Fear as "The Great Motivator""Of all the emotions ... fear is the one which is likeliest to get things moving."1
Smallpox. Anthrax. Chemical terrorism. Airplane attacks. Sniper attacks.
Most of us have experienced these fears at some point over the last 19 months, if not consistently, or at least fleetingly. "What if ... " has become a common refrain as legislators scramble to fund antiterrorist actions and smallpox vaccinations.
It is unlikely, however, that we have spent even half as much time worrying about medical errors -- which kill approximately 98,000 people each year.
This statistic in no way diminishes the gravity of the terrorist attacks. But we need to be aware of how fear -- which led to improvements in security after Sept. 11 -- can be used in the medical field as well.
3,000 people died on September 11, 2001. Fear of follow-up attacks led to improvements in security for every public facet of society -- airports, baseball stadiums, shopping malls, convention centers.
Five died of anthrax apparently distributed through the U.S. mail. Fear of additional infections led to improved security in mail delivery, not just at the post office but also at in-house mailrooms for businesses and schools.
Last October, 10 people were killed and three critically injured by two snipers eventually captured in Washington, D.C. As fear gripped the Washington metro area, people kept their children home from school, stopped fueling up their cars, shopping at home improvement stores and walking through parking lots alone. People became more aware of license plates, white vans and trucks.
In 2002, 254 died of West Nile virus. Millions of Americans in affected states, fearing fatal encephalitis, changed their habits to avoid mosquitoes -- wearing long sleeves and pants, and staying indoors at dawn and dusk.
No one thus far has died from smallpox or its vaccination. But fear has led to a federal vaccination program for smallpox. (And fear of complications from the vaccine is preventing many healthcare workers from being vaccinated.)
"Fear is the great motivator -- and skill is its offspring. If necessity is the mother of invention, fear is the mother of competence, the mother of excellence."2
Regardless of the object of fear -- be it disease, terror or error -- we cannot deny that fear itself is indeed a great catalyst for action. That fear, properly channeled to the appropriate action, can be a positive force for good.
But what actions are appropriate to counter the fear of medical errors? Over-treating (by ordering unnecessary tests and labs) to avoid accusations of malpractice is not the answer; it leads only to inefficiency in the medical system. Education, first and foremost, is the appropriate action. In the current medical climate -- with the high rates of medical errors and the resulting rising costs of malpractice insurance -- education is fundamental.
- Education about proper diagnoses, tests and procedures.
- Education about correct surgical sites.
- Education about double-checking patient names and prescriptions to ensure the right person is receiving the right medication in the right dosage.
- Education about look-alike or sound-alike medications.
- Education about checking patient records for allergies.
- Education about infections.
- Education about equipment and its proper use and maintenance.
- Education about blood transfusions and organ transplants.
The much-hyped case of Jesica Santillan, who died after receiving a heart-lung transplant from a donor with a non-matching blood type, is a primary example of an error that could have been easily prevented. Asking simple questions about blood type or allergies can literally mean the difference between life and death.
Educating healthcare workers to do it the right way, every time, and to ask the right questions, every time, is essential. Knowledge of proper procedures is essential. Knowledge of what not to do is just as important.
So how does one obtain such knowledge? Read the latest journals (don't let them pile up in the magazine stand at home or on your desk at work). Visit healthcare related Web sites; AORN and APIC consistently provide up-to-date infection control-related knowledge. Attend seminars. Take continuing education courses -- in-house, online or in the pages of your favorite infection control magazine, Infection Control Today.
This month, our Best Practices department addresses an ongoing problem: surgical site infections. According to the Centers for Disease Control, there are an estimated 500,000 surgical site infections in the U.S. each year, which equal one-quarter of annual nosocomial infections. The cost -- to both finances and health -- is astronomical. Bonnie Barnard explores the problem in-depth and tells us exactly how to prevent it.
Our continuing education program is designed with you in mind. Upcoming topics include asepsis, patient safety standards and how to prepare for JCAHO surveys. If there are topics you'd like us to address in future issues, please let us know. If you have written an educational piece that is relevant to an infection control course, let us know that, too.
If you have upcoming in-house educational sessions, please feel free to distribute copies of the Best Practices to your "students" for them to submit for continuing education credits. The courses are intended for the good of your employees in the short term; in the long term, they contribute to continued health for all of us.
1. McClellan JL. www.pygalgics.com/F/fear.html
2. Morgenstein, Henry. www.nmc.edu/~hmorgenstein/essays/fear.html