Prevention & Disclosureof Medical Error

Dr. Ramadan Ibrahim

Director

Health Regulation Department

Dubai Health Authority

Prevention & Disclosure of Medical Error

Dr. Layla Al-MarzouqiHead of Clinical Governance Health Regulation Department

Dubai Health Authority

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Medical Liability Law - 2008

Medical Malpractice

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Medical ComplaintExpressions of dissatisfaction or concerns about a health care

service made by consumers.

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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

][5][6]

medication errors : most common medical mistakes, 1.5 million people /yr.

7,000 people were estimated to die /yr from medication errors.

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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

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MiscommunicationFailure 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

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Communication is the best Defense Against Medical

Malpractice

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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.

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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

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• 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

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• 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

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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 itEmbarrassingOnce you say sorryMedical lawyer

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• 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 suitshelp in starting grievance for doctors/

patients

“How am I going todisclose an error in a way that

maintains a patient’s trust ?”

WhoWhenWhereHow

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 possibleAsk patients if they would to have familysecond person in the meeting introduction

Communication speech: slowly, softly, simple, pause frequently, give warning

Listen without interruption

Sitting Eye contact/ body language

What informationDetailed information about the eventHow their health will be affectedWhy?Problem correction and avoidance How will it prevented in futureOffer supportApology

“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

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Follow uprecord details & minute it

Don’t BlameExpress causationRespond anger with angerPanic if malpractice suit is threatenedInform about litigation opportunity

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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."

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Thank You