A few months ago, an ambulatory lady visited a reputed hospital in Chitwan for nasal surgery. She died right after the operation, prompting irate people to vandalise the hospital and manhandle the doctors accusing them of medical malpractice. Such incidents have now become common in Nepal. About two months ago, a serious example of medical error was observed at one of the reputed hospitals during the treatment of Rihan—a normal newborn baby—who had five head operations, hospital-acquired infection and a high dose of paracetamol followed by irreparable damage. If key stakeholders keep silent when such types of incidents occur, trust between doctor and patient will be seriously jeopardised, and the doctor's dedication and motivation to treat a patient will diminish, hampering the overall quality of care.

Every day, medical errors occur around the world. Medical errors are unintended results due to acts of omission or commission in the planning or execution of medical procedures. It is estimated that medical harm is the third leading cause of death in the United States. Moreover, a systematic review revealed that the overall prevalence of preventable patient harm was found to be 6 percent, out of which 12 percent was severe or leading to death. In Nepal, we severely lack data related to medical errors. Only fatal incidents are published in the media sporadically.

Some types of patient harm are unavoidable or inevitable for which almost nothing can be done with the available technology. For instance, a patient can get a severe anaphylactic reaction due to the intake of paracetamol—a commonly used medicine to control fever. The only thing we can do is reduce preventable medical harm to the utmost.

Going deeper into the reasons, the immediate causes are drug-related, diagnostic, medical procedure-related and healthcare-acquired infections; however, their underlying causes are more system-related: the people, technology and tools involved, organisational values, and the structure in which the system operates. For example, the burnout of healthcare providers is one of the major causes of medical errors in the United States. Another potential aspect is miscoordination and miscommunication between patients and doctors and among healthcare providers. In the case of Rihan, the Nepal Medical Council proved the doctor's failure in counselling, briefing and coordinating.

Although the patient and the family are the primary victims in case of medical error, doctors also suffer significant mental stress and damage to their reputation, hampering their career. A study in the United States and Canada revealed that medical errors led to significant mental stress among the doctors who committed them. These effects, if not prevented, ultimately hamper the quality of care.

Being multifactorial, the approach to mitigating preventable harm to the patient should be integrated. Throughout the world and especially in the context of Nepal, we have a severe shortage of records related to medical errors. To address this problem, it is imperative to collect and monitor data regularly. Proper recording and reporting can reveal the root causes of medical errors, prevent recurrence of similar events by using appropriate preventive measures and help to generate long-term strategies to improve patient safety. Recently, Nepal Medical Council issued a notice telling doctors to follow standard treatment protocol strictly and telling the public to seek legal remedy in case of medical error. This action is not sufficient to reduce medical errors. A proactive role is required to empower patients, healthcare providers, and health institutions.

The provision of pharmacists at every hospital and proper counselling about medicines is crucial as medication-related errors are most common. Further, hospital-acquired infections can be prevented by strict adherence to infection prevention guidelines. From the perspective of doctors, work-life balance is equally important, especially to those working under high work pressure. To reduce burnout among healthcare providers, periodic breaks, refreshments, and skills to reduce stress can play a significant role.

Patients should be equally cautious about medical harm. Informing people about the hazardous effects of unnecessary use of medicines, diagnostic procedures and treatment interventions are highly needed. For this, the government and the concerned agencies should conduct awareness programmes at different levels. It is also necessary to educate patients about their right to redress when medical errors occur. Further, a conducive environment should be created so that patients can easily report to the concerned agency about medical errors followed by an unbiased investigation and legal action.

It is the responsibility of patients, healthcare providers, the concerned agencies and the community to reduce medical errors. Quality is an essential principle of a competent health care system. This can only be maintained when an integrated approach is applied. Otherwise, medical errors and vandalisation of hospitals will be a regular feature rather than an exception.

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