Prevention & Disclosure of Medical Error

Report
Prevention & Disclosure
of Medical Error
Dr. Ramadan Ibrahim
Director
Health Regulation Department
Dubai Health Authority
Prevention & Disclosure of Medical
Error
Dr. Layla Al-Marzouqi
Head of Clinical Governance
Health Regulation Department
Dubai Health Authority
Medical Liability Law - 2008
.
Medical Malpractice
Medical Complaint
Expressions of dissatisfaction or concerns about a health care
service made by consumers.
.
44,000-98,000 preventable deaths each year in U.S.
hospitals.
This is the equivalent of losing a jumbo jet airliner full of
122-270 passengers / day.[4
medication errors : most common medical mistakes, 1.5
million people /yr.
7,000 people were estimated to die /yr from medication
errors.
.
.
Medical errors are associated with:
•
•
•
•
•
•
•
•
.
Inexperienced physicians & nurses
New procedures
Extremes of age
Complex & urgent care
Poor communication
Improper documentation
Inadequate nurse-to-patient ratios
Similarly named medications
Miscommunication
Failure to convey relevant medical information to key
players in medical team & to patient/family
Affect patient safety & quality health care
Lower compliance
Over investigation
Reduce patient satisfaction
.
Communication is the best
Defense Against Medical
Malpractice
.
Researchers at State University of NY reported
that claims related to communication failure
increased from $21.7 million in 1991 to $91
million in 2010.
.
Reasons for miscommunication
• Time issue for physicians
• Doctor manages a very high volume
• Patients referred to many specialists before a diagnosis
is made
• Educational disparity between doctors & patients
• Doctor shopping
• Communication breakdowns between changing shifts
.
• Do not expect patients to have a prior
understanding of the biology and treatment of
medical condition
• Being positive and supportive is one thing, but
manage expectations of each patient
.
• Best defense any doctor can have is excellent
communication skills
• All medical professionals should develop a
habit of writing down what has been
communicated to patient. So if there is a
lawsuit, documentation can be provided
• Informed consent
.
Disclosure of Medical error
.
have any of you been personally
involved in
a near miss?
a minor error?
the disclosure of the error to a patient?
Reasons for not disclosing error:
I don’t want to talk about it
Embarrassing
Once you say sorry
Medical lawyer
• Medical error is not preventable but is it
reducible
• Patient disclosure is important in the
medical error process
.
Medicine differs from before
Now a days:
• Internet
• Question
• Take part in treatment
Deeply human connection relationship
Medical injury is different from other
injuries in two ways
Disclosure
does not always protect
the physician from legal law suits
help in starting grievance for doctors/
patients
“How am I going to
disclose an error in a way that
maintains a patient’s trust”?
Who
When
Where
How
No ideal way/standard
Disclosure skills.
Openness has potential to heal not to
harm
• Open
• honest
• compassionate conversation
Fundamental measures for disclosure:
•
•
•
•
Apology
Explanation: what happened/ effect
Assurance : analysis/learn
Follow up : what has been done
Disclosing :
A soon as possible
Ask patients if they would to have
family
second person in the meeting
introduction
Communication
speech: slowly, softly, simple, pause
frequently, give warning
Listen without interruption
Sitting
Eye contact/ body language
What information
Detailed information about the event
How their health will be affected
Why?
Problem correction and avoidance
How will it prevented in future
Offer support
Apology
“I am sorry for what happened to you”
whether it was an adverse event due to an error
“I am sorry for what I did to you”
when adverse event was caused by an error or system
failure
.
Follow up
record details & minute it
Don’t
Blame
Express causation
Respond anger with anger
Panic if malpractice suit is threatened
Inform about litigation opportunity
Use of rationalization to cover up medical errors
– "Why disclose the error? The patient was going to die anyway.«
– "Telling the family about the error will only make them feel
worse.«
– "Well, we did our best. These things happen.«
– It was the patient's fault. If he wasn't so (obese, sick, etc.), this
error wouldn't have caused so much harm."
.
Thank You
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