Objective of Section
To describe the harms that may occur in the delivery of care to patients with diabetes and to present harm prevention and mitigation strategies.
- The definition of harm is patient injury inflicted as part of the process of care delivery. Not all harm is preventable. Efforts to improve patient safety attempt to decrease the likelihood of harm by creating safer systems as well as safe behaviors for individuals working within the system.
- Harm can occur in any setting where patients with diabetes are found. Understanding setting-specific risk points will assist health care professionals in reducing risk and will provide leaders with the knowledge required for systems redesign.
- Harm can occur as a result of therapy-specific risks. Understanding therapy-specific risks and the ways to mitigate the risks will allow care providers to lessen the likelihood of harm.
In 1999, the Institute of Medicine published the seminal work “To Err is Human,”1 which shed light on the harm created by medical error. In fact, medical error contributes to more than 200,000 deaths per year.2 Over the past 15 years, it has been demonstrated that not all patients and health care settings are at the same risk of having harm occur.3 For multiple reasons, patients with diabetes are at significantly greater risk than most patients. They often have multiple comorbidities and complications that increase their likelihood of using health care services. Additionally, some of the medications used to reduce blood sugar—both oral and injectable agents—carry a risk of hypoglycemia. Therefore, patients with diabetes are at risk for harm from medical errors by individual health care professionals, systems errors by health systems that are poorly designed, and inappropriate actions by patients themselves due to lack of knowledge or skills.
Achieving safe diabetic care requires active attention at all levels. From newer, more physiologic medications, to increasingly advanced monitoring devices, to enhanced systems designs to improve care transitions, diabetic care is receiving the attention that is required from leaders in industry, health care systems, and patients. This section introduces these advances and issues within the patient safety movement as it relates to the patient with diabetes.