An Overview of Medical Errors in Refractive Surgery

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An Overview of Medical Errors in Refractive Surgery The Institute of Medicine defines medical errors as the failure of an action planned earlier to be completed as desired or use of a wrong plan to achieve a particular aim. Medical errors are a costly and devastating risk that can affect every medical specialty. If a patient is found to have received wrong treatment and harmed from their healthcare, the physician is faced with litigation for medical negligence. Medical errors in refractive surgery can lead to loss of vision. A 2013 study explored the source of preventable medical errors in refractive surgery with the aim of improving awareness among refractive surgeons and preventing the occurrence of such errors. Let’s see what these experts have to say.

Major Types of Error Sources A large number of problems related to including myopia, Refractive surgery

ophthalmologic consultations are for ocular refraction or refractive defects hypermetropia and/or astigmatism. aims to correct these defects and

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eliminate dependence on glasses. The 2013 study identified three significant sources of error in this surgical procedure: •

Data Entry Errors – This type of errors involves sphere +/- sign inversion and wrong decimal position.

An example for sign inversion cited in the study involved a 56-year-old man who was hyperopic with a manifest refraction of +3.50 -0.50 x 075 in the right eye and the intended treatment was +3.80 -0.50 x 075 in the right eye. However, the sign was incorrectly entered as negative (-) so that it the treatment was interpreted as -3.80 -0.50 x 075 in the right eye, which resulted in the patient receiving myopic instead of hyperopic treatment.

•

Cylinder Conversion Error – In this case, the study gives the example of a patient presented for LASIK. The patient has a preoperative manifest refraction of -6.00 -2.00 x 180 in the right eye and the intended treatment was -8.00+2.00 x 90. However, cylinder conversion error led the data to be incorrectly entered as -8.00+2.00 x 180 and the results of the surgery were accordingly affected. The surgeon then determined the patient was a good candidate for LASIK enhancement to correct this error. But a second cylinder conversion error occurred during the conversion, which ultimately doubled the patient’s astigmatism.

•

Patient Identification Error – In another example of a patient identification error, the study describes the

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case of a 47-year-old male who was presented for LASIK with manifest refraction -7.00 +1.00 x100 in the right eye and -6.00 + 1.00 x 080 in the left eye.

But he and was misidentified as another patient and received that patient’s treatment of -3.00+0.50 x 009 in the right eye and -3.00 +1.00 x 005 in the left eye.

After the operation, the manifest refraction of the 47year-old was found to be -3.00 +1.00 x105 in the right eye and -2.50 +1.75x 095 in the left eye. The treating surgeon decided on LASIK enhancement for this patient to correct the error and the patient received LASIK re-treatment, resulting in a UDVA of 20/20.

The study found cylinder conversion error as the leading cause of error and stressed the need for a foolproof system to prevent conversion errors. The study also noted that data entry and transcription errors form around 26% of all medical errors and that the error rate in clinical database entry is between 2.3% and 26.6% which shows that data entry error is also a significant issue. The study recommends consistent adherence to proper timeout protocol to prevent treating the wrong patient. Healthcare experts recommend that surgeons keep safety checklists to double-check settings and treatment plans just before the surgery begins.

EHR can Increase Data Entry Errors While there is already a large volume of ophthalmologic consultations for correcting refractive defects, such consultations can be expected to increase further with

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expanded coverage under Obamacare. Though Electronic Health Records (EHRs) are very useful to manage this surge, they pose a greater risk of errors caused by physicians inadvertently making data entry mistakes while handling a large number of records and patient care – at the same time. The biggest problem with EHR is that once an error is made, it spreads fast and is quite difficult to correct due to the following reasons: • In order to reduce the time spent for clinical documentation, physicians usually copy-paste data within EHR. So they make a data entry mistake, it is populated to all parts of EHR • EHRs are connected to several other health care systems and EHR information is transmitted between those systems with the help of health information exchanges. So incorrect information in a record gets distributed widely in a short span of time Experienced and trained transcriptionists can ensure accurate data entry into EHRs. Many transcription services offer three level quality assurance programs in which proofreaders and editors further scrutinize the initial transcripts. The combined EHR-transcription approach can reduce data entry mistakes and clinical errors, and enhance patient care.