According to the Journal of Patient Safety, preventable medical errors cause at least 210,000 deaths per year. Medical errors are the third leading cause of death in America, behind heart disease and cancer. Unfortunately, mistakes made in the Neonatal Intensive Care Unit (NICU) represent a significant part of those numbers. The Archives of Disease in Childhood (ADC) reported that medication errors are eight times more common in the NICU than they are in the hospital. Standards of care require that medical professionals prevent these errors. By addressing resident physician fatigue, inadequate doctor to patient ratio, and increasing provider awareness and communication, errors in the NICU can be avoided.
Care in the NICU
During the neonatal period, infants require special care and attention. In the NICU, they can be closely monitored and properly treated to avoid injury. Babies may be admitted to the NICU because they suffer from prematurity, respiratory problems, seizures, birth asphyxia, neonatal encephalopathy or hypoxic ischemic encephalopathy (HIE). If not treated properly, these conditions can worsen, causing cerebral palsy and other permanent disabilities.
Common NICU Errors
According to the Journal of Perinatology, human error and high alert medications are to blame for most medication errors. The ADC also stated that drug dispensing in the NICU can be particularly difficult. Pharmacists dilute standard dosages to make them suitable for infants. Also, because of low quality systems of infant identification, newborns are often misidentified. Infants in the NICU are at risk for being misidentified and receiving the wrong dose or medication. Below are some of the different reasons why medication errors occur.
- Weight-based dosages
- Off-label drug usage
- Out of stock medications
- Misidentification of infants
- Misidentification of medications
If neonatal resuscitation is delayed or not performed properly, injuries can occur. Lack of oxygen, known as asphyxia, can cause the following injuries and disabilities.
- Hypoxic ischemic encephalopathy (HIE)
- Cerebral palsy
- Damage to the white and grey matter of the brain
- Periventricular leukomalacia (PVL)
- Intraventricular hemorrhage
Improper Ventilation or Overventilation
If an infant’s breathing machine, known as a ventilator, is not monitored properly, the machine can breathe too fast or too slow. Breathing too fast is known as overventilation. Overventilation can cause damage to the lungs, causing bronchopulmonary dysplasia, pneumothorax, lung collapse or puncture.
Overventilation can also cause hypocarbia. When a baby breaths too fast they take in oxygen, but they also breathe out more carbon dioxide. Hypocarbia is a dangerous condition in which the carbon dioxide level in the blood drops below normal for too long. Decreased carbon dioxide causes decreased blood flow to the brain and can lead to periventricular leukomalacia, brain damage and cerebral palsy.
Failure to Diagnose and Treat Dangerous Birth Injuries and Neonatal Conditions
Diagnosing and treating the below injuries and conditions quickly and properly can help prevent permanent neurological and physical damage to newborns.
- Respiratory problems
- Hypoxic ischemic encephalopathy (HIE)
- Neonatal hypoglycemia
- Brain bleeds
- Neonatal Encephalopathy
Resident Physician Fatigue
Resident physician fatigue causes exhaustion, depression, anger and anxiety in medical staff and significantly increases the likelihood of medical negligence. In “Dying to Sleep: Using Federal Legislation and Tort Law to Cure the Effects of Fatigue in Medical Residency Programs,” Andrew E. Gefell discusses the importance of adjusting schedules and reforming programs for resident physicians. It is commonplace for a physician to work 24 hour shifts. Resident physician fatigue causes compromised quality of care, dangerous medical mistakes and liabilities. Hospitals should provide reasonable hours for their resident physicians to ensure that patients are receiving quality care.
Patient to Doctor Ratio
According to a 2012 study by the Association of Medical Colleges, by 2020, there will be a mass shortage of doctors. They expect a loss of 90,000 doctors, including 45,000 patient care physicians. Even today there are not enough doctors per patient. Georgia, reported as one of the worst states for doctors looking to practice, has a ratio of 179.9 doctors per 100,000 people. According to the Centers for Disease Control and Prevention (CDC), the number of births per 1,000 women increased for 2014. The general fertility rate (GFR) rose by 1 percent for the first time in seven years. With an increase in the newborn population and a decrease in medical students, hospitals must ensure appropriate staffing of their nurseries to make sure the appropriate care providers are available.
The July Effect
The July Effect is the increase of errors that occur around the same time that medical students are graduating from school. A study led by Harvard University documented this effect by researching 20 years of medical malpractice claims from five different insurance companies. They found that in the month of July, medication errors spiked by 10 percent. There was a direct correlation between the graduation date for medical students and the amount of medical errors. The study concluded that residents played a role in a third of the cases where medical errors occurred. Neonatal intensive care differs from adult patient care in many different ways. Newborns need experienced and communicative doctors who work as a team with the staff and the parents. Since newborns cannot communicate with medical providers like an adult would, they need intuitive adults who can communicate and advocate for them.
The Weekend Effect
According to a British Medical Journal article and a study by the Department of Primary Care and Public Health, Imperial College London, and the National Audit Office, London, United Kingdom, babies born on the weekend have an increased risk for higher rates of neonatal infection, injury and stillbirth. William L. Palmer, MA, MSc and his colleagues studied 1.3 million deliveries. They found that there was a lower standard of care on the weekend due to under staffing, a difference in hospital policies and availability of resources.
Parents and medical professionals of all kinds need to communicate and ask questions. While it is fully the doctor’s obligation to ask questions about the patient, below are a few questions to ask the physician while in the NICU.
- How many years of experience do you have working in the NICU?
- Are there additional medical professionals who share your expertise?
- What is the opinion of other qualified providers?
- Do you have the medical equipment necessary to treat my baby? (Ex. Hypothermia/cooling treatment, resuscitation equipment)
- Can you explain my child’s condition?
- What is the diagnosis?
Medical professionals must prevent medical errors in the NICU. Being honest and open about the risks can help to prevent future medical errors. Residents who are fresh from medical school must request reasonable work shifts and request more supervision when they know they need assistance with a patient. In these cases, open discussion and consideration about risk for medical errors prevents injury. To reduce medication errors, clinical pharmacists, doctors and nurses must be mindful and considerable of an individual patient’s needs. All medical providers should closely monitor medication dosages. Administration, doctors, pharmacists and nurses must work together to create a culture of safety within the NICU. When everyone works together, less errors occur.
If your newborn was harmed by a medical error, please contact us to find out if you have a potential case. At Reiter & Walsh, PC, we have the experience and knowledge to help your child to get the care they need. For your free case review, please contact an attorney from our legal team. You may contact us in any of the following ways:
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