Definition: What is a medical error?
Medical error: the failure of a planned action to be completed as intended, or the use of a wrong plan to achieve an aim (the Institute of Medicine, as cited in Wilson & McCaffrey, 2005).
- The research included in this paper includes errors that occur in the hospital setting.
- In 2005, 98,000 hospitalized Americans died from medical errors.
- Death numbers exceeded fatalities from motor vehicle accidents, breast cancer, and acquired immune deficiency syndrome.
- Includes all errors, such as mishandled surgeries, diagnostic errors, equipment errors, and medication errors.
- The author of this article is a registered nurse. The suggestions herein may be applicable to other health professionals (including physicians and osteopaths).
Medical errors are underreported across the health care industry (Uribe et al., 2002). The research from 2005, as reported by Wilson & McCaffrey, said medical errors rank as the eighth leading cause of death of Americans in the United States. Disclosure of medical errors is in the best interest of the patients and health care professionals alike, and consequentially implies both ethical and professional obligations. The reporting of medical errors results in positive patient outcomes in health care. Litigation occurrences are reduced (Wilson & McCaffrey); the main reason for reporting errors, Uribe said, is because the reporting of medical errors is an essential component of patient safety. Included in the definitive reference to medical errors are “near misses,” events when serious medical errors could have been imminent but were inadvertently avoided. Medical errors are also referred to as Patient Safety Events (PSEs) and these terms may be used interchangeably. This paper is written from the perspective of a registered nurse.
Medical errors monitored and can greatly be reduced through nursing research and transparency. Nursing research, through the process of research design, is the methodology that results in the creation of nursing theory in quantitative research and determines the strength of nursing theory in qualitative research (which results in rigorous research design.); resulting in nursing theory credibility (Polit & Beck). Transparency when addressing PSEs leads to quality improvement resulting in positive patient outcomes through prevention of future occurrences (Pak, 2013). Nursing practice, based on solid Evidence-Based Practice (EBP) has proven to result in positive effects on patient outcome, notable called “best practice” in nursing (Tappen, 2016). Health promoting behaviors, by which all nurses are committed (and others who serve patients within the medical field) result in a plan of action leading to best practice in patient care.
Medical errors potentially result in serious, inevitable, potentially permanent harm to patients’ safety. Health care providers are never immune to errors regardless of their extensive training, precise actions, and mastery of skills (Hashemi, Nasrabadi, & Asghari, 2012). Reporting medical errors results in positive outcomes in health care. The reporting of medical errors is an essential component of patient safety (Uribe et al., 2002). Furthermore, litigation occurrences are reduced; transparency is in the patients’ best interests (Wilson & McCaffrey, 2005). Two research studies presented informative information about medical errors and the reporting of medical errors. The first, a quantitative study, has shown that the consolidation of similar medical errors is helpful in preventing further occurrences (Kang & Gong, 2017). This study, known as the Semantic Similarity Integration, is the system that streamlines the consolidation of similar patient medical errors. Kang & Gong have proven that data analysis, through the compilation of like PSEs and the analyses of when and how these events occurred is useful for the prevention of future occurrences.
The second study is qualitative. Theresa Pak (2013) designed a cross-sectional qualitative study and hypothesized that in the event of a medical error, patient safety is contingent upon full disclosure, transparency, and organizational accountability. Disclosure is “a communication of a healthcare professional that acknowledges the occurrence of an error, discusses what happened, and describes the link between the error and outcomes in a manner that is meaningful” (Mater et al., as cited in Pak, 2013). Pak said that patient safety is more of a process and less of an endpoint. Patient safety encompasses five components: measurement of harm; understanding causation; identification of solutions; evaluations; and translation evidence into safer care. Barriers to disclosure include uncertainty of health care workers about what to say to patients; lack of training in communicating the error; fear of malpractice; and lack of institutional support (Pak, 2013). From the results of Pak’s study that influence EBP (evidence-based practice), one may conclude that the harmful and potentially harmful damage resulting from PSEs can, indeed, become a segue for improvement in patient care outcome when approached with integrity and honesty. For example, Nurse leaders can create a culture that supports patient safety as a shared value between leaders and staff; nurse leaders can create an environment in which all team members feel responsible and accountable for ensuring patient safety; nurse leaders can create and environment in which frontline staff are not afraid to be heard and uphold accountability by including staff in the solutions (Vogelsmeier & Scott-Cawiezell, as cited in Pak, 2013); nurse leaders play a pivotal role in providing demonstrative human caring values and advocacy for both patients and staff as leaders within their own organizations (Pak, 2013).
In contrast, the quantitative study (Kang & Gong, 2017) , concluded that PSEs are reported from recorded events (many events are not reported); the reporting process must be implemented in a timely manner for positive patient outcomes; and the rigor of scientific strength depends upon patient safety events that are reported, compiled into a user-friendly database, and evaluated for comparative analysis for patient care quality improvement, such as educational purposes and communication enhancement. Extreme honesty with patients, residents (of long-term care facilities), and their families is not only “the right thing to do.”: The disclosure of medical errors to patients and their families involves patients and families in creating solutions that reflect a patient-centered approach to patient safety (also, organizational safety). Extreme honesty also can build trust and strengthen the practitioner-patient relationship (as well as reduce malpractice awards and settlements) (Horowitz, 2016). Alexander Pope said, “To err is human, to forgive, divine.”
How should the error be reported? There are safety guidelines recommended by Martin J. Hatlie, founder of the Chicago-based Partnership for Patient Safety, that include a prompt, straightforward apology that steers clear of medical jargon and finger-pointing, focus on the facts. Never, says Hatlie, should the communication come via e-mail or telephone. In preparation, it is important to review what you will say and to have answers to questions you can predict. Set the scene: choose a private area so that no one will interrupt; reach out and touch—never on the back, head, or shoulder—stay between the elbow and the fingertips; give the patient some control—allow patients and family to make choices, using language such as, “I’d like to talk about some things that have happened withy your care. When is a good time for this? Hatlie as cited in Weiss, 2007). Emphasize that you care about what happened to them, not that you are seeking to absolve yourself of responsibility (through finger-pointing at another health care worker, for example). Perhaps others (a family member of the patient, another nurse) can be in the room—not a lawyer. “Steer clear of sweeping statements, such as ‘Don’t worry, the expenses will be taken care of.’” (Weiss, 2007). All disclosure documents must be documented with date, time, and be legible and factual. For the most serious events, notify your attorney, the risk manager of your insurance company, and pertinent facility co-workers who may be circumstantially involved.
In the wake of a medical error an apology is first and foremost. These suggestions offer methods of action when a medical error occurs. When the discussion about the error becomes a ‘blame and shame’ game (Horowitz, 2016), all lose. The nursing board looks at numbers of occurrences and the circumstances around those occurrences, such as, is the nurse absent a lot (is there a substance abuse problem), or does she have good hygiene (is she abused at home; are there bruises?). A circumstantial process segues into enhanced learning and healing for all parties involved. Honesty trumps all when working with medical errors and making mistakes; it is through honest disclosure (in an appropriate way) that hope for resolution and a chance of never repeating the same mistake are possible.
REFERENCES
Hashemi, F., Nasrabadi, A.N., & Asghari, F. (2012). Factors associated with reporting nursing errors in Iran: A qualitative study. Nursing 2012, 11:20. Retrieved from http://www.biomedcentral.com/1472-6955/11/20.
Horowitz, A.C. (2016). Medical errors disclosure: How a SNF discloses errors can affect reimbursement and reputation. Legal Landscape. Retrieved from https://www.ltlmagazine.com.
Kang, H. & Gong, Y. (2017). Developing a similarity searching module for patient safety event reporting system using semantic similarity measures. BMC Medical Informatics and Decision Making 17, 75-83.
Doi: 10.1186/s12911-017-0467-8.
Pak, T. (2013). The nurse leader’s perspective and role in disclosure of medical errors and adverse clinical events: A qualitative study. (Doctoral dissertation). Retrieved from ProQuest LLC. (1546297).
Polit, D.F. & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Wolters Kluwer.
Uribe, C.L., Schweikhart, S.B., Dow, M., & Marsh, G.B. (2002). Perceived barriers to medical-error reporting: An exploratory report. Journal of Health Care Management, 47(4), 263-280.
Tappen, R (2016). Advanced nursing research: From theory to practice (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Weiss, G. G. (2007). Should you apologize? Medical Economics, 70-78. Retrieved from https://www.contemporaryobgyn.net.
Wilson, J. & McCaffrey, R. (2005). Disclosure of medical errors to patients. Medical0Surgical Nursing, 14(5), 319-323.