farmdoc's blog post number 92

Florence Nightingale said ‘…the very first requirement in a hospital…(is)…that it should do the sick no harm’. But hospitals still cause harm. According to the landmark Quality in Australian Health Care Study, up to 16% of hospitalised patients suffer an adverse event: 50% of these events are preventable and 10% of the preventable events cause death or permanent disability. Nationally that’s about 9,000 unnecessary deaths each year, folks. In my work, each month or two I peruse someone’s hospital case file – seeking information, or determining if something occurred or not. Last week I needed to know whether or not a woman, who whilst in hospital for an infection developed a blood clot in her leg, had received clot prevention. Invariably the case files I examine are shambolic: pages in jumbled order, handwriting mostly illegible, undecipherable signatures, idiosyncratic abbreviations, no problem list etc. It’s been said that hospital adverse events are not primarily the fault of staff (who make mistakes like everyone) but of systems which haven’t been properly designed to avoid errors. In the 1960s Lawrence Weed, an American MD, invented the problem oriented medical record. Forty years later the POMR is still not widely used. It would prevent many – perhaps most – hospital adverse events, save many lives, and is easily computerised. But until it’s used, dear Florence’s first requirement will remain a pipedream.