September 3, 2020
Medical Mistakes Continued
This article is part two of two articles discussing “Medical Mistakes” as a whole. In part one we took a look at diagnostic errors, surgical errors and issues within the emergency department. In part two we will be revisiting medical errors across the healthcare industry and discussing:Most common and reoccurring medical errorsMisdiagnosis and unnecessary treatmentsA look at the reality of medical mistakes – misdiagnosis case studyMain causes of medical mistakes and how to risk manage themMissed part one? You can read ‘Medical Mistakes – Preventing Emergency Room and Surgical Errors’ here.
Reoccurring Medical Mistakes Across the Industry
The list of medical mistakes that occur within healthcare unfortunately reaches far and wide. Despite this there are a large number of medical mistakes that reoccur regularly in the healthcare industry that can be easily preventable. Here is a list of common medical errors often caused by technical errors, teams and individual staff members:Patient Related Issues – Such as inappropriate patient identificationHuman Related Issues – Such as negligence from staff members and miscommunicationImproper flow of information between staff members and medical departments and/or between staff and the patientAnaesthesia – Errors in providing dosage and/or administrating the inappropriate kind of anaesthesia Delays in treatment – Due to high demand, patient backlog, slow timing on the day service and/or lack of internal staff management Misdiagnosis and/or Delayed Diagnosis of Medical Condition – therefore leading to inappropriate and/or delayed treatmentInfection – Caused by lack of sanitary care in medical environment (from medical environment to patient) Infection – Caused by lack of appropriate care during medical treatment (e.g. infection caused by inappropriately handled surgical treatment by medical professional)Failure to Act on Patient Test Results Inadequate monitoring of patient before and after procedure Failure to task appropriate precautions prior to surgery/treatmentTechnical Medical Errors – where machines have not been properly monitored, tested or updated prior to useCommunication errors
More On Misdiagnosis and Inappropriate Treatments
Studies have recently shown that more people die from medical mistakes than they do from car accidents, pneumonia and diabetes – a shocking discover. As we have previously discussed misdiagnosis and delayed diagnosis can also have devastating and life threatening implications depending on what patients are suffering, and what the misdiagnosis is. For example misdiagnosis on a patient who has cancer can lead to cancer progression being caught in later stages where it is harder to treat, missing opportunities to treat cancer in it’s early stages. Alternatively, a patient who does not have cancer has misdiagnosis of cancer, can be put through scans and tests that promote risk of cancer, and therefore indirectly lead to cancer later on in life. For example, CT and MRI scans that are used to diagnosis cancer also increase risk of cancer cells occurring in one’s lifetime.In both examples, both patients have a delay in their actual diagnosis, meaning their actual medical conditions have room to grow, worsen and weaken the patient. This can lead to lower quality of life and/or eventual death in extreme cases. Misdiagnosis can lead to the providing patients with inappropriate and sometimes unnecessary forms of treatment. This error of misjudgement can also lead to life threatening results.
Michael Skolnik (Case Study)
The following is a look at the clinical case of Patty Skolnik’s (founder of the Citizens for Patient Safety) son Michael Skolnik. Michael Skolnik’s is a prime example of the devastating implications medical errors can have. Misdiagnosed by a medical professional, Michael underwent brain surgery that left him partially paralysed and unable to speak. It was later discovered that Michael did not need any brain surgery to begin with. He lost his his life two years after the surgical error was conducted, succumbing to multiple infections. Before suffering these life altering surgical errors, Michael Skolnik was training as a nursing student himself. His parents have since created an organisation dedicated to improve communication between healthcare workers and patients to reduce the effects and number of medical errors. Misdiagnosis and unnecessary treatments happen during tests as well. Studies show that $4700 Billion USD in America are spent every year on unneeded tests, procedures and treatments.
Main Causes of Medical Mistakes & Protecting the Client
If we look closely at some of the main causes of Medical Mistakes across all healthcare categories, we can see that there are many ways to risk mitigate healthcare work to protect the client and protect the healthcare worker from medical negligence claims.
1. Communication Problems
Most of the time the common cause of medical errors are where communication problems have occurred through both verbal and written forms of communication. This can occur between physicians, nurses, healthcare team members, surgical teams and even the patient themselves. Poor communication equates to some of the worst errors possible. In some cases, poor communication can also promote misdiagnosis, misinterpretation and an incorrect evaluation of the patient assessed. It can even lead to procedure without consent, or issues relating to consent where patient has consented to one procedure and this has been mistaken to consent regarding a different procedure due to lack of patient knowledge, lack of communication or misinterpretation. How do you prevent errors in communication? Ensure paperwork is neatly submitted, clear and concise. When passing on paperwork or notes regarding patient assessment and suggested diagnosis/protocol, always discuss and re-evaluate with staff members that are being passed on the information and/or the patient. There are various methods and structures that can be implemented into the workplace to make areas of communication more efficient. As a medical professional working in your environment you will understand best that every working environment is different and every team and system is different. Discuss communication issues with your colleagues and identify in your team where those communications lack of the most. By identifying these key problems you will be better equipped to deal with them.
2. Inadequate Information Flow
This for obvious reasons, feeds into errors involving communication. If systems are not in place to ensure the flow of information within the work force is fluid and clear to navigate, communication errors will occur. This is most likely to cause and encourage issues involving lack of crucial essential information that will be needed to influence prescriptions, medical decisions and procedure referrals. Other common errors due to lack of information flow are poor coordination of medication orders (prescriptions) and orders for transfer of care. Lack of information flow means you and your team (or workforce as a practice) is disconnected and does not interact efficiently with one another to ensure work is done properly, efficiently and safely. If this is the case than protocols and team building exercises may be needed to promote and ensure effective communication. Additionally, methods of communication may need to be revisited, reassessed on their effectiveness and either updated or replaced with fresher more effective methods.
3. Human Related Problems
Human related problems can occur all the time individually or within a healthcare team. These problems are caused when the standard of care, policies, processes and procedures/services offered are not followed efficiently as required and expected by the business and the patient. Actions that lead to mistakes via human related problems include:Poor documentation produced on/for patient Incorrect labelling of specimens for testingKnowledge based errors – where procedures are incorrectly handled because medical professional does not have base medical knowledge of procedure required On a monthly basis, periods of training, refresher courses and individual assessments should be conducted with all staff members in their field of medical practice with a staff or team manager, to establish that all members of staff:a) have the required standard of knowledge in their medical field and role without the assistance of another medical professional b) retain required standard of knowledge regarding their position in medical teams and the expected standard of care they are required to give out to patients c) that the staff member is inline with updated protocols, methods of management and communication, and is therefore following these updated processes and not following outdated processes no longer in use by the workplaceThis can and should be done to assess their ability in their general medical role and to asses their individual ability to maintain a high level standard of care when conducting specific tasks with high risk of medical error (e.g. labelling specimens for testing, etc).
4. Patient Related Issues
Errors can sometimes originate from the very first initial patient encounter and assessment where major miscommunication has initially occurred. These issues can lead to:Inaccurate and inappropriate patient identificationIncorrect patient assessments Failure to obtain patient consent Obtained patient consent based on misinformation and miscommunication (patient agrees to something different than what is being offered but due to miscommunication both patient and medical professional believe consent is for the same procedure) Insufficient Patient Knowledge If methods of communication and general flow of information within the workforce has initially been approved and amended, patient related issues should reduce in number and in risk of occurring. It is important to remember that good processes of information and communication is not limited between healthcare professionals, but is equally just as important between the patient and the healthcare professionals dealing with them. Always ensure your patient is well informed of their assessment and the procedures being put forward for their benefit.If they patient appears remotely confused, or is struggling to keep up on the situation, take a few minutes to ensure your patient is brought up to speed. If your patient needs to see more than one healthcare professional and more than one healthcare department, ensuring you fully explain the situation to the patient, and that the channel of information and communication between you and the various medical professionals and departments working with the patient, are accessible and clear to avoid miscommunication.
5. Technical Errors
Mistakes caused by “technical errors” are where complications or failures in testing, delays in diagnostics or incorrect results are provided based off the break down of medical devices (implants, grafts and equipment). In our part one blog, Medical Mistakes – Preventing Emergency Room & Surgical Errors, we talked briefly on the best ways to risk manage technical errors. The most effective way to catch machine technical errors before they occur is to conduct regular tests and assessments of the machines and devices used on a daily basis, prior to the first patient appointment, to ensure the device is working and reduce delay should there be any issues. In a large medical entity environment this may be more than difficult to keep up. However, whilst it will cost, training can be provided to medical professionals based on the medical devices and machines they specifically use in their department. If trained appropriate staff members should have knowledge required to do their own tests and checks on equipment prior to their appointments without the presence of a mechanic or technician. Staff members training in this manner will also be less likely to break said equipment therefore reducing the chance of break down day to day in a medical environment. These checks can be done at the start of the day, prior to the first day’s appointment regarding use of the medical device, and at the start of every new shift, where medical professionals come off work and other staff members come on to start their shift. Staff training to manage machine, devices and technology will relieve pressure put on technical support and management to test machines in short spaces of time and allow them to spend more time fixing broker equipment without being rushed, ensuring a better job. While this may take time and many be complicated to arrange for large workforces, it is worth consideration, especially if you experience many technical errors within your workplace on a regular basis.
Revisiting Medical Negligence Claims
In the end of the day it is important to remember that risk management will help prevent risks of receiving a claim and risk of encountering medical errors and mistakes in the workplace, but they won’t stop them 100%. In the event your fool proof risk management strategy sees a medical negligence claim slip through, you must ensure you are fully protected. While it is a legal requirement for you to have Medical Malpractice Insurance in order to practice within the UK, many opt out of full coverage for policies that leave them exposed to various forms of medical negligence. Insurance is designed to protect you – to get the most out of your insurance policy where you are 100% covered for the work you conduct, make sure you choose contractual indemnity as your choice of coverage. Medical Negligence claims involving medical errors can be tricky, have high compensation costs and greatly impact your reputation. If you are insured via discretionary indemnity, the provider that covers you are legally allowed to cherry pick which policies they pay out for – this means there is a 50% chance you will be covered for your claim. If your provider chooses not to cover your claim then you will be expected to cover all legal and compensation costs out of your own pocket (even if you have paid for your insurance). When covered via contractual insurance, your provider pays out 100% for the claims you are covered for. For more information, you can read our blog Discretionary VS Contractual Indemnity. If you have contractual indemnity already, then you should double check your policy to ensure you are covered for medical errors that occur, and out of those errors, what kind are you not covered for. If you find yourself uncovered for the medical errors you are most at risk of in your line of medical profession, we offer over the phone consultations and silent reviews to best outline where you are covered and where you are exposed to negligent claims. For more information regarding silent reviews, or risk management advice regarding medical mistakes, surgical errors and emergency room errors, please contact us via a call back form or the email email@example.com.
Please note that this article is intended to serve as value-adding information, and you should consult with a professional when taking steps in arranging Medical Error protection.