PCH reports one error in review

Friday, March 16, 2007

Officials at Putnam County Hospital reported one medical mistake in 2006, according to a new State Health Department review made public earlier this month.

The mistake, according to the report, was a patient who had a surgical item accidentally left inside his or her body following an operation.

Hospital Administrator Dennis Weatherford told the BannerGraphic the object was removed from the patient during a subsequent operation and without further incident.

He said he supports the health department's new report, called the Medical Error Reporting System, or MERS, because it makes hospitals "more transparent" to the public and will hopefully improve patient care over time.

Weatherford said Putnam County Hospital has had a system for reporting mistakes in place for years, but until now it has been done internally.

The hospital keeps track of these incidents and handles them through meetings with staff and members of the hospital board and will continue to do so, he said, but with the added element of a public report.

"I think it's important for us to be transparent," he said.

Of 27 potential medical mistakes, PCH reported just one, however, health facilities have up to six months from the time of an event to report it to the state health department. For that reason, the department says it plans to issue it final 2006 report in August of 2007.

The entire preliminary report is available to the public on the Indiana government website, www.in.gov/isdh. Visitors to the website can read an overview of the report online as well as the rules that health facilities have to follow and statistics for individual facilities.

The hospital was the only Putnam County facility required to be included in the report.

Weatherford said he has been discussing the report with officials from other hospitals in western Indiana for some time.

Health officials say the report was created to help improve patient safety at the state's hospitals, ambulatory surgery centers, abortion clinics and birthing centers. There were a total of 287 facilities included in the first-of-its-kind report.

The list of 27 medical mistakes that health facilities can report includes surgery being performed on the wrong body part or patient, retention of a foreign object in a patient's body after surgery, an infant being released to the wrong person, death or serious disability associated with medical errors, sexual assault of a patient on the facility grounds and death or injury of a patient or staff from physical assault on the facility grounds.

According to the health department, the most common mistakes among facilities are objects being left in a body after surgery, surgery performed on the wrong body and stage four and five pressure ulcers acquired by a patient after admittance to the hospital.

A total of 77 mistakes were reported at facilities across the state last year, a majority occurring at hospitals and the remaining at surgery centers, according to the report.

The health department plans to follow up with the facilities to make sure they are following the proper procedures for reporting mistakes. This includes making sure the facility has a plan in place to report these mistakes; if they reported the mistakes in a timely manner; and if they have developed a plan to address past mistakes.

The health department is required to report which of the 27 reportable events occurred, the facility where the event occurred and the quarter of the calendar year in which the event occurred.

They do not have to report the identity of the patient who experienced the medical error or the identity of the health care worker who made the mistake.

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