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With increasing public attention to patient safety have come calls for more participation by patients and their advocates in the search for solutions. Some of these calls have focused on individual healthcare organizations, such as efforts to include patients on hospital safety committees.1 Most, however, have involved enlisting patients in efforts to improve their own individual safety—often framed as a version of the question: “What can patients do to protect themselves?” This chapter will explore some of the opportunities and challenges surrounding patient engagement in their own safety, including errors caused by patients themselves. The issues surrounding disclosure of errors to patients are covered in Chapter 18.

A previously healthy 10-month-old girl was taken to a pediatrician’s office by her monolingual Spanish-speaking parents, worried about their daughter’s generalized weakness. The infant was diagnosed with iron-deficiency anemia. At the time of the clinic visit, no Spanish-speaking staff or interpreters were available. One of the nurses spoke broken Spanish and in general terms was able to explain that the girl had “low blood” and needed to take a medication. The parents nodded in understanding. The pediatrician wrote the following prescription in English:

Fer-Gen-Sol iron, 15 mg per 0.6 mL, 1.2 mL daily (3.5 mg/kg)

The parents took the prescription to the pharmacy. The local pharmacy did not have a Spanish-speaking pharmacist on staff, nor did they obtain an interpreter. The pharmacist attempted to demonstrate proper dosing and administration using the medication dropper and the parents nodded their understanding. The prescription label on the bottle was written in English.

The parents administered the medication at home and, within 15 minutes, the baby vomited twice and appeared ill. They took her to the nearest emergency department, where the serum iron level one hour after ingestion was found to be 365 mcg/dL, twice the upper therapeutic limit. She was admitted to the hospital for intravenous hydration and observation. On questioning, the parents stated that they had given their child a tablespoon of the medication, a 12.5-fold overdose. Luckily, the baby rapidly improved and was discharged the next day.2

Any discussion of patient engagement needs to start from square one—do patients understand their care and the benefits and risks of various diagnostic and therapeutic strategies (i.e., informed consent)? If patients cannot understand the basics of their clinical care, it seems unlikely that they can advocate for themselves when it comes to safety.

Unfortunately, many patients are in no position to understand even the basics of their care, let alone serve as bulwarks against errors. First of all, nearly 60 million Americans (20% of the population) speak a primary language other than English at home, and 25 million have limited English proficiency.3 Both of these populations nearly doubled in the United States between 1980 and 2009 (Figure 21-1). Few hospitals have adequate translation services4—translation ...

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