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PATIENT SAFETY

Introduction

This guide looks at medical errors and steps you can take to ensure your safety. A medical error is when a mistake is made that can negatively affect the patient. Examples can include errors in diagnosis or in a surgical procedure, mistakes in giving medications or in the use of medical equipment, misinterpretation of a test or lab results and others. A medical error can involve the failure to carry out a plan of action or use of the wrong plan. An individual can cause the error or it might happen because of a failure in the system.

Medical errors can take place in health care facilities, pharmacies, doctor's offices and even in your home. They can involve complex systems like how a hospital tracks the medical services given to patients or a common task like giving food high in salt to a patient who needs a salt-free diet.

While advances have improved medical care and extended the lives of many people, the complexity of the American health care system also contributes to medical errors. In addition, poor communication between patients and their health care providers can lead to mistakes as well.

You can play an important part in patient safety by being actively involved in your health care and the health care of your loved ones. This guide will look at some of the more common problems and the actions you can take to prevent them.

Topics Include:

Health Care Team

Medicine Safety

Safety in Health Care Facilities and in Home Care

Prevention of Infections

Prevention of Falls

Health Care Team

Most people no longer have just one physician who takes care of them throughout their lives and knows there entire medical history. You might change primary care physicians, visit various specialists or find yourself in a hospital emergency department. At your doctor's office you might see the doctor, nurse practitioner or another professional. You might receive your care through a clinic where you see a different provider every time you visit.

The one constant in this care is you. You are the most important member of your health care team. You know your history, medications, allergies, illnesses and surgeries. Part of your responsibility is to educate yourself about your conditions and treatments and to share important information about your health with your health care providers.

Communication between you and your health care providers is an important part of patient safety. You have the right to ask questions and to have matters explained to you in a way you understand. You have the right to know what treatment choices are available for your care.

In addition you may find yourself being an advocate for loved ones because they are unable to make health care decisions--or a loved one may need to represent you if you are unable to speak for yourself.

Tips for Being a Part of Your Health Care Team:

  • Inform all of your health care providers about your medical history including any treatments, surgeries, medications, allergies or medical conditions.
  • Tell all of your providers about every medication you take, including prescriptions, over-the-counter medicines, vitamins and herbal supplements.
  • Write down questions and take them to your appointment. You might want to take notes during the visit or take someone with you to act as your advocate. They can help you speak up, ask questions and take notes. Later you can talk with this person about your situation and choices.
  • If you need to have medical care, ask what treatment choices you have.
  • If something is said that you do not understand, ask for a clearer explanation.
  • If tests are performed and you do not receive the results, call the office and ask for them. You can also request a copy of the results.
  • If you want another opinion about a diagnosis or treatment, request one from another doctor. Ask if your health insurance will pay for a second opinion.
  • If you are not satisfied with your health care provider you may want to choose another one.
  • If you have a medical condition, are getting a certain treatment or are taking medications--educate yourself in these matters. Ask your health care provider for educational materials and use your local library or the Internet to learn more.

Health Care Surrogate Designation

If you are unable to be active in your health care due to physical or mental incapacity (such as being in a coma or developing dementia) and you do not have a health care advance directive--health care decisions may be made for you by a guardian appointed by the courts, your spouse, adult child, parent, adult sibling or, under certain circumstances, another adult relative or close friend.

If you would like someone to represent you if you are unable to make decisions yourself, you can designate a health care surrogate. Further information can be found in the pamphlet Health Care Advance Directives.

Medicine Safety

Actively managing and learning about your medications is an important part of patient safety. Following are suggestions to better protect yourself and your loved ones when taking medications.

Do your health care providers know all of the medications you take?

Some medicines and supplements may cause harm if used together. Learn about the medications and supplements you take and any interactions they may have. At least once a year review all of your medicines (prescription and non-prescription) and supplements (vitamins and herbs) with your health care providers.

Whenever you are prescribed medication, ask if the new medicine will interact with other medications or supplements you currently take.

Can you read your prescription?

If you cannot read your prescription, the pharmacist may misread it and give you the wrong medicine. Florida law requires that the prescription be written clearly, so make sure you ask for a clearly written prescription. However, many doctors now use electronic prescribing so your prescription may be sent to the pharmacy through a secure Internet connection. Learn more at E-prescribe.

Before leaving the pharmacy check the medication label to see that it is written to you and it's the same name and strength as written on the prescription. Check this every time you fill a prescription.

Be familiar with how your medicine looks. If it looks different than what you took before, talk with your pharmacist before taking it.

Do you read your medication label and insert?

The label will tell you how much to take, when and how long to take it, and if there are restrictions. For example, the label might say you shouldn't drink alcohol while taking the medication, stay out of the sun, or avoid certain foods or other medications. The insert will include information about safety precautions and side effects. (A side effect is, for example, when an allergy or cold medicine might also make you sleepy.) If you have questions about the label directions, safety precautions or side effects, talk with your pharmacist.

If you cannot clearly read the label ask the pharmacist to use larger type. If you do not understand the directions ask the pharmacist to explain.

Is there a danger of buying medication that has been altered or that isn't what the label says it is?

A good way to protect yourself is to confirm that the pharmacy where you buy your medication is licensed by the State of Florida. Each pharmacy is required to post the company's license as well as the license of the pharmacy manager.

If you buy prescription medication over the Internet, or by mail order, it is important to be a wise shopper. First see your own health care provider for a prescription. Check to see if the company is licensed in the state in which it operates or if the National Association of Boards of Pharmacy (NABP) certifies the company through its VIPPS program (Verified Internet Pharmacy Practice Sites ™). Visit the NABP website nabp.net or call (847) 391-4406.

Be cautious buying medications over the Internet or by mail order. If the company is not legitimate, you may end up with fake, altered or expired medication that will not help you and may cause harm. In addition, the website or mail order company may appear to be based in the United States, but actually be operating outside of the U.S. where quality and safety controls may not be available.

Is there a danger in taking over-the-counter (OTC) medications?

Some OTC medications should not be used with certain prescription drugs. Read your medication label/insert and talk with your pharmacist if you have questions.

Also compare active ingredients before taking more than one medication at the same time. Many OTC and prescription medications contain the same active ingredient, which means you could take more than the recommended dose. For example, if you take a pain medication along with a cough, allergy or sleep medicine, they may contain the same drug and the combination may be more than is safe to take at one time.

While your health care provider or pharmacist can alert you to unsafe combinations of drugs, you can also watch for the following two common ingredients:

  • Acetaminophen is used in over 600 products, especially headache and cold medicines. Taking more than is recommended can lead to liver damage or failure.
  • NSAIDs (nonsteroidal anti-inflammatory drugs) are common pain relievers. Overuse, or when used in combination with some drugs, can lead to stomach bleeding or kidney damage.

OTC medications are meant for temporary relief. If you need to use a medication longer than it says on the label--see your health care provider. You may have a serious medical condition or your provider may recommend another form of treatment.

Why is it important to know the correct dosage to take?

Medications can make you sick, injure you or sometimes cause death when taken incorrectly. Do not take more of the medication than is recommended. Some things to watch out for:

  • Over-the-counter (OTC) medications come in a variety of strengths. For example, pain relief medication may be regular, extra strength or time-release; they may be pills, liquid or capsules. Follow package directions for dosage.
  • Some people mistakenly think taking three pain relief pills at one time will relieve the pain more quickly. Or they take too many pills within a 24-hour time or for too many days. Taking more than the recommended dose can be dangerous.
  • If you take prescription medication, do not change the dosage before discussing it with your health care provider.
  • An adult dosage of medication should not be given to children. Follow directions prescribed by your child's doctor and for OTC medications by the children's strength and follow the directions. An incorrect dosage can quickly have a dangerous effect on children because of their smaller size.
  • Some seemingly harmless OTC medications may not be appropriate for children. For example, the American College of Pediatrics recommends that aspirin not be given to children.
  • The elderly can also be more sensitive to medications and their side effects. Check with your physician if you become drowsy, confused, dizzy, or have other side effects, as your physician may be able to adjust or change your medication.

Tips on Safe Handling of Medications:

  • Put medications in a safe place away from children (and animals) and keep them in childproof bottles.
  • If there is an adult who has difficulty reading labels or in knowing when to take medication, have another adult oversee the medication.
  • If medication poisoning occurs call your doctor or the Poison Information Center at (800) 222-1222 or, if life threatening, call for emergency assistance which in most areas is 911.
  • Do not store medications in your bathroom as the moisture and heat could change or destroy their effectiveness. If you store medication in the kitchen protect it from heat and moisture. Find out if your medication should or should not be stored in the refrigerator.
  • At least once a year review all of your prescription and over-the-counter medications as well as vitamins and supplements. Do not continue to use medications that have changed color, consistency or odor. Safely throw away any medications that have expired, that you no longer use or whose labels you can no longer read.
  • Throw out old medicine in a sealed, outdoor trash can in a manner that children, animals or other adults cannot take it. Used syringes and needles should be placed in a hard container (like a used laundry soap bottle) with a tight lid and then thrown into the trash. To dispose of controlled substances, like narcotics, you may want to ask your pharmacist or health care provider for advice.
  • If you take several medications you may want to keep a list and schedule of when you take each one. Some people keep track of their medications by using a pill organizer they fill once a week. Ask your pharmacist about pill organizers or other tracking aids.
  • If your medications are delivered by mail or another delivery service--make sure they do not sit outside your home for a lengthy period of time, they're not exposed to heat/cold and that they will not be tampered with or stolen.

Safety Tips on Taking Medications:

  • If you have an allergic reaction, call your health care provider, or if life threatening, call for emergency assistance which in most areas is 911.
  • Learn about possible side effects of your medication, what you can do about them and when they might be dangerous or life threatening.
  • If you forget to take your medicine, as scheduled, immediately taking the missed dose may not be the best thing to do. Read the package insert or call your pharmacist for advice.
  • Some people do not take their prescribed medications because they can't afford them. If you do not take your medications or you skip doses, you may be able to get less expensive drugs by comparing the pharmacy prices in your area. You can compare pharmacy prices in your area by accessing FloridaHealthFinder.gov and clicking on the "Prescription Drug Prices" tab under Compare on the home page. The site has price information on the top 150 most commonly used prescription drugs in Florida.
  • If you cannot afford your medications talk with your health care provider as he or she may recommend a less expensive medicine or may have free samples. Also, you may be eligible for prescription assistance programs (see the next section).
  • Some medications should not be cut in half, chewed, or have the capsules opened as this will affect the medication, could cause harm or even result in death. Read the insert or ask your pharmacist if you have questions.
  • If you arrange for your child to be given medication at day care or school, ask about the procedures for storage, administration and record keeping. Every so often confirm that your child is being given the medication correctly.
  • Do not take medication for recreational use or use medication prescribed to a friend or family member, even if you have the same illness or symptoms as that person. Doing so is illegal and can be dangerous or even deadly.
  • Because older established drugs have been on the market longer more is known about their effectiveness and side effects. When you are prescribed a medication ask your physician how long it has been on the market. If there are medication choices ask which will best serve your needs.

Prescription Assistance Programs

The following programs may offer assistance if you meet their eligibility requirements:

  • Medicare Part D Prescription Drug Assistance is an insurance benefit to help people with Medicare pay for prescription drugs and is provided through Medicare approved private health plans. For more information contact Medicare's toll-free number (800) 633-4227 or TTY (877) 486-2048 or visit Medicare.gov.
  • Sunshine for Seniors, a state sponsored program, is for people 60 years or older. It provides referral to drug assistance programs, helps seniors choose the best program, and can help with the application process. Call the Elder Helpline toll-free number (800) 963-5337.
  • The National Council on Aging has a referral service for people 55 years or older. Visit BenefitsCheckUp.org.
  • Some drug companies offer low or no cost medicine to low-income individuals. Ask your pharmacist if he or she knows of programs or do a search on the Internet of the companies that make your medicines. Some programs can also be found under the Medical Help Resources tab on FloridaHealthFinder.gov.

You may also want to read Understanding Prescription Drug Costs at FloridaHealthFinder.gov under the consumer guides tab.

Safety in Health Care Facilities and in Home Care

As a patient, resident in a facility or a person receiving home care services it might be challenging to be an active member of your health care team. You may not feel well. You may be given medication that makes you drowsy. You may be frail and find it difficult to speak up for yourself. But even with these challenges you still play a very important part in your health care team and you have the right to be involved in your care.

It's important to have clear communication with your health care providers. If you think you may not be able to be clear, due to a temporary condition or to longer term declining health, you may want to have a loved one be your advocate and speak up for you. You may also want to designate someone as your health care surrogate.

Before entering a health care facility or receiving services from a home care provider you may want to learn more about the choices you have and the following resources on FloridaHealthFinder.gov can provide helpful information:

While Receiving Care:

  • You have the right to review records related to your care. If you're receiving medical care under a physician's orders you will have a plan of care that describes your treatment. If a plan of care is not required other kinds of records may be kept.
  • When you are admitted, transferred or discharged from a health care facility review your medications with your physician. Find out if there were medication changes and if you need to throw away any unused medicine that was replaced by a different drug or dosage.
  • If you are in a facility where you have an identification (ID) bracelet, check that it can be read and correctly identifies you. If your ID bracelet doesn't have the correct information, if it comes undone or if it can't be read--ask that it be replaced.
  • When you are given medication, ask the person to check the medication, the order and your identification so you receive the correct medicine and dosage at the correct time.
  • Be familiar with how your medicine looks and if it looks different than what you were given before--talk with the nurse or aide before taking it.
  • Ask what hours you are scheduled for medications. Tell the nurse or aide if a medication time passes and no one has brought your medication.
  • Before a medical test or procedure is done, ask the person to check the order and your identification. Ask what is going to be done and why.
  • Tell your nurse or physician if you have a reaction to your treatment or if your symptoms get worse.
  • If you are bed bound ask what safeguards are in place to prevent blood clots and skin ulcers.
  • While staying in a hospital or ambulatory surgery center, try to have a family member or friend with you at all times, if possible.

While Receiving Care in a Health Care Facility:

  • If you have a loved one with Alzheimer's disease or dementia in a health care or long-term care facility ask what safety precautions are in place for patients who wander.
  • Ask the facility what procedures are in place should the facility need to be evacuated due to an emergency or natural disaster, like a fire or hurricane. You can even ask to see the facility's Emergency Action Plan.
  • Ask the facility what their policies are concerning restraints and seclusion of patients/residents.

While Receiving Care In Your Home:

  • When receiving services in your home try to have a backup plan if the caregiver does not show up for the scheduled appointment. A home health care provider is required to provide all scheduled visits, so tell the agency's director of nursing or administrator if someone doesn't show. If the problem continues you may want to change agencies.
  • If you need medical equipment and supplies, your home care provider is required to train you and your loved ones in the correct use of the equipment. Keep written instructions as well as the company's phone number nearby. Call them if you have questions or problems. If the equipment has alarms or error messages, learn what these mean and what you need to do when these occur.
  • The home care provider is required to give you a phone number to call when you have questions or problems. If you're receiving nursing or therapeutic services or if you're on life-support equipment, the company must be on-call 24-hours a day, 7 days a week.
  • If you have a physical or mental condition that will require help with evacuation and sheltering during a disaster, like a hurricane, the home care provider must help you register with the Florida Division of Emergency Management.

Safety Tips for Surgery & Medical Procedures:

  • If you have a choice, pick a health care provider and facility with experience in the surgery/procedure you are having. By using the hospitals and ambulatory surgery centers comparison tool on FloridaHealthFinder.gov you can view the number of visits and range of charges on over a 150 medical conditions and procedures performed at ambulatory surgery centers and the number hospitalizations and range of charges for hospitals. Additional information on hospitals includes average length of stay as well as rates for readmissions, complications and infections, and mortality. The hospital comparison tool provides comparison of pediatric care as well as adult care.
  • Carefully follow directions about what you need to do prior to the surgery or procedure. If you don't understand the directions ask them to be explained to you.
  • Ask your health care provider if you need to stop any of your medications prior to the surgery/procedure. Also, ask what you can eat or drink prior to the surgery/procedure.
  • Make sure it is clear who will perform the surgery/procedure, what exactly will be done and what to expect after the surgery/procedure.
  • Ask what safeguards are in place to ensure the correct surgery/procedure is done at the correct site on the correct patient.
  • Ask if you will need a blood transfusion and what safety precautions are in place to assure you receive the correct blood type. If possible, you may want to donate your own blood prior to the surgery/procedure. Tell your doctor if you have ever had a reaction to a blood transfusion.
  • Ask if there is a risk of complications after your surgery/procedure and what symptoms you should watch for.
  • Have a loved one available during your surgery/procedure to be your advocate. Tell your physician if you want your loved one consulted, if needed, and to report to them once the surgery/procedure is complete.
  • Learn about your follow-up care including healing of the surgery site; how much rest you will need; what medications, food, and activities to avoid; and when you can return to work and other activities.
  • Make sure your health care provider answers all your questions and concerns.

Safety Tips for Anesthesia:

When preparing for a surgery or procedure you will also want to learn about anesthesia. Anesthesia is medication that keeps you from feeling pain and sensations during a surgery/procedure. Ask exactly who will give you anesthesia and monitor your vital signs.

Tell your doctor and the anesthesiologist if you have ever had a reaction to anesthesia. Tell them all the medications you take (prescribed, over-the-counter, vitamins and herbal supplements) and any allergies you may have. Also, let them know if you have any medical problems and, though this may feel personal, if you have a drinking problem or use drugs recreationally. This information is very important for safe anesthesia care.

Ask about restrictions on medications, food and alcohol before and after the use of anesthesia.

After surgery under general anesthesia (the kind that puts you to sleep) you may continue to feel drowsy, tired, or weak for a few days and you may have problems with coordination and thinking clearly. For at least 24 hours after receiving general anesthesia do not drive, use machines or do things that could be dangerous if you are not alert.

If You Have a Complaint:

If you have a complaint about your health care provider or health care facility talk with them first to see if the matter can be resolved. If you are still not satisfied and want to file a complaint with the State of Florida, call the toll-free number (888) 419-3456. Or you can fill out a Health Care Facility Complaint Form.

Prevention of Infections

The Centers for Disease Control (CDC) states that about two million people a year get an infection during their stay in a hospital in the United States. A person can also get an infection in non-hospital settings like nursing homes, dialysis centers, physicians' offices or in their own home.

Data is available on infection rates at Florida hospitals. If you are going to receive care or treatment in a hospital you may want to check your hospital's infection rates or compare several hospitals in your area. You can find infection rates on the hospital comparison tool on FloridaHealthFinder.gov.

Tips on Infection Prevention:

  • A patient can be at risk of getting an infection, so if you are ill do not visit a person who is sick at home or in the hospital. If a patient has an infection, he or she may transfer it to others, so take precautions to protect yourself.
  • The CDC states that clean hands are the most important part in preventing the spread of infection.
    • If you are giving care be sure to wash your hands before and after, and if you are receiving care do not be afraid to ask your health care providers if they washed their hands.
    • As a patient, it's also important to keep your hands clean, particularly after handling soiled items or after using the bathroom.
    • If you are visiting an ill person, wash your hands before and after the visit.
  • Gloves should be worn if coming into contact with body fluids, soiled items or when inserting any invasive devices (like a catheter). Hands should be washed before and after using gloves. The gloves should be thrown out after caring for a patient.
  • If you have a drainage tube or a catheter that comes lose, immediately tell your caregiver or health care provider. A drainage tube might be inserted to drain a wound; a catheter might be a Foley catheter (a thin tube inserted to remove urine from the bladder) or an intravenous line (or IV) that is inserted into a vein to give fluids.
  • If you have either a catheter or a wound, keep the skin clean and dry around your IV catheter dressing or wound dressing. If the dressing gets wet or comes lose tell your caregiver or health care provider.
  • Long nails and artificial nails can continue to hold infectious germs even after a good hand washing. If a patient is at risk of getting an infection the CDC states caregivers should keep their nail tips to ¼ inch in length and should not wear artificial nails.
  • Other ways germs can spread are through droplets (from an infected person coughing, sneezing, or talking, etc); airborne transmission (which may require special air handling and ventilation for treatment); items that have picked up germs like medical equipment or any item that can then spread infection; or when animals or bugs transmit infection (like mosquitoes, flies, or rats).
  • Sometimes it may be necessary for the patient, staff or visitors to wear protective masks or gowns.
  • Under certain circumstances a patient may be placed in isolation in a hospital to protect the patient and to prevent the spread of infection. Patients placed in isolation will have signs posted outside their hospital doors. Before entering the room ask the hospital staff about visiting restrictions and any protective requirements for the patient, staff or visitors.
  • Some medical equipment and items may require special handling during and after use, for example, needles, catheters or items soiled with body fluid (like blood on a bandage). Some items can be thrown in the regular trash, but others may need to be placed in a biohazard waste container. Other items may be able to be sterilized or disinfected for future use.
  • Ask your health care provider about proper use and disposal of gloves, gowns, masks, medical equipment and supplies.
  • The patient's bed linens and clothing should be changed and washed regularly, or immediately if they become soiled. The patient's surroundings should be kept clean.
  • Tell your health care provider if you show signs of a possible infection, like a fever, chills, pain, redness, swelling, a discharge or other symptoms.
  • If you are diabetic, you have a higher risk of developing an infection. Be careful about controlling your blood sugar and especially talk with your health care provider about your diabetic care needs if you have surgery, need wound care, will be bedridden or other situations that might lead to infection.
  • If you are given antibiotics for an infection, use all the medication until it is finished. Even if you feel better do not stop taking the antibiotic.

Prevention of Falls

Injuries from falls are of particular concern for the elderly and for patients who might be frail or disoriented from illness, recovering from surgery or on medication. Whether you're in a health care facility or your own home, check for the following to help prevent falls:

  • If you are in a hospital bed the side rails may need to be kept up. Ask your caregiver to lock the brakes on your bed. If needed, call for help to get out of bed.
  • Make sure throw rugs and floors are not slippery. Keep the floor clear of clutter.
  • Use shoes that give good support and are not slippery.
  • Use a walker, cane or wheelchair if needed and learn how to use them correctly.
  • Eyeglasses or a change in eyeglasses may help, as poor vision can contribute to falls.
  • Make sure you have good lighting.
  • Consider a bedside commode if walking to the bathroom in the middle of the night is difficult.
  • Use chairs and a bed that are easy to get in and out of.
  • Grab bars in the bathroom, a raised toilet seat, shower chair and non-slip mat in the tub or shower are good safety features.
  • Stairs should have handrails on both sides, have good lighting and be clear of objects.
  • Ask your physician if an adjustment in your medications could improve coordination.
  • An exercise program, even for the frail elderly, can help improve balance and strength and help prevent falls. You may want to consult an exercise trainer or participate in an exercise program geared towards your skill level.

Review your surroundings and see what other actions can be taken to help prevent falls.

Additional Consumer Guides Include:

A Patient's Guide to a Hospital Stay

Assisted Living in Florida

End-of-Life Issues - A Practical Planning Guide

Florida Medicaid

Health and Human Services Programs

Health Care Advance Directives

Home Health Care in Florida

Long-Term Care

Nursing Home Care in Florida

Understanding Prescription Drug Costs

Note: This is not designed to offer medical or legal advice. Please consult with your physician for medical advice and an attorney for legal advice.

Information is current as of December 2013.

This may be copied for public use. Please credit the Agency for Health Care Administration for its creation.

If you have comments or suggestions, please call (850) 412-3750.


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