How is iatrogenesis managed and prevented?

Management and Prevention of Iatrogenesis

Iatrogenesis should be managed through a multidisciplinary approach focused on prevention, early detection, and prompt intervention to minimize morbidity, mortality, and impact on quality of life. 1

Definition and Types of Iatrogenesis

• Iatrogenesis refers to unintentional or occasionally inevitable harm to patients caused by medical personnel during patient management, examinations, or therapeutic procedures 2
• Four main types have been identified: clinical, social, cultural, and technological iatrogenesis (the latter involving errors related to health information technologies) 3

Prevention Strategies

Systematic Approaches

• Implement comprehensive protocols for high-risk procedures such as colonoscopy, with detailed pre-procedure risk assessment 1
• Maintain and reinforce clinical pharmacy activities including prescription analysis, dose adaptation, medication reconciliation, and educational follow-up 1
• Prioritize patients at highest iatrogenic risk through systematic identification of risk factors 1
• Deploy clinical expertise centered on prevention of drug-related problems, particularly adverse effects and interactions 1

Risk Assessment and Monitoring

• Identify high-risk patients, including elderly (>65 years), those with multiple organ failures, and immunocompromised individuals 4
• Monitor nursing workload as excessive workload is associated with increased iatrogenic complications 4
• Implement hypoglycemia management protocols in hospitalized patients, especially those with diabetes 1
• Track and document all iatrogenic events in medical records for quality improvement 1

Management of Specific Iatrogenic Complications

Iatrogenic Colonoscopy Perforation (ICP)

• For ICPs detected during procedure, attempt immediate endoscopic repair 1
• For delayed recognition of ICP, CT scan is the most accurate diagnostic tool 1
• Treatment options include:
  • Conservative management for hemodynamically stable patients without sepsis (bowel rest, IV hydration, broad-spectrum antibiotics) 1
  • Laparoscopic approach as first-line surgical management when appropriate 1
  • Conversion to open surgery when necessary based on patient status and tissue viability 1
• Schedule surveillance colonoscopy 3-6 months after successful ICP treatment 1

Iatrogenic Urinary Tract Injuries (IUTIs)

• Employ CT with excretory phase for evaluation of urinary tract anatomy in high-risk procedures 1
• Early recognition and repair of injuries leads to more favorable outcomes 1
• Be vigilant for delayed presentation, as 50-70% of ureteral injuries are missed intraoperatively 1

Medication-Related Iatrogenesis

• Implement hypoglycemia prevention protocols including proactive surveillance of glycemic outliers 1
• Identify common preventable sources of iatrogenic hypoglycemia: improper prescribing, inappropriate management, and nutrition-insulin mismatch 1
• Review treatment regimens when blood glucose is ≤70 mg/dL (3.9 mmol/L) 1
• Be alert to iatrogenic hypoglycemia triggers: sudden reduction of corticosteroid dose, reduced oral intake, emesis, NPO status, inappropriate timing of insulin 1

Surgical Iatrogenesis

• Use laparoscopic approach when appropriate to reduce length of stay and morbidity in stable patients 1
• Take care to avoid iatrogenic bowel injury during adhesiolysis and bowel resection 1
• Consider damage control surgery with temporary closure and planned second-look operation in cases of severe sepsis/septic shock 1

Organizational Approaches

• Conduct failure mode effect analysis and root cause analysis to prevent problems and avert errors 3
• Analyze all major iatrogenic complications to identify associated factors and implement preventive measures 4
• Maintain continuous monitoring and auditing of procedural standards and related complications 1
• Foster close collaboration between specialists (e.g., endoscopists and surgeons, pharmacists and clinicians) 1
• Deploy telemedicine when appropriate to reduce face-to-face interactions that may increase iatrogenic risk 1

Special Considerations for Elderly Patients

• Recognize that older adults are at particularly high risk for cascade iatrogenesis (serial development of multiple medical complications) 5
• Balance secondary prevention measures with overall quality of life and patient goals 1
• Present lifestyle modifications to elderly patients in terms of improved function, independence, and quality of life rather than longevity 1
• Improve health literacy among seniors as a key aspect of preventing iatrogenesis 1

Continuous Improvement

• Develop educational programs specifically designed for patients and their families 1
• Promote wider use of noninvasive monitoring techniques 4
• Encourage physician skill development, cultural refinement, and continuous self-education 2
• Analyze errors systematically as part of healthcare quality improvement 2