March 2018

Early this week, the Patient Safety Action Network shared and discussed the ECRI Institute’s Top 10 list of Patient Safety Concerns.  After review of ECRI’s list and report, and much debate, our group decided to create our own list.  Our members have rich knowledge and firsthand experience with patient harm. We know what patients’ priorities are and we’ve infiltrated the work of others on local, state and federal levels towards solutions to end medical harm. This list comes from the collective voices of PSAN.

We recognized that no list is ever complete and we will continue to work on our list.

Do you have ideas on how to fix these problems?

1. Healthcare Acquired Infections, Sepsis
   1. Prevention
   2. Early detection/treatment of infections and sepsis
   3. Screening patients for colonization of multidrug resistant organisms
   4. Multidrug resistance
   5. Lack of new antibiotics available
   6. Prescribing inappropriate antibiotics for existing diagnosis/microorganism
   7. Overuse of antibiotics
       
2. Pharmaceuticals
   1. Use of unsafe drugs/adverse effects of medicines
   2. Ignoring black box warnings
   3. Poor FDA process for approval of drugs
   4. Failure to coordinate medications to determine patient sensitivity and need
   5. Overuse of pharmaceuticals
   6. Inappropriate/irresponsible prescribing of opioids, benzodiazepines, psychotropic drugs
       
3. Unsafe Medical Devices
   1. Poor vetting of new devices
   2. Continued use of known unsafe devices, e.g., surgical mesh, breast implants, Essure
   3. Inadequate warnings, information for patients on risks for use of certain devices
   4. Inability to sanitize/sterilize reusable devices
   5. Promoting use of devices that are very expensive and are no improvement over older devices, e.g., robotic vs laparoscopic surgeries
       
4. Patient Engagement, Communications
   1. No shared decision making
   2. Poor informed consent
   3. Poor communications between healthcare team and patient
   4. Dismissing patient and family concerns
   5. Failure to communicate errors to patients and families
   6. Exclusion of patients and families in Root Cause Analysis
   7. No list of robust and well known enforceable PATIENT RIGHTS
       
5. Failure to Rescue
   1. Healthcare worker alarm fatigue
   2. Lack of continuous monitoring in hospital setting (e.g., “Dead in Bed”)
   3. Need for rapid response teams in every hospital
       
6. Medical and Surgical errors
   1. Concurrent surgeries
   2. Wrong patient
   3. Wrong site
   4. Wrong procedure
   5. Failure to use surgical check lists
   6.   Need for audio/video recording in surgical suites
   7. Anesthesia errors
   8. Diagnostic errors, including imaging and diagnostic test interpretation errors, leading to misdiagnosis
   9. Medication errors: dose, route, patient, medication, time, mixture
   10. Maternal deaths and harm
        
7. Professionalism, Oversight and Availability
   1. Failure to practice evidence based medicine
   2. Allowing dangerous doctors to continue practicing
   3. Inaccessibility to appropriate healthcare (financial, geographic, shortage of professional healthcare providers)
   4. Poor professional nurse staffing in hospitals, long term care/rehab, dialysis centers
   5. Nurse and doctor shortage; nurse/doctor work overload
       
8. Pricing, Costs and Insurance
   1. Complete and total disregard for cost of care
   2. Insurance company interference with physician prescribing and ordering
   3. Healthcare insurance literacy
   4. Out of network, observation status and other insurance tricks
   5. Financial ruin because of healthcare costs, leads to inability to access needed care
       
9. Transparency, Accountability, Integrity
   1. Medical errors and harm not listed on death certificates, no accurate medical error death data
   2. Falsifying medical records after harm
   3. Underreporting of harm and lack of public information on harm
   4. Protection of Profession at any cost
   5. Erosion of rules barring companies from trying to convince doctors to use drugs and devices in untested ways
   6. Selling of sickness; more disclosure and oversight of drug and medical device marketing to healthcare providers
   7. Dissecting the hearts out of medical students