Careful monitoring of the child’s medical and dental histories is important. Close monitoring of the child’s vital signs and respiration during treatment is essential, and staff members who monitor patients must have advanced training. In several adverse incidents, the dental assistant was inadequately trained in the proper monitoring of the patient and the appropriate protocol for emergency medical treatment (Weaver, 2007). Staff must be knowledgeable and prepared for dental and medical emergencies. Additionally, because many medications employed in pediatrics are used “off label” (utilized for purposes other than their intended action), they have never been trialed in that population. This means that the best dose is unknown, and there is potentially a much narrower therapeutic index (margin of safe dosage). The medications that are available in pediatric-specific forms also have varying doses. For example, acetaminophen comes in children’s formulation (160 mg/5 mL) and infants’ formulation (160 mg/1.6 mL). The larger percentage of liquid oral medications in pediatric settings increases the risk of a preventable adverse event, such as accidental intravenous administration. Pediatric medications also cover a broad range of weights, from the tiniest baby in the neonatal intensive care unit to 17- and 18-year-olds. Combine this with the complexity of calculations that may be required and it becomes easy to misplace or not see a decimal point. When errors do occur, pediatric patients are less likely to be able to tolerate them because their organs are immature and they metabolize drugs very differently from adults. Additionally,
children often do not have the communication skills to alert clinicians to potential drug errors or adverse effects (TJC, 2008). The practitioner needs to enlist the help of parents and guardians in protecting children in clinical situations. As outlined in Table 3, parents and families can help reduce the likelihood of adverse events by being fully informed and asking questions about their child’s care. Older adults The aging process imposes several threats to older adults in the healthcare system. Vision and hearing may be diminished, and cognitive abilities may be impaired to varying degrees. These problems contribute to difficulty in communicating among patients and caregivers. Illnesses that require hospitalization foster anxiety and possible confusion, which also impede communication, potentially leading to errors. Older patients are also vulnerable to medication errors. The declining ability of the aging body to metabolize and eliminate drugs – along with potential visual, hearing, and cognitive issues – may lead to a misunderstanding or failure to recognize a potential drug error. Older patients are also at high risk for falling. Among older adults, falls are the leading cause of injury deaths (CDC, 2009). Falls are also the most common cause of nonfatal injuries and hospital admission for trauma (CDC, 2009). The reasons for falls include vision problems, medication effects, and existing health problems such as arthritis, postural hypotension, and fragility (Gray-Miceli, Capezuti, Lawson, & Iyer, 2007).
Table 3: Twenty Tips to Help Prevent Medical/Dental Errors in Children: Patient Fact Sheet Be Involved in Your Child’s Health Care 1. The single most important way you can help prevent errors is to be an active member of your child’s healthcare team. Medicines 2. Make sure that all of your child’s doctors and dentists know everything your child is taking (including prescription and over-the- counter medicines and dietary supplements such as vitamins and herbs) and his or her weight. 3. Make sure your child’s doctor or dentist knows about any allergies and how your child reacts to medicines. 4. When your child’s doctor or dentist writes a prescription, make sure you can read it. 5. When you pick up your child’s medicine from the pharmacy, ask: Is this the medicine that my child’s doctor (or dentist) prescribed? 6. Ask for information about your child’s medicine in terms you can understand – both when the medicines are prescribed and when you receive them at the hospital or pharmacy. 7. If you have any questions about the directions on your child’s medicine labels, ask. 8. Ask the pharmacist for the best device to measure your child’s liquid medicine. Also, ask questions if you are not sure how to use the device. 9. Ask for written information about the side effects your child’s medicine could cause. Hospital Stays 10. If you have a choice, choose a hospital at which many children have the procedure or surgery your child needs. 11. If your child is in the hospital, ask all healthcare workers who have direct contact with your child whether they have washed their hands. 12. When your child is being discharged from the hospital, ask his or her doctor to explain the treatment plan you will use at home. Surgery 13. If your child is having surgery, make sure that you, your child’s doctor, and the surgeon all agree and are clear on exactly what will be done. Other Steps You Can Take 14. Speak up if you have any questions or concerns. 15. Make sure you know who (such as your child’s pediatrician) is in charge of his or her care. 16. Make sure that all health professionals involved in your child’s care have important health information about him or her. 17. Ask a family member or friend to be there with you and to be your advocate. Choose someone who can help get things done and speak up for you if you can’t. 18. Ask why each test and procedure is being done. 19. If your child has a test, ask when the results will be available. 20. Learn about your child’s condition and treatments by asking the doctor and nurse and by using other reliable sources. Note: Adapted from AHRQ. (2002). 20 Tips to Help Prevent Medical Errors in Children: Patient Fact Sheet . Retrieved from http://archive.ahrq.gov/
consumer/20tipkid.htm Patient education
Central to the patient safety movement is the participation of patients. The single most effective way that patients can help to prevent medical/dental errors is to be actively involved in their own health care. To be fully involved, patients must receive
informed care. Although offering patient education is required by accrediting agencies and institutional policies, constraints of time and resources may limit the amount of attention this aspect of care receives. However, providing patient education
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