Abstract: Medical errors are known as the most important challenges that healthcare systems in all countries are encountered to them. To provide security and safety for patient is one of the major items in the health care systems. Confessing medical errors imposed on patient and education system is found to be an important aspect of medical ethics and care in turn lowers incidence of errors. Given the importance of identifying and reporting occurred medical errors, the present research aimed to assess medical errors in hospital wards of Shohadaye Ashayer Hospital Khorramabad so that findings of this research can inspire us to incorporate medical errors as a very important subject in the curriculum of medical students and finally physicians can do best examination and treatment with minimal or no errors and inaccuracies. The present research is descriptive in nature which lasted from April to March 2015. Statistical population (subjects) included employees and supervisors, nurses, staffs, lab safety facilitator, pharmacy safety facilitator, surgery room personnel, equipment and personnel in the hospital wards, including the emergency department, men surgery, women surgery, operating room, orthopedics, internal medicine ward, neurology, laboratory room, surgery, infectious, ophthalmic, reception, pharmacy and CCU hospital in Shohadaye Ashayer Hospital- Khorramabad. © 2009-2016, JGPT

Astaraki, Peyman.

Mahmoudi, Ghafar Ali.

Masoudi, Reza.

Nasiri, Manouchehr.

Tarrahi, Mohammad Javad.

shahrekord university of medical scinces

                                                   ISSN 0975 -8542     Journal of Global Pharma Technology      Available Online at www.jgpt.co.in                                                                                                                                                                                                                                                        RESEARCH PAPER © 2009-2016, JGPT. All Rights Reserved.                                                                                                                                                                                               27  Evaluation of Medical Error Status in Various Wards of Shohadaye Ashayer Hospital, Khorramabad, Iran Ghafar Ali Mahmoudi1, Peyman Astaraki1, Manouchehr Nasiri2, Mohammad-Javad Tarrahi3, Reza Masoudi4*  1Faculty of Medicine, Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.  2Center for Quality Improvement and Patient Safety of Shohadaye-Ashayer Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran.  3Department of Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.  4Medical Plants Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.  *Corresponding author: Reza Masoudi. Abstract: Medical errors are known as the most important challenges that healthcare systems in all countries are encountered to them. To provide security and safety for patient is one of the major items in the health care systems. Confessing medical errors imposed on patient and education system is found to be an important aspect of medical ethics and care in turn lowers incidence of errors. Given the importance of identifying and reporting occurred medical errors, the present research aimed to assess medical errors in hospital wards of Shohadaye Ashayer Hospital Khorramabad so that findings of this research can inspire us to incorporate medical errors as a very important subject in the curriculum of medical students and finally physicians can do best examination and treatment with minimal or no errors and inaccuracies. The present research is descriptive in nature which lasted from April to March 2015. Statistical population (subjects) included employees and supervisors, nurses, staffs, lab safety facilitator, pharmacy safety facilitator, surgery room personnel, equipment and personnel in the hospital wards, including the emergency department, men surgery, women surgery, operating room, orthopedics, internal medicine ward, neurology, laboratory room, surgery, infectious, ophthalmic, reception, pharmacy and CCU hospital in Shohadaye Ashayer Hospital- Khorramabad.  Keywords: Medical Error, Hospital, Khorramabad, Iran.  Introduction Mistakes in human action are inevitable and serve as an integral part of human reality [1]. Medical errors are among the most important challenges facing health systems in all countries [2, 3]. Confessing medical errors imposed on patient and education system is found to be an important aspect of medical ethics and care in turn lowers incidence of errors [4]. Medical errors may occur while inpatient care in hospitals, interpretation of laboratory results, diagnosis, surgery, prescription drugs, medical devices etc. [5].   Some factors such as fear of reputation loss among colleagues, fear of blaming by colleagues, fear of litigation patient and prosecution, prejudice and fear of negative Reza Masoudi et. al., Journal of Global Pharma Technology. 2016; 10(8):27-31 © 2009-2016, JGPT. All Rights Reserved.                                                                                                                                                                                           28 propaganda against doctors and medical impact of the declaration are the main drawbacks for self-reporting. According to principles of medical ethics, when a type of medical error is occurred, wrongdoer should present honest report on what went wrong [6]. In US medical errors caused the death of 88,000 people [7]. In Britain medical error economical loss has been estimated to be 2 billion £, causing damage to 850,000 people per year [8].   According to research, out of 10 people admitted to hospital, a person experienced a traumatic event that about half of them are preventable. At the same time about one third of these events are harmful for patients [9]. People are fallible and errors are inevitable even in the best organizations [10]. Error disclosure is a basis for maintaining and improving patient safety. Health care providers have moral and professional obligation for errors disclosure [11, 12].   Given the importance of identifying and reporting medical errors, the present research deals with medical errors in hospital wards of Shohadaye Ashayer Hospital- Khorramabad so that findings of this research can inspire us to incorporate medical errors as a very important subject in the curriculum of medical students and finally physicians can do best examination and treatment with minimal or no errors and inaccuracies. Methods The present research is descriptive in nature which lasted from April to March 2015. Statistical population (subjects) included employees and supervisors, nurses, staffs, lab safety facilitator, pharmacy safety facilitator, surgery room personnel, equipment and personnel in the hospital wards, including the emergency department, men surgery, women surgery, operating room, orthopedics, internal medicine ward, neurology, laboratory room, surgery, infectious, ophthalmic, reception, pharmacy and CCU hospital in Shohadaye Ashayer Hospital- Khorramabad.   The data collection instrument in the present research is self-reports of hospital staffs in 2015.  Results and Discussion As it can be seen in table 1, emergency ward with 165 errors accounted for highest error and reported large number of medical error (table 1). The wards laboratory (276), hospital pharmacies (158) and internal (136) were the most important error reporting units (Table 2). Additional information on this is specified in Table 2 and 3. As it is illustrated in table 4, the nurses accounted for largest number of medical errors (398). Information on jobs and staffs are presented in table 4.  Table 1: The errors made at different hospital wards and various units of Shohadaye Ashayer Hospital Khorramabad in 2015 Infectious Men burning CCU Neurology Women surgery Emergency 71 2 2 42 49 165 Men surgery Autoclave Neurosurgery Men Orthopedic Hospital pharmacy Eye & ENT 37 2 29 15 19 27 ICU Neurology Hospital Reception Surgery-ICU Lab Operation room Internist 5 1 10 5 5 143 BICU All wards Women burning hematology Radiology Dialysis 7 1 2 10 1 21 Orthopedic Operating Room Not Declared Urology ICU General Laundry  6 7 28 19 1   Table 2: Statistics on wards and units reporting medical error in terms of ward or month and year Ward Number of medical errors till March 2015 Ward Number of medical errors till March 2015 Emergency 8 Urology 18 Hospital pharmacy 276 Dialysis 21 Internist 158 Radiology 16 Reza Masoudi et. al., Journal of Global Pharma Technology. 2016; 10(8):27-31 © 2009-2016, JGPT. All Rights Reserved.                                                                                                                                                                                           29 Table 2: Continue Infectious 136 General ICU 1 Eye and ENT 39 Surgical ICU 7 Women surgery 13 BICU 2 Men surgery 24 Informatics 3 Neuro surgery 17 Physiotherapy 1 Hematology 6 autoclave 1 Neurology 7 Not Declared 2   Table 3: Number of medical error reported by wards in 2015 Dialyze  Neurology  Urology  Women surgery Infectious  Internal  Hospital pharmacy Laboratory 16  18 21 24 39 136 158 276 BICU  Not declared General ICU Neurosurgery Hematology Emergency Eye ENT Men Surgery 3  5 6 7 7 8 13 13 Men burning Surgery room Surgery Surgery room Orthopedic Orthopedic men Autoclave ICU radiology Women burn 1  1 1 2 2 2 2 2 Endoscopy  ICU Neurology Outpatient Pharmacy CCU Laundry Pathology Medical documents Informatics -  - - - - - - 1 Reception  Spirometry ESWL Sonography Dental Clinic Laundry  -  - - - - - -   Table 4: Number of medical errors made by staffs in hospital Operating room personnel  1 Doctor 4 specialist  1 Laboratory staff 4 receptionist  1 Head nurse 12 Patient  2 Secretary 13 Supervisor  2 Safety liaison 37 CT scan technician  2 Not Declared 268 Anesthesia staff  3 Nurse 398 Services  4    Table 5: Details on staffs reporting medical error in hospital Secretary 1 Anesthesia staff 2 Services 1 Laboratory staff 3 Health expert 1 Staff 10 Equipment Personnel 1 Head nurse 59 Supervisor 1 Safety liaison 151 Operating room personnel 1 Pharmacy liaison 177 CT scan technician 1 nurse 225  As it can be seen, it was found that nurses, pharmacy and laboratory personnel had the most medical error with number of 225, 177 and 151 respectively. Medical errors are inevitable and at the same time are very common in the health system. Most benefit after the occurrence of medical errors is when a basic plan and systematic mechanism is present to evaluate and analyze the occurrence of medical errors and errors can be serves as opportunity to reform the health system and prevention of repeated next errors. When not resolve the root causes of the error and the error is frequently not detected by a particular person or any other person to replace him will be repeated.   Systematic approach to errors culture to organize and participate actively in staff meetings and team-purpose medical errors and identify and knowledge of the causes that lead to medical errors are, in effect prevent their occurrence is so necessary. When an adverse event occurs is important to find out who has made a mistake but we must examine the failure of defense mechanisms against what has been the emergence of error. Medical mistakes are inevitable and occur sporadically, sometimes mistakes are minimal and safe but in some cases are serious enough can endanger patients' lives.  Although error reports and events to promote patient safety alone do not forgivable, however, learning from mistakes Reza Masoudi et. al., Journal of Global Pharma Technology. 2016; 10(8):27-31 © 2009-2016, JGPT. All Rights Reserved.                                                                                                                                                                                           30 is essential if error-free report in order to spread the culture of blame and punishment, spread of reported errors is expected to prevent similar occurrences in the future. Hence here results of 94 medical errors by hospital personnel for April 2015 have been presented and it should be noted that error detection is a basis for maintenance and promote patient safety. Despite the moral obligation and professional service providers to disclose the error, error reporting among nurses is much less than its real value. Laboratory testing process consists of three stages: before, during and after each test, which are potential sources of error. Given the importance of laboratory results in patients' health with regard to the safety and health of patients, requires extensive attention to error sources [13].  Literature showed that the main source of error in pre-experiments that covers most errors so that most important are patient misdiagnosis, inappropriate tubing, small sample size, lack of patients' demographic data, changes in the elements and components of the sample in the sample, poor quality samples such as hemolysis and clotting as well as lack of proper transport of samples to the laboratory. We should believe that laboratory errors can be a factor for some improved cases or sudden death. This is where laboratory errors get importance and we must remove or reduce the effort associated with these errors.  Medication errors are a global problem can lead to serious injuries and even death of patients. The primary outcome was a natural medication errors and increase patient length of stay in hospital and increased cost would be staggering. In general medication errors on patients, nurses and organizations have a negative impact, leading to a decline in quality of care. According to the importance of patient safety topics necessary to create an effective system for reporting and recording errors by minimizing reporting barriers is essential to reduce medication errors.    Conclusion The main purpose of medical error reporting systems is to learn from the experience of other health systems. It is important to note that this system alone will not improve patient safety but it is appropriate feedback to report that leads to changing and upgrading systems and methods.   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Kellogg V, Havens D (2003) Adverse events in acute care: an integrative literature review, Res Nurs Health, 26(5): 398-400. 8. Vincent C, Neale G, Woloshynowych M (2001) Adverse events in British hospitals: preliminary retrospective record review, BMJ, 322 (7285):517-519. Reza Masoudi et. al., Journal of Global Pharma Technology. 2016; 10(8):27-31 © 2009-2016, JGPT. All Rights Reserved.                                                                                                                                                                                           31 9. Mazor M, Simon SR, Yood RA (2009) Health plan members’ views about disclosure of medical errors, Ann Intern Med, 140:409-418.  10. Barach P, Berwick DM (2003) Patient safety and the reliability of health care systems, Ann Intern Med, 138:997–998. 11. Lawton R, Parker D (2002) Barriers to incident reporting in a healthcare system, Qual Saf Health Care, 11(1):8-15.                             12. 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Evaluation of medical error status in various wards of Shohadaye Ashayer Hospital, Khorramabad, Iran

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