• Section 1. Course Objectives and Reducing Medical Errors

    Welcome To proceed though the course use the Navigation Bar on the left. Click on  “Section 1” to activate the Case Studies and start the course. 

    Introduction

    The prevalence of medical errors in the United States is a significant and ongoing problem. In November 1999, the Institute of Medicine (IOM) released a report estimating that as many as 44,000 to 98,000 patients die as the result of medical errors in hospitals each year. These alarming numbers have resulted in a significant focus on reducing medical errors in the healthcare system.1 

    The causes of medical errors are many and varied. Medical errors can incorporate mistakes made in medication, surgery, laboratory results and diagnosis to name a few.2

    This course summarizes systems that are now being put into place to help decrease the risk of medical errors as well as recommendations that have been made.  Dietitians need to make themselves aware of the issues surrounding medical errors and the scope of the problem as well as what is currently being done to correct them.

    Video Lecture #1 - Course Introduction

    Author: Sharon Richmond - MBA, RD, LDN, CLT

    Course Objectives

    The prevalence of medical errors is a significant problem and after completing this course, the dietetics professional will be able to:

    1. Explain the prevalence and types of medical errors
    2. Describe the benefit a Root Cause Analysis and Action, RCA2 (RCA “squared”) in reducing medical errors
    3. Define medial errors, adverse events, and Sentinel Events
    4. Explain medication errors prevention issues and hospital solutions
    5. Identify the National Patient Safety goals
    6. Explain the best practices in developing a Safety Culture
    7. Define the role of the Registered Dietitian in preventing medical errors
    8. Explain state legal reporting requirements

    Reducing Medical Errors 

    The approach to improving patient safety needs to be that of a comprehensive and team nature.  There is no one single solution to this on-going problem but rather many solutions and systems that must be in place and working properly to decrease the risk of medical errors once and for all.  The focus must not be on blaming individuals but on learning from past errors and preventing future ones.  The goal of healthcare professionals should be to learn the strategies and systems that are currently being put into place and to enable these systems by taking necessary action.

    The belief is that errors can be prevented or decreased significantly by designing systems that would make it hard for healthcare personnel to do the wrong thing and make it easier for them to consistently do the right thing.  Reducing the risk of medical mistakes will take a huge commitment from all people that work within the healthcare community, including Registered Dietitians.

    As dietitians we have access to a patient’s medical chart therefore we have access to vital information.  We have direct contact to each patient and to his or her current medical treatment.  It is important for dietitians to be a vital part of the healthcare team and to be a vital part of the team that works together to decrease the risk of medical errors.  As dietitians, it is our specific responsibility to pay special attention to prescribed diets, to medications that may have a nutritional impact, to any other significant nutritional issue, and to other specific issues that may grasp our attention within our specialty.

    Course Completion Requirements

    To complete this course you must read the course content and successfully complete the assignments in the following sections: (go to the exercises by clicking on the Blue links)

    Section 2: Case Study #1

    Section 4: Case Studies #2 to #5

    Section 5: Case Study #6

    Section 2. Medical Errors Prevalence, Definitions & Root Cause Analysis