When Nicole awoke from what was supposed to be a minimally invasive laparoscopy procedure in 2007 she found herself in agony, but the illegible handwritten notes of a now-disgraced surgeon meant the nurses initially offered her no pain relief.
The Guardian exposed gynaecologist Dr Emil Shawky Gayed in June for performing unnecessary operations on women – including needlessly removing reproductive organs – at five NSW public hospitals over more than two decades, and since then dozens more women have come forward alleging they were mutilated.
Dr Gayed was banned from practicing medicine for three years by the NSW Civil and Administrative Tribunal last month, but by then he had already relinquished his medical license.
Following what was supposed to be a fast and low-risk procedure, Nicole said she woke up in Manning Rural Referral Hospital in Taree in “the most excruciating pain I have ever been in”.
The clinical staff were confused about her level of pain as the procedure had only required small incisions.
“The nurses couldn’t explain what had happened to me because no one could read his handwriting on my notes,” Nicole said. “They said I would have to wait for Dr Gayed.”
Although she was supposed to have been discharged after half a day, by 7pm and still pain relief free she “begged” the nursing staff to call her husband.
Arriving soon afterwards, he asked them to provide his wife with painkillers. She was offered Panadol.
It was only when he demanded they provide her with the strongest pain medication available that they examined Nicole to discover Gayed had surgically opened her up from hip-to-hip.
“They examined me and were mesmerised. None of them knew why. They had never seen this kind of surgery before,” she said.
Nicole said Gayed originally insisted endometriosis had made the surgery essential, but later claimed he thought he had accidentally cut her bowel and “had to open me up just to check”.
The New South Wales Department of Health has launched an independent inquiry into the scandal that has affected at least 45 women, including the management of any complaints made about Gayed, as well as adverse events or performance issues. The actions of the local health districts are also being investigated.
While the Gayed case is extreme, the illegibility of doctor’s handwriting is a known risk to patient care and one that can be drastically improved by electronic records.
Figures from Queensland’s Princess Alexandra Hospital showed that medication errors dropped by 44 per cent after it went fully digital last year.
Manning Rural Referral Hospital went live with electronic medical records to emergency departments and operating theatres, as well as limited electronic functionality to the wards, as part of NSW Health’s first phase implementation that was completed in 2011. Phase two, scheduled to go live at the Taree facility in 2019, will extend the functions and introduces electronic clinical documentation for patients in hospitals, including comprehensive clinical risk assessments, checklists, progress notes, clinical summary and patient history. EHealth NSW's eMeds platform is also due to go live at the hospital between January and March next year.
But a preventable problem persists worldwide despite the harm it causes. In the UK, two thirds of hospitals and numerous GPs continue to use paper prescriptions.
In February, the then British health secretary pledged to end handwritten prescriptions in the NHS following a report that found medication mistakes kill up to 22,300 patients in the UK each year.
The government-commissioned research claimed NHS staff make 237 million drugs errors annually, with more than a quarter of them injuring patients.
“It can’t be right that hospitals are recording vital information like prescriptions using pen and paper, yet only one third of trusts use eprescribing effectively, despite these systems halving the risk of error,” Jeremy Hunt said in a speech to the Patient Safety Conference in London as he set a five-year target to implement electronic prescriptions throughout the NHS.
About one in 12 prescriptions is thought to contain an error, and the problem is compounded by badly handwritten notes.
“This new study shows medication error in the NHS and globally is a far bigger problem than generally recognised, causing appalling levels of harm and death that are totally preventable,” Hunt said.
Between 2 and 3 per cent of all Australian hospital admissions are medication-related, with at least 230,000 admissions annually caused by patients taking too much or too little of a medicine, or taking the wrong medicine, with an estimated annual cost of at least $1.2 billion.
In the US, medication mistakes cause at least one death every day and injure about 1.3 million people each year.
The cost of drugs errors worldwide has been estimated at US$42 billion annually or almost 1 per cent of total global health expenditure.
To help reduce the deaths and injuries, last year the World Health Organisation launched an initiative to reduce avoidable medication-associated harm internationally by 50 per cent over the next 5 years.
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