How to Disclose Medical Errors.pptx

Medical errors are a growing concern in health care organizations.
No matter how well trained or hard working, healthcare providers make mistakes, just like other professionals.
Some data suggest that medical errors occurs up to 80 times per 100,000 consultations.
Medical errors are the third leading cause of death in the United States.

1. How to Disclose Medical Errors

2. Lecture Outline Definition of Medical Errors Magnitude of the Problem Areas of Medical Errors Types of Medical Errors Negligence vs. Malpractice Rationale for Error Disclosure Guidelines for Disclosing Errors

3. ‘ Medical Errors ’ are defined as “Preventable events in medicine that harm patients. These are errors of commission (what is done to a patient) and errors of omission (what should have been done but is not)”. They are not including intentional or reckless actions that harm the patient. Definition of Medical Errors

4. Magnitude of the Problem Medical errors are a growing concern in health care organizations. No matter how well trained or hard working, healthcare providers make mistakes, just like other professionals. Some data suggest that medical errors occurs up to 80 times per 100,000 consultations. Medical errors are the third leading cause of death in the United States.

5. Areas of Medical Errors Diagnostic (e.g., delay in diagnosis, failure to employ indicated tests, use of outmoded tests, failure to act on results of testing). Treatment (e.g., error in administering a treatment, error in the performance of a therapeutic procedure, inappropriate or not indicated care). Preventive (e.g., failure to provide proven prophylactic intervention, inadequate monitoring or follow-up of treatment). Other (e.g., failure of communication, equipment failure, another system failure).

6. Types of Medical Errors Slips: Actions not carried out as intended or planned (e.g., injecting a medication intravenously when the doctor meant to give it subcutaneously). Memory lapses: Missed actions and omissions (e.g., forgetting to monitor and replace serum potassium in a patient treated with furosemide for acute congestive heart failure). Mistakes: Errors brought about by a faulty plan or incorrect intentions (e.g., treating a patient for a suspected pneumonia when the patient was misdiagnosed and actually has a pulmonary embolism).

7. For example, a physician may decide to forgo entering a patient’s allergies into the electronic record due to time constraints in starting treatment. If this act led to an adverse medication reaction due to a missed allergic reaction, it would technically be considered a malpractice and not an error. Negligence vs. Malpractice Medical Negligence refers to an act of carelessness, not intent to harm. It means the physician made a mistake in the good faith belief that he was fulfilling the medical standards of care and doing the right thing by the patient.  Medical Malpractice comes with a physician’s intent. This does not necessarily mean the intent to harm a patient, but the intent to perform some action (or omission) while knowing it could result in harm to the patient.

8. Rationale for Error Disclosure Errors create significant distress for patients who report feeling angry, depressed, and traumatized. Therefore, patients might lose trust in both their care providers and the healthcare system. The purpose of the medical error disclosure is to convey a human, compassionate, and empathetic response to the patient’s misfortune. Error disclosure benefits the patient by easing the worry, decreasing anxiety, and alleviating confusion. This may be conducive to the patient’s healing.

9. Guidelines for Disclosing Medical Errors Meeting should be arranged as soon as possible in order to brief the patient/family about what happened, the course of action, treatment, and follow-up Medical professionals find it difficult to acknowledge their errors openly before patients and colleagues. It may be less traumatic if a physician follows practical guidelines for disclosing such events. The following 4 steps are recommended for a successful error disclosure.

10. SET UP the conversation Gather as much information as possible for the patient and family. Preserve the confidentiality of patient information Consider which members of the patient’s personal support system should be present. Identify which members of the health care team should take part in the disclosure with you. Find a private and quiet place to meet. Use the patient’s name and introduce yourself and any other individuals in attendance. Sit down and minimize distractions. Make an opening statement and start from the beginning and prepare the patient/family with a shot across the bow: There has been an unanticipated event in your care and I am here to tell you everything I can. Share the information you know and explain objectively what occurred: You did not receive the antibiotics we intended to give you last night. Make factual conclusions and resist the urge to speculate on what may have happened. 1

11. LISTEN and assess understanding Invite questions and listen openly. Listen openly, allow silence and explore emotion. After sharing a sentence or two about the event, ask if they are ready to hear more details. Allow time for a response. Throughout this conversation, there may be comments or behaviors reflecting grief responses such as anger or disbelief. Avoid responding to anger with anger. Assess understanding. Be ready to repeat information or give information in another way if needed. Encourage patients and families to ask questions so they gain understanding. Anticipate varied responses from different people. Be prepared to listen and offer support. 2

12. APOLOGIZE sincerely Explain that the event was not expected or intended. Allow yourself to be vulnerable, vulnerability is sincerity. Express regret for what happened and offer a personal apology if appropriate. Apologize more than once. When appropriate, use phrases of reassurance such as, “We are going to take care of you.” Avoid blame and be careful not to prematurely assign blame with phrases like “we screwed up,” or “this is _____’s fault.” Subsequent conversations after additional investigation will better address this. 3

13. DISCUSS next steps Reassure the patient he will receive the ongoing medical care they need: We will monitor you closely and provide any further care you need. Explain that further investigation will take place to learn how the error happened and to make sure a similar event does not happen again to him or anyone else. Assure the patient that results of this investigation will be shared with them. Arrange follow-up meetings to provide updates about the event(s) 4

14. CASE SCENARIO You administer a flu shot to a patient, who almost immediately develops an allergic response. Nothing in the chart indicates a medication allergy. Upon further investigation, you learn that your patient’s chart was mixed up with the chart of another patient having the same name. Hints and tips Introduce yourself. Ascertain the patient’s current understanding of what the situation is. Give a warning shot statement, such as “ I have some bad news for you ... ”. Explain the situation (the error) that has occurred in simple words, avoiding medical jargon. Pause awaiting the reaction of the patient. offering an appropriate apology. Show empathy, and responding to the patient’s emotions. Avoid excuses and blaming others. Remain calm and avoid the display of feelings of anger and argumentation. State how the harm will be remedied. Reassure the patient that this error will not occur in the future with him or any other patient. State possible actions to avoid this error in the future. Answer any further questions. Offer an opportunity to discuss the situation with a more senior member of the team if necessary. Confirm and agree on a plan, including the timing of follow-up.