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Bahador M,
Volume 64, Issue 9 (9-2006)
Volume 64, Issue 9 (9-2006)
Abstract
At the middle of the 20th century, autopsy has a fundamental role in medical education in Iran, guided by the influential Oslerian philosophy “as is your pathology so is your medical practice”. Students not only attended autopsies, but also had learnt to conduct them. In contrast, today the use of autopsy in medical education is falling down to death. Although this falling is worldwide, but the situation in Iran is much worse. Rarely Iranian medical schools deal with educational autopsy and some of them are quite unfamiliar with autopsy. There are several reasons for this declining including sophisticated medical education with autopsy, community attitudes ,clinicians’ and pathologist’ reluctance, hospital concern about legal action, religious attitudes, consent from the family and funding priorities. Even with new diagnostic modalities, autopsy remains an important tool for quality and safety assurance. A systematic review of reports on autopsies from USA, European and Australian hospitals, revealed 9 to 40% (on average 23.5%) of clinically missed diagnoses and managements involving the principal or underlying cause of death. The key roles of hospital autopsies are Improving safety and quality in diagnosis and treatment, Providing benefits to families, Advancing understand-ing of disease, Allowing good programming for emerging disease and frequently seen disease, and Educating medical and allied health professionals. We have concluded that, reversing the decline of autopsies will require cooperative action at several levels of the healthcare system, particularly including clinicians and pathologists and also governmental and financial bodies and legal authorities.
Mehdi Sanatkar, Seyed Hossein Sadrossadat, Hamed Ghassemi , Ali Reza Ebrahim Soltani , Mohammad Reza Shaverdi, Habibeh Bagheri ,
Volume 77, Issue 2 (5-2019)
Volume 77, Issue 2 (5-2019)
Abstract
Background: Although significant advances have been made in scientific and medical technology, but the rate of medical complaints has also risen. The purpose of this study was to investigate the effect of handling of medical malpractice cases in the hospital complaints committee on the reduction of patient complaints to law enforcement authorities.
Methods: In this descriptive study, patients complained about ophthalmology from April 2005 to December 2005 at Farabi Hospital, Tehran, were evaluated. The complainant's patients, if confirmed by the trusted doctors, were invited to complaints committee, and the subject of the complaint was examined and tried to obtain patient satisfaction.
Results: A total of 87 patients complained to ophthalmologists completed a complaint form 71 (81.7%) of the cases were male. Statistically, the number of complaints was significantly lower in those with lower education (P=0.02). The prevalence of primary disease, 52 cases (59.8%) was cataract and 14 cases (16%) due to refractive errors and refractory surgery. In the examination of complaints by trusted doctors in the hospital, 11 cases of ophthalmologic error were identified, with a mantle rate of 12.6%, and the cases were reviewed by the complaints committee. Of the cases of complained that confirmed by the committee, only one person sued the law enforcement, which represented 9% of the defaulted item. These statistics showed a significant decline compared to the past year at the same center, and the percentage of defaults to law enforcement was 37.5% (P<0.05).
Conclusion: Establishing committees to handle complaints of ophthalmologic failures in hospitals and providing a clear and honest atmosphere to hear the subject of complaints by patients and their companions, and then trying to get patients' satisfaction and helping them continue their treatment can lead to reduced complaints of patients to the authorities Legal, like forensics medicine department and medical council.
Methods: In this descriptive study, patients complained about ophthalmology from April 2005 to December 2005 at Farabi Hospital, Tehran, were evaluated. The complainant's patients, if confirmed by the trusted doctors, were invited to complaints committee, and the subject of the complaint was examined and tried to obtain patient satisfaction.
Results: A total of 87 patients complained to ophthalmologists completed a complaint form 71 (81.7%) of the cases were male. Statistically, the number of complaints was significantly lower in those with lower education (P=0.02). The prevalence of primary disease, 52 cases (59.8%) was cataract and 14 cases (16%) due to refractive errors and refractory surgery. In the examination of complaints by trusted doctors in the hospital, 11 cases of ophthalmologic error were identified, with a mantle rate of 12.6%, and the cases were reviewed by the complaints committee. Of the cases of complained that confirmed by the committee, only one person sued the law enforcement, which represented 9% of the defaulted item. These statistics showed a significant decline compared to the past year at the same center, and the percentage of defaults to law enforcement was 37.5% (P<0.05).
Conclusion: Establishing committees to handle complaints of ophthalmologic failures in hospitals and providing a clear and honest atmosphere to hear the subject of complaints by patients and their companions, and then trying to get patients' satisfaction and helping them continue their treatment can lead to reduced complaints of patients to the authorities Legal, like forensics medicine department and medical council.
Shayesteh Khorasanizadeh , Faranak Behnaz , Masih Ebrahimy Dehkordy , Houman Teymourian , Homeyra Kouzekanani ,
Volume 77, Issue 6 (9-2019)
Volume 77, Issue 6 (9-2019)
Abstract
Background: Hypoglycemia is a condition when blood glucose level is lower than 70 mg/dl in people without diabetes. The symptoms of hypoglycemia include tachycardia, sweating, pallor, pupillary dilatation. Hypoglycemia is a non-lethal and often preventable clinical problem in non-diabetic patients that can occur during fasting or after dining.
Case presentation: A 52 years old man referred to Shohada-e-Tajrish Hospital, Tehran, with diagnosis of kidney stones candidate for percutaneous nephrolithotomy (PCNL). The patient underwent general anesthesia and after 40 minutes, the surgeon requested injection of tranexamic acid because of bleeding, but unintentionally the patient received 100 unites of crystalline insulin by nurse anesthesia. Vital signs were stable, the patient's blood glucose was 85 mg/dl and he had no sweat. Then the therapeutic intervention consisted of administering a bolus dose of 50 cc 50% dextrose water (DW) and then infusion of 50% dextrose water over that time. The patient was monitored for 10 hours in recovery and also received 1 mg of glucagon. The blood glucose was checked frequently. Fortunately, there were not any detectable hypoglycemic attacks (blood glucose less than 70 mg/dl) during that time. Throughout the first three hours in ICU, he suffered from severe hypoglycemic episodes and treated by DW 50% (bolus stat and infusion) and after stabilization of vital signs he transferred to ward.
Conclusion: The mortality of iatrogenic hypoglycemia is lower than other causes of hypoglycemia. However, on time diagnosis and aggressive treatment can prevent serious complications. In addition, proper communication between health care providers and precise checking of drugs labels before injection can dramatically decrease these events.
Case presentation: A 52 years old man referred to Shohada-e-Tajrish Hospital, Tehran, with diagnosis of kidney stones candidate for percutaneous nephrolithotomy (PCNL). The patient underwent general anesthesia and after 40 minutes, the surgeon requested injection of tranexamic acid because of bleeding, but unintentionally the patient received 100 unites of crystalline insulin by nurse anesthesia. Vital signs were stable, the patient's blood glucose was 85 mg/dl and he had no sweat. Then the therapeutic intervention consisted of administering a bolus dose of 50 cc 50% dextrose water (DW) and then infusion of 50% dextrose water over that time. The patient was monitored for 10 hours in recovery and also received 1 mg of glucagon. The blood glucose was checked frequently. Fortunately, there were not any detectable hypoglycemic attacks (blood glucose less than 70 mg/dl) during that time. Throughout the first three hours in ICU, he suffered from severe hypoglycemic episodes and treated by DW 50% (bolus stat and infusion) and after stabilization of vital signs he transferred to ward.
Conclusion: The mortality of iatrogenic hypoglycemia is lower than other causes of hypoglycemia. However, on time diagnosis and aggressive treatment can prevent serious complications. In addition, proper communication between health care providers and precise checking of drugs labels before injection can dramatically decrease these events.
Babak Mostafazadeh , Mohammad Javad Amirian , Saeed Shabani ,
Volume 77, Issue 10 (1-2020)
Volume 77, Issue 10 (1-2020)
Abstract
Background: Medical malpractice is one of the most important legal issues in medicine committed more or less by physicians. The medical staff has inadequate or deficient awareness of medical errors and their importance. Therefore, this study investigated the frequency of medical malpractices/errors resulting in death in files referred to the Iranian Legal Medicine Organization.
Methods: The study population in this descriptive cross-sectional research consisted of all doctors who had been sued in Tehran's Legal Medicine Organization (Forensic Committees of Tehran Province) from the first day of July 2018 to the end of December 2018. The study was carried out in and under supervision and support of the Legal Medicine Research Center. Data were collected using a checklist of the files from Tehran's Legal Medicine Organization.
Results: The results showed that most medical errors are of organizational types. Major medical failures occur in university-affiliated hospitals among the male technical staff aged 41-50 years with a work experience less than 6 years. Most complaints were recorded against general practitioners, general surgeons, and anesthesiologists, respectively. The smallest percentage of the complaints related to orthopedics, urologists, and ear, nose, and throat (ENT) specialists.
Conclusion: The results of the study indicated that most of medical failures have of an organizational nature and occur in university hospitals among male technical officials who are in the fifth decade of life with a low work experience. So, paying attention to these issues can help the better selection of technical officials. The technical authorities of the hospitals must be careful about the responsibilities given to them. In order to reduce the failure of the technical authorities of the hospitals, doctors with a high standard of service should be appointed as technical officers. These doctors ought to possess legal knowledge and be familiar with the course of complaints filed in the judiciary.
Methods: The study population in this descriptive cross-sectional research consisted of all doctors who had been sued in Tehran's Legal Medicine Organization (Forensic Committees of Tehran Province) from the first day of July 2018 to the end of December 2018. The study was carried out in and under supervision and support of the Legal Medicine Research Center. Data were collected using a checklist of the files from Tehran's Legal Medicine Organization.
Results: The results showed that most medical errors are of organizational types. Major medical failures occur in university-affiliated hospitals among the male technical staff aged 41-50 years with a work experience less than 6 years. Most complaints were recorded against general practitioners, general surgeons, and anesthesiologists, respectively. The smallest percentage of the complaints related to orthopedics, urologists, and ear, nose, and throat (ENT) specialists.
Conclusion: The results of the study indicated that most of medical failures have of an organizational nature and occur in university hospitals among male technical officials who are in the fifth decade of life with a low work experience. So, paying attention to these issues can help the better selection of technical officials. The technical authorities of the hospitals must be careful about the responsibilities given to them. In order to reduce the failure of the technical authorities of the hospitals, doctors with a high standard of service should be appointed as technical officers. These doctors ought to possess legal knowledge and be familiar with the course of complaints filed in the judiciary.
Ali Mohammad Mosadeghrad , Parvaneh Isfahani, Taraneh Yousefinezhadi,
Volume 78, Issue 4 (7-2020)
Volume 78, Issue 4 (7-2020)
Abstract
Background: Medical errors are those errors or mistakes committed by healthcare professionals due to errors of omission, errors in planning, and errors of execution of a planned healthcare action whether or not it is harmful to the patient. Medical error in hospitals increases morbidity and mortality and decreases patient satisfaction and hospital productivity. This study aimed to determine the prevalence of medical errors in Iranian hospitals.
Methods: This study was conducted using systematic review and meta-analysis approaches. All articles written in English and Persian on the prevalence of medical errors in Iranian hospitals up to March 2019 were searched in Web of Science, PubMed, Elsevier, Scopus, Magiran, IranMedex and Scientific Information Database (SID) databases, and Google and Google Scholar search engines. In addition, reference lists of the retrieved papers were hand-searched. A total of 9 studies matching the inclusion criteria were identified, reviewed, and analyzed using comprehensive meta-analysis software.
Methods: This study was conducted using systematic review and meta-analysis approaches. All articles written in English and Persian on the prevalence of medical errors in Iranian hospitals up to March 2019 were searched in Web of Science, PubMed, Elsevier, Scopus, Magiran, IranMedex and Scientific Information Database (SID) databases, and Google and Google Scholar search engines. In addition, reference lists of the retrieved papers were hand-searched. A total of 9 studies matching the inclusion criteria were identified, reviewed, and analyzed using comprehensive meta-analysis software.
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Results: The prevalence of medical errors was reported in 9 studies and prevalence rate ranged from 0.06% to 42%. Most studies used reporting forms completed by hospital employees for determining the prevalence of medical errors (67%). Only three studies collected data by reviewing patients’ medical records. Accordingly, the overall prevalence of medical error in Iran's hospitals based on the nine published articles was 0.01% (95% Cl 0%-0.01%) during 2008 to 2017. The highest medical error was recorded in a hospital in Shiraz, 2.1% (95% Cl: 1.4%-2.7%) in 2012. A significant statistical correlation was observed between medical errors and sample size (P<0.05).
Conclusion: The prevalence rate of medical error in Iran is low. It is strongly recommended to use more advanced and valid methods such as occurrence reporting, screening, and the global trigger tool for examining medical errors in Iranian hospitals. Proving adequate education and training to patients and employees, simplifying and standardizing hospital processes, enhancing hospital information systems, improving communication, promoting a safety culture, improving employees’ welfare and satisfaction, and implementing quality management strategies are useful for reducing medical errors. |
Abolghasem Pourreza, Ali Mohammad Mosadeghrad , Masoumeh Parvizi-Shad ,
Volume 78, Issue 5 (8-2020)
Volume 78, Issue 5 (8-2020)
Abstract
Background: Medical errors are those mistakes committed by healthcare professionals due to wrong execution of a planned healthcare action or execution of a wrong healthcare action plan whether or not it is harmful to the patient. Medical errors may cause patients to suffer and have huge financial costs for the healthcare system. Identifying and measuring medical errors and adverse events are essential for improving patient safety. The objectives of this research were to measure medical errors and adverse events rates, to identify their severity and also analyze their underlying causes in a general educational hospital in Tehran, Iran by using The Global Trigger Tool.
Methods: A descriptive, cross-sectional, and retrospective approach was used in this study. The medical records of 377 hospitalized patients between April 2015 and March 2016 were examined using simple random sampling method. Patient’s records were reviewed by a nurse using The Global Trigger Tool. Then, a physician authenticated the findings of the adverse events and rated their severity. The causes of adverse events were identified using brain storming and Ishikawa Cause And Effect Diagram.
Methods: A descriptive, cross-sectional, and retrospective approach was used in this study. The medical records of 377 hospitalized patients between April 2015 and March 2016 were examined using simple random sampling method. Patient’s records were reviewed by a nurse using The Global Trigger Tool. Then, a physician authenticated the findings of the adverse events and rated their severity. The causes of adverse events were identified using brain storming and Ishikawa Cause And Effect Diagram.
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Results: A total of 205 triggers were detected, and 60 adverse events were identified. About 15.9 percent of patients experienced an adverse event. The rate of adverse events was 19.1 per 100 admissions and 5.7 per 100 Admission days or hospitalization days. Almost half of the adverse events were in the E and F categories (temporary harm). Bleeding, nosocomial infections, and patient fall were the leading adverse events. Employees and working processes were the underlying causes of the medical errors and adverse events. The Global Trigger Tool found 100 times more adverse events than the voluntary reporting method.
Conclusion: The adverse event rate of this study was high. Hospital managers should take appropriate actions to reduce medical errors and adverse events and enhance patient safety. The Global Trigger is a Powerful, reliable, strong tool for identifying adverse events and measuring their severity. |
Samaneh Assarzadeh, Shirin Sadat Badri, Sakinah Haddad , Marjan Mansourian, Shadi Farsaei, Saeed Abbasi,
Volume 78, Issue 8 (11-2020)
Volume 78, Issue 8 (11-2020)
Abstract
Background: Intravenous (IV) injection of drugs is one of the most common methods of drug prescription in hospitals, which is a complex, potentially hazardous and erroneous method; accordingly, it requires control methods to reduce the potential risks. This study focused on determining the frequency and types of different medication errors while preparing and administering mostly used IV drugs in three intensive care units (ICU) and one general department in AL-Zahra hospital, Isfahan, Iran.
Methods: This cross-sectional observational study was conducted for 6 months from September 2017 to March 2018. To determine the frequency of different medication errors, a quoting sampling method was applied to select and observe 400 cases of IV drug administrations. All nurses from any studied department were included in this study. Different stages of preparation and administration of the observed drugs were compared to an instructed checklist prepared by the clinical pharmacist.
Methods: This cross-sectional observational study was conducted for 6 months from September 2017 to March 2018. To determine the frequency of different medication errors, a quoting sampling method was applied to select and observe 400 cases of IV drug administrations. All nurses from any studied department were included in this study. Different stages of preparation and administration of the observed drugs were compared to an instructed checklist prepared by the clinical pharmacist.
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Results: Totally, 75 nurses were recruited from ICU-1 (N=29), ICU-2 (N=18), ICU-3 (N=19), and nephrology (N=9) departments. Type of department and occupation were the influential factors on nursing errors; also, a significant relationship was found between different work shifts and the occurrence of nurses’ errors, mostly seen in the evening work shift (P=0.037). The mean of nurses’ errors in IV drug administration was not correlated with other factors including age, work history, and the number of patients managed by each one. Also, a positive correlation was found between the number of nurses in each work shift and the number of errors (P=0.008).
Conclusion: Medication errors in each stage of drug administration may lead to the hazardous clinical outcome or serious side effects such as thrombosis, infection or eventually lead to morbidity or mortality. Therefore, being aware of these errors and establishing observational policies can prevent unpleasant events related to drug administration. |
Navid Kalani, Naser Hatami, Mohammad Zarenezhad, Alireza Doroudchi , Mahdi Foroughian, Esmaeil Raeyat Doost ,
Volume 79, Issue 5 (8-2021)
Volume 79, Issue 5 (8-2021)
Abstract
Background: Medical malpractice is a serious problem in the health care system. This study aimed to review the medical negligence in Iran.
Methods: Based on the PRISMA checklist, a search for scientific records was done separately by two researchers. All the articles that had selection criteria were evaluated in terms of methodological quality. Medical malpractice was assessed in four main divisions including negligence, Lack of skill, Carelessness and non-compliance with government regulations). The bias test was performed using the Egger’s test. Revman software was used to analyze the data.
Results: In the present study, 25 studies that examined the country's medical malpractice from April 1994 to March 2018 were included in the meta-analysis. Negligence has been implicated in 1,105 cases of the 2,068 claims. Lack of skill in 255 out of 2068 cases, 432 cases of carelessness and 244 cases of non-compliance with government regulations Were recorded the results of the meta-analysis showed that OR negligence was 0.76 (CI 95%: 0.66-0.87), lack of skill was 0.61 (CI 95%: 0.49-0.76), carelessness was 0.62 (CI 95%: 0.50-0.76) and non-compliance with government regulations was 0.66 (95% CI: 0.60-0.73). In the review of the confirmed negligence ratio of the registered complaint files, only 19 studies mentioned this ratio. The results of the meta-analysis of these 19 studies showed that the OR ratio of the confirmed negligence of complaints was 0.6 (95% CI: 0.41-0.86). From all claims, General surgeons had OR of confirmed medical malpractices, equal to 0.47 (CI 95%: 0.37-0.60), gynecologists with OR equal to 0.49 (CI 95%: 0.36-0.66), general practitioners with OR equal to 0.43 (CI 95%: 0.30-0.63) and orthopedic specialists with an OR of 0.44 (CI 95%: 0.32-0.61).
Methods: Based on the PRISMA checklist, a search for scientific records was done separately by two researchers. All the articles that had selection criteria were evaluated in terms of methodological quality. Medical malpractice was assessed in four main divisions including negligence, Lack of skill, Carelessness and non-compliance with government regulations). The bias test was performed using the Egger’s test. Revman software was used to analyze the data.
Results: In the present study, 25 studies that examined the country's medical malpractice from April 1994 to March 2018 were included in the meta-analysis. Negligence has been implicated in 1,105 cases of the 2,068 claims. Lack of skill in 255 out of 2068 cases, 432 cases of carelessness and 244 cases of non-compliance with government regulations Were recorded the results of the meta-analysis showed that OR negligence was 0.76 (CI 95%: 0.66-0.87), lack of skill was 0.61 (CI 95%: 0.49-0.76), carelessness was 0.62 (CI 95%: 0.50-0.76) and non-compliance with government regulations was 0.66 (95% CI: 0.60-0.73). In the review of the confirmed negligence ratio of the registered complaint files, only 19 studies mentioned this ratio. The results of the meta-analysis of these 19 studies showed that the OR ratio of the confirmed negligence of complaints was 0.6 (95% CI: 0.41-0.86). From all claims, General surgeons had OR of confirmed medical malpractices, equal to 0.47 (CI 95%: 0.37-0.60), gynecologists with OR equal to 0.49 (CI 95%: 0.36-0.66), general practitioners with OR equal to 0.43 (CI 95%: 0.30-0.63) and orthopedic specialists with an OR of 0.44 (CI 95%: 0.32-0.61).
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Conclusion: The results of this study help to understand the current position of medical negligence studies in the country to identify the cause of the malpractice and develop new studies for the future.
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Mohammad Hossein Kalami , Zeinab Borjian Boroujeni , Peghah Ardi, Ahmad Abolfathi, Mohsen Babaei, Ali Asadi, Mahdi Zareei,
Volume 81, Issue 1 (4-2023)
Volume 81, Issue 1 (4-2023)
Abstract
Background: Medical Laboratories have a great impact on patient safety and 80-90% of medical diagnoses are based on the results of laboratory tests. Medical procedures from the initial diagnostic steps such as a test or a simple injection to specialized treatment steps may be erroneous. The aim of this study was to determine the type and rate of human error, equipment, materials and procedures in all stages including before analysis, during analysis and after analysis to analyze the causes and find logical solutions to reduce of them.
Methods: This cross-sectional descriptive study was performed in a medical center in Tehran, Iran during the years 1400-1401. Data collection was considered in accordance with the instructions of the Laboratory Affairs Department of the Ministry of Health and Medical Education regarding the type of errors in the field of job description in each of the technical and non-technical sections. Data was analyzed by IBM SPSS software, version 22 (SPSS Inc., Chicago, IL, USA) software.
Methods: This cross-sectional descriptive study was performed in a medical center in Tehran, Iran during the years 1400-1401. Data collection was considered in accordance with the instructions of the Laboratory Affairs Department of the Ministry of Health and Medical Education regarding the type of errors in the field of job description in each of the technical and non-technical sections. Data was analyzed by IBM SPSS software, version 22 (SPSS Inc., Chicago, IL, USA) software.
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Results: During the period of study, the number of referred patients was about 45,000 and the number of tests 594,000. The total number of errors was 837. The ratio of errors to the patients was 1.9% and to the tests 0.15%. The 37 types of errors were identified and reported in this study. Of these, 11 types of errors were in the pre-analysis, 14 types during the analysis and 12 types of errors in the post-analysis stage. The frequency of errors in the three stages was 180(21.5%), 312(37.3%) and 345(41.2%), respectively that the errors rate did not have a normal distribution and a significant difference was observed (P<0.05, df=2).
Conclusion: Due to the variety of reported errors and the importance of their role in other stages of diagnosis and treatment, it is necessary that all human, equipment and process errors in all stages of laboratory analysis be carefully recorded and corrective and preventive measures be taken to minimize them. |
Hadi Lotfi, Morteza Izadi, Ehsan Lutfi , Hadi Esmaeili Gouvarchin Ghaleh,
Volume 81, Issue 7 (10-2023)
Volume 81, Issue 7 (10-2023)
Abstract
Deliberate or threatening use of viruses, bacteria, toxins, or poisonous substances prepared from living organisms to cause death or disease in humans, animals, and plants is called bioterrorism. These agents can be spread by spraying them in the air, causing infection in animals, transferring this infection to humans, or contaminating water and food sources. Defense measures, such as emergency responses to this type of terrorism, are unfamiliar and unknown. The general state of helplessness caused by the lack of complete preparation and the lack of anti-pollution strategies complicates the issue. The ability and widespread interest of civilian personnel to participate in the development of chemical and biological weapons is directly related to easy access to academic excellence around the world. Another factor is the tempting misuse of freely available electronic data and knowledge about the production of antibiotics, vaccines, and conventional weapons with their various complex details. The use of animals in laboratory research to better understand the mechanisms of disease and treatment and to overcome the limitations of clinical trials has a long history. For many viruses, laboratory diagnostic methods and reagents must be continuously modified to account for genetic variations and variants. Unlike bacterial diseases, many of which can be treated with antimicrobial drugs, there are fewer medical countermeasures to combat viral infections. Many of these pathogens are lethal or cause debilitating diseases in humans, making it ethically inappropriate to test the effectiveness of these countermeasures on human volunteers. Researchers must have a correct understanding of various animal models so that they can make the correct choice, gain a better understanding of the clinical symptoms of viral diseases, and provide possible options for treatment and vaccine development. It should be noted that decision-making when faced with a biological attack should be done away from too much fear, and this requires researchers to have prior knowledge of facing these threats. Despite all these checks and measures taken in advance, the international preparedness against these attacks is weak, which can be attributed to the lack of global plans to deal with the epidemic.
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