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 .