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medical error

The medical ethics principle of disclosing medical errors is fidelity. Classification: 1) close calls, near misses - catching wrong medicine before given to patient 2) adverse event - falls, medication error, etc 3) sentinel event - results in death, serious physical or psychologic injury - wrong site surgery - suicide - must be reported immediately Epidemiology: - most frequent errors are errors associated with: a) laboratory & radiologic testing (44%) 1] failures or delays in test ordering, performance 2] appropriate clinician interpretation 3] follow-up of abnormal test results b) clinician assessment (32%) Management: 1) minimize or eliminate harm - closed loop communication to reduce errors in medication & its administration 2) filing of incident report as required by institution 3) physicians must inform patients about medical errors if the information will impact on patient's present & future health& well-being 4) patients want to be informed of all medical errors, regardless if there was an adverse outcome [1] - this optimizes informed decision making, promotes trust, may reduce stress, & may mitigate risk of litigation [1] - provide an early, open, honest account of the error & apologize formally to the patient - telling the truth shortly after the error is discovered is ethically obligatory & is the accepted standard of care. 5) inform patient that steps are being taken to prevent future errors [1] Notes: - concerns that disclosing an error promotes litigation are not supported by data - 3rd leading cause of death in U.S. after heart disease & cancer [9]

Related

harm

Specific

diagnostic error (missed diagnosis)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 14, 17. American College of Physicians, Philadelphia 2006, 2015
  2. Schiff GD et al. Diagnostic error in medicine: Analysis of 583 physician- reported errors. Arch Intern Med 2009 Nov 9; 169:1881. PMID: 19901140
  3. Gallagher TH et al Talking with Patients about Other Clinicians' Errors. N Engl J Med 2013; 369:1752-1757October 31, 2013 PMID: 24171522 http://www.nejm.org/doi/full/10.1056/NEJMsb1303119
  4. Gallagher TH, Studdert D, Levinson W. Disclosing harmful medical errors to patients. N Engl J Med. 2007 Jun 28;356(26):2713-9. PMID: 17596606
  5. Gallagher TH, Garbutt JM, Waterman AD et al Choosing your words carefully: how physicians would disclose harmful medical errors to patients. Arch Intern Med. 2006 Aug 14-28;166(15):1585-93. PMID: 16908791
  6. Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, editors. To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press (US); 2000. PMID: 25077248 Free Books & Documents Free full text
  7. Kachalia A, Kaufman SR, Boothman R et al Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med. 2010 Aug 17;153(4):213-21. PMID: 20713789
  8. Murphy JG, McEvoy MT. Revealing medical errors to your patients. Chest. 2008 May;133(5):1064-5. PMID: 18460511
  9. Frellick M Medical Error Is Third Leading Cause of Death in US. Medscape Medical News. May 3, 2016 http://www.medscape.com/viewarticle/862832 - Makary MA, Daniel M Medical error-the third leading cause of death in the US. BMJ 2016;353:i2139 PMID: 27143499 http://www.bmj.com/content/353/bmj.i2139
  10. Mansour R, Ammar K, Al-Tabba A et al Disclosure of medical errors: physicians' knowledge, attitudes and practices (KAP) in an oncology center. BMC Med Ethics. 2020 Aug 20;21(1):74 PMID: 32819353 PMCID: PMC7439528 Free PMC article