Itzhak Brook MD, MSc.Professor of Pediatrics and Medicine

Georgetown University School of Medicine

Preventing Errors in Oncology:A Physician’s Perspective as a

Cancer of the Neck Patient

Tracheo-esophageal speech with a voice prosthesis

Overview1

• Hospitalization after surgery• Physician's errors• Nurses errors• Preventing errors• Advocacy• Suggestions for improving care

1. Brook I. Neck Cancer- A Physicians’ Personal Experience. Arch Otolaryngol Head Neck Surg. 2009;135:118.

Hospitalization after Laryngectomy

• Emotional unpreparedness• Pain, weakness & complete

dependency • Tube feeding • Connected to lines• Humidified oxygen & suctioning • Blood drawn almost daily• Unable to talk ( writing only)

Medical errors

• Occur at all levels-nurses, physician

• Reluctance to complaint (dependency)

• Laryngectomees more vulnerable and less able to abort errors because their inability to speak

Physician’s Errors• Failure to detect cancer

recurrence• Early feeding• Removal of scar tissue instead

of the tumor• Forgetting to write down orders

Nurses’ Errors (1)

• Not responding to calls• Forgetting to connect the call button.• Not washing hands or using gloves • Not placing the oral thermometer in

a plastic cover• Using an inappropriately sized blood

pressure cuff • Administer an incorrect dose of a

medication

Nurses Errors (2)•Administer medications orally instead of an NG tube•Administer medications through the NG tube dissolved in hot water (causing esophageal burn)•Connecting suction machine to wall without a bottle of water•Not rinsing the hydrogen peroxide after cleaning the tracheostomy tube (causing severe irritation)

Preventing medical errors (1)• Better & uniform training. • Adhere to established standards• Perform regular records review to detect

and correct errors• Employ only well trained medical staff. • Counsel, reprimand, and educate staff who

make errors. Dismiss those who continue to make mistakes.

• Develop & meticulously follow algorithms, set procedures & bedside checklist for all procedures.

Preventing medical errors (2)• Increase supervision & communication

between health care providers• Educate patients & caregivers about patient

condition & treatment plans • Encourage patient advocacy (family/friend) to

ensure appropriate management• Respond to complaints. Admit responsibility

when appropriate & discuss these with the family and staff

• Investigate all errors and take preventive action

Advocacy• Choosing the appropriate treatment

(laser, conventional surgery)• Get a second opinion• Look for an expert in your type of

surgery• Do not confuse friendliness with

expertise • Ask for the true prognosis

Be Your Own Advocate• Decrease chances of medical errors by

being informed and not hesitating to challenge & ask for explanations

• Become an “expert” • Have a family or friends with you in the

hospital• Get a second opinion• Educate your medical caregivers about

your condition and needs (prior to and after surgery)

Improving surgeons’ attitude after laryngectomy

Patient should ask • that they be patient, allow more

time for communication • Explain what will happen• Understand the challenges of

life as a laryngectomee

Improving surgeons attitude after laryngectomy

• Need patience and sensitive, allow more time for communication

• Explain what is happening• Understand the tremendous life

changing event of becoming a laryngectomee

• Examine all parts of the body

Patient’s post surgical care can be improved by:

• Educating patient and family about the short & long term medical & social implications of the procedures

• Greater personal attention by surgical team (spending more time, provide information)

• implementing standard techniques of nursing care

Patient’s post surgical care can be improved by (2):

• Greater vigilance & better communication among staff to avoid medical errors

• Educate surgeons: proper medical and psychological post surgical care, special needs of patients after major surgery

Blog site for book: http://dribrook.blogspot.com

Thanks for your attention!

Any Questions?

Itzhak Brook MD, Professor of Pediatrics and Medicine

Georgetown University School of Medicine

ib6@georgetown.edu

http://dribrook.blogspot.com

Phone: 202-744 8211