- To err is human. The first concept is to consider that the error is a phenomenon inherent in human nature and occurs even in the most perfect systems. That is, it is necessary to assume that, regardless of training and care of people, mistakes can happen and invariably occur in any human process, including the complex sanitario.

Given that you can not change the human condition, to improve the safety of care, the realistic then it will change the conditions under which people work. This is necessary to create health insurance systems that are resistant to human error, that is, to help prevent errors, to identify and / or minimize their consequence. This concept is one that seeks to highlight the title of the first report of the Institute of Medicine: To err is human. Building a safer health system.

- Safety does not reside in individuals, but is a characteristic of a system as a whole. Errors should be analyzed from the perspective that occur because there are failures in system components (system approach) and not by incompetence or failure of individuals (person approach), as has been the traditional approach to ahore..

When accidents are analyzed from the perspective of systems analysis is usually to check that even the simplest not due to a single failure, but almost always the result of the combination of multiple failures or errors, among which are distinguished on the one hand, latent failures or defects present in the system itself linked to deficiencies in the organization, working procedures, technical resources, labor conditions, etc. and, secondly, active faults or errors of the professionals who work involved in that system failures. Consequently, punish or eliminate the individual “guilty” of the error will not change the latent defects of the system and it is likely that the same mistake again happen again. Therefore, it is said that when an accident should not be trying to find who was involved in it, but what matters is analyzed to identify how and why it has.

- To improve the security of the systems must learn from mistakes that occur. Only then can identify the root causes and develop strategies to prevent repitan. This requires creating a professional culture is not punitive discard the idea of guilt and promotes communication and error analysis.

In the health field, this is a huge cultural change, since traditionally the medical and society itself have assumed that health professionals are “perfect” and work without error, that is, that mistakes are unacceptable or are associated with negligence. Therefore, in the field of medicine has always tended to cover up errors for fear of professional prestige and possible sanciones. In fact, at present, unlike what happens in other industries, health care institutions often do not have protocols for action known to all professionals who specify what to do and how to handle errors when they occur or have established channels to communicate and constructively analyze information about the errors, nor, more importantly, have structures to find solutions and make improvements to prevent similar mistakes happening again.

Moreover, there are other barriers imposed by the legal systems that pose perhaps the greatest obstacle to the development of communication programs and analysis errors. In this sense it is necessary to change the legal rules so as to ensure the protection and confidentiality of information in order to avoid the logical fears of being involved in professional malpractice lawsuits. This adaptation of legal rules is a crucial step to encourage error reporting.

- The general culture, the flow of decisions and procedures of an organization play a role in security. The study of organizations called “high reliability”, ie those working in high-risk conditions and yet have a low frequency of accidents, has made us aware that possess specific characteristics that explain its low accident rate. These features are those that seek to introduce in such areas.

Thus, these organizations show a constant concern for safety which considered a corporate value. Do not rely on its success, but systematically review and monitor their organization and working procedures. Do not wait for an accident, but that anticipate and investigate all circumstances and changes that may compromise their seguridad. They rely on the standardization of equipment and procedures to reduce variability. Educate their members in safe practices, the form in teamwork and trained to take less and observe. They have flexible decision structures based on the experience of professionals working at the forefront, especially in situations of crisis. Have non-punitive systems of communication and information flow failures and incidents, and demonstrate the value of this information and use it to make changes constructive.

The elderly are particularly vulnerable to drug side effects. To prevent accidents, it is necessary to limit the length of orders and to observe certain precautions.

Rheumatism, hypertension, sleep disorders, diabetes, osteoporosis, pain … with age, prescription longer. They will sometimes involve up to half a dozen treatments, if not more at risk to cause accidents toxic. Nearly half the drugs are consumed in France by people over 60 years.

In return, 10% of hospitalizations of elderly people are linked, at least in part, to a medical accident.

Bodies Underperforming

Several factors make the elderly more susceptible to the risk of medication errors, that is to say the side effects of treatment.

* The liver and kidney, the two bodies to ensure the degradation and elimination of drugs are less effective with age. Consequently, the chemical molecules remain longer in the blood and tissues before being eliminated and may accumulate over the catch. Doses well tolerated by young people can cause toxic effects in older people.
* The drugs are distributed differently in the body of the elderly. In fact, muscle mass and water in the body decreases with age, while body fat increases. Thus, drugs that dissolve in water (called water-soluble) will see their levels (and therefore their effects) in the blood increased, while soluble will be stored in fatty tissues.
* Some drugs enhance the effects of other molecules or alter their metabolism. These interactions are difficult to manage, is one of the major drawbacks of multiple treatments.
* Malnutrition and dehydration are common in the elderly. They increase the concentration and toxic effects of drugs.
* The toxicity of drugs to certain organs is more important than they are already the site of lesions. This explains why many complications are more frequent with age.
* Falls are a significant risk to the elderly. They are favored by many drugs, including sedatives and antihypertensives.
* The proliferation of drugs and changes in treatment are an obvious factor of poor monitoring and error. The risk is even greater among the elderly, which combines the difficulties associated with taking multiple medications for a memory and less powerful.

Make a choice

Some precautions can reduce the risk of accidents.

* During any consultation, it is essential to specify the doctor already prescribed medications.
* A hierarchy should be established between the different treatments, and retain only those with proven efficacy and are really necessary. Some drugs have little risk of overdose, but they increase the risk of errors or discouragement, for a doubtful benefit. It is estimated that 25% of prescriptions are ineffective and irrelevant.
* Concerning the so-called comfort drugs, if the order is growing dangerously, a choice must be made with the doctor to keep only those that significantly improve the quality of life.
* When choosing a treatment, physicians should emphasize the extent possible, the one with the largest margin between therapeutic and toxic effects and avoid those with a slow elimination and may accumulate in the organization.
* Doses should consider the weight and age of the person. For chronic treatments, it is often useful to start low dose and gradually increase the dosage until the desired therapeutic effect. In contrast, the analgesic or antibiotic treatment the first dose should be reduced for a quick effectiveness. Only subsequent doses will be reduced.
* The very latest drugs, which have rarely been specific studies in the elderly should be avoided.
* When it is followed by several specialists, it is preferable to have a GP who can link and check the consistency of different requirements.
* It is very important to drink to avoid dehydration, which would add toxic effects.
* When prescribing, it is best to ask the doctor what to do if you miss a drug.
* Use a pillbox reduces the risk of errors.
* Any unusual event, especially confusion, fatigue, should lead to suspicion of a toxic effect and to consult his doctor. It is the same in case of diarrhea, vomiting or fever, which may disrupt e treatment.
* Finally, seniors who are already several treatments must avoid the most self-medication.