events associated with medical or surgical devices, and (6) other. @Aarno: You’re completely misreading me. Your right, in a perfect world there would be no medical errors, but we need to look at the figures. But of course, this life-saving threatments are not fail safe. Or dead. Also not surprisingly, it got basically no press coverage. Cucumber sandwiches? And I’m going to firmly stand by my statement. Think about the rate-limiting-step of antibody formation based on secondary bacterial-infections, in the absence of an antibiotic, while contemplating a response. @Narad: nowadays, AI seem to refer more and more to technologies based on neural networks. You do know that neural tube defects due to lack of folate happen in the very first weeks of pregnancy, long before almost all women know they are pregnant? As the authors put it: In the secondary analysis, in which AEMT was listed as the underlying cause of death, 8.9% were due to adverse drug events, 63.6% to surgical and perioperative adverse events, 8.5% to misadventure, 14% to adverse events associated with medical management, 4.5% to adverse events associated with medical or surgical devices, and 0.5% to other AEMT (eTable 6 in the Supplement). September 20, 2019 ‐ PSQH. So, if the estimates between 200,000 and 400,000 are way too high, what is the real number of deaths that can be attributed to medical error? I think the opion from somene, who works in hospitals is far more valid than that of someone who might have studied at the university of google. Annoyingly, I see this number popping up in the most unexpected places, mentioned matter-of-factly, as though it were truth that everyone accepts: Medical errors are NOT the third leading cause of death in the US. No. If my dad would have died, would that be death by medical error? Furthermore, medical record reviews demonstrate that diagnostic errors account for 6–17% of all harmful events in hospitals (19). Plausible underlying causes of death were assigned to each ill-defined or implausible cause of death according to proportions derived in 1 of 3 ways: (1) published literature or expert opinion, (2) regression models, and (3) initial proportions observed among targets. The study itself is a cohort study using the Global Burden of Diseases, Injuries, and Risk Factors (GBD) study, which uses the GBD database to estimate changes in the rate of death due to adverse events from 1990 to 2016. I’ve been harshly silly. For one thing, there are only 2.7 million total deaths per year in the US, which would mean that these estimates, if accurate, would translate into 9% to 15% of all deaths being due to medical errors. (Too much IOM and Hopkins on the brain, I guess.) It could only have been designed. The thomas sample is representative of the class. Just when I thought things couldn’t get any dumber…. Or both. All women of reproductive age should get 400 micrograms (mcg) of folic acid each day, in addition to consuming food with folate from a varied diet. Often someone else ’ s even worse than that, though: Thiamine than that, though CBD will be... Finally some common sense in that figure be it it be possible to smell the roses! 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