Does Your Service Report Medical Errors To THE PATIENT ?

[RaceMedic]

First of all, yes I admitted my mistake, it was a long time ago, would handle differently now. Second, I hypoyhisized a serious medical mistake that harmed the patient, not a minor oops. Third, note that I asked how your "service" handles that, not the medic, bit I doubt there are many in this room whoever report it to the patient. Fourth, if u have harmed a patient, they have a right to sue. I can not tell u how disappointed in this room's members today ; I see lawyers in here not patient advocates. I know u guys and galls are better than this, change the word "patient" to "your child or your mom", and tell me u r still buying the stuff u r shoveling?

I would expect the medic to follow protocol. I would still expect a thorough investigation in to the events that took place. I do not expect anyone to willingly and needlessly hang themselves and potentially end their career without due process.

Change the scenario anyway you want. The response from me will continue to be the same.

Race

So how many patients have received notification by your service dfib?

That is a personnel issue and until you are in management and part of the process and not the cause of it, You will never know that number. Not to mention that number will never be known to the public nor anyone outside of administration and legal council.

You really do not understand this concept do you ?

Race

[DFIB]

So how many patients have received notification by your service dfib?

My patients? None have recieved notification. I am just an EMT so I haven't had the chance or the means to screw up yet. I am sure my time will come once I am working cardio and pushing meds.

As for others in my service ... I don't have a clue. I am not that far up the food chain.

[chbare]

A significant consideration is the fact that we need to determine the extent, damages and processes that led to and resulted from the error. This is the reason we report errors and perform investigations and a root cause analysis. Going to a patient immediately following an error does no good as we often cannot provide the patient/family detailed information about the situation. Often, details and implications are not fully realised until the investigation phase. This is also why we have QI/QA processes in place, to identify issues and manage issues. In addition, many errors occur that are often unnoticed or unrecognised until the QI/QA process occurs and somebody identifies a potential issues. Also, how do we define an error and implications of said error? Technically, you could error by placing your chest pain patient on a non-rebreather at 15 LPM when said patient lacks dyspnea and have no signs or symptoms of hypoxaemia or hypoxia. Yet, many people are doing this. Should all of these "errors" be reported?

Certain members of this site appear to lack basic understanding of the investigative process. it is less about "CYA" as some have put it and more about performing a good investigation in order to uncover as much information as possible, allow people to analyse and process said information, enable people to make plans of corrective action and allow people to assess the extent of damages.

Often, this process leads to the identification of system wide issues that can be improved to prevent future problems. A medical error is not typically associated with a single event, but rather associated with a series of issues that all played a role in causing the error.

[Just Plain Ruff]

A significant consideration is the fact that we need to determine the extent, damages and processes that led to and resulted from the error. This is the reason we report errors and perform investigations and a root cause analysis. Going to a patient immediately following an error does no good as we often cannot provide the patient/family detailed information about the situation. Often, details and implications are not fully realised until the investigation phase. This is also why we have QI/QA processes in place, to identify issues and manage issues. In addition, many errors occur that are often unnoticed or unrecognised until the QI/QA process occurs and somebody identifies a potential issues. Also, how do we define an error and implications of said error? Technically, you could error by placing your chest pain patient on a non-rebreather at 15 LPM when said patient lacks dyspnea and have no signs or symptoms of hypoxaemia or hypoxia. Yet, many people are doing this. Should all of these "errors" be reported?

Certain members of this site appear to lack basic understanding of the investigative process. it is less about "CYA" as some have put it and more about performing a good investigation in order to uncover as much information as possible, allow people to analyse and process said information, enable people to make plans of corrective action and allow people to assess the extent of damages.

Often, this process leads to the identification of system wide issues that can be improved to prevent future problems. A medical error is not typically associated with a single event, but rather associated with a series of issues that all played a role in causing the error.

This is how my service or my last service dealt with this sticky issue

1. Medic makes an error and recognizes the error.

2. Medic reports error to nurse receiving patient and physician

3. medic reports error to supervisor or boss

4. Supervisor contacts receiving facility either the nurse or the doctor and gathers information on whether error caused harm or not.

5. Meeting with medic involved is established, medic involved gives process leading up to error and is given chance to suggest what could have been done differently. This meeting involves the medical director and supervisor who received the report as well as any QI or QA person as well as risk management.

6. If error determined to be a mistake on the medics part only then discipline or re-training occurs

7. IF error is determined to be a system wide occurrence or could happen again then policies are re-done and re-training entire system

8. If error killed patient or caused significant damage then service lawyers are brought in to advise and recommend action

9. It can go on from there. But that's the start of the process.

I cannot give a good number of patients who were told about the errors. I'm not in management or Risk management so I don't know. NOr am I the services attorney which probably has the final say as to whether to notify the patient.

Simple, not really.

[DwayneEMTP]

The problem that I believe that Flaming is having is that intelligent investigation is not dramatic enough.

Any solution that is not likely to cause people pain and make him appear to be a hero is going to be unsatisfactory.

And for the record. My wife and I cared for my mother, my mother in law, and my father in law throughout the entire process as they died slowly and painfully from assorted cancers. And in each case possible errors in their care were reported to us. It was made clear that the best known treatments available were being brought to bear in the most intelligent manner that they were able, but that there were simply no sure answer.

One of those errors almost certainly brought about the death of my mother in law much earlier than necessary. A misdiagnosis of the return of her cancer caused her return to cancer treatment to be delayed by approx. 8 months. That was a sad meeting, where the doctor was obviously upset and understood that he was putting his and many other people's asses on the line, layed out the errors and explained why he believed that they occurred. It made sense, and, for the record, no law suits were initiated.

My mother was unwell during her Kemo treatments and her condition was believed to be a side effect of those treatments. It was later discovered that a shunt placed in her ureter had been pulled loose, allowing the ureter contents to leak, causing some of the symptoms that were mistakenly attributed to the Kemo. Again, the Drs were perfectly honest, admitted that upon hindsight that it probably should have been discovered sooner, and repaired the issue. No law suits were filed, nor considered.

(Side note. Maybe the most compassionate medicine I've ever seen came from this same doctor. She said, "Myrt, with your type of cancer, near the end of your life the pain will be terrible and almost impossible, if not impossible to manage.

You need to be very careful about the shunts that we've put in your ureters. They pull out very easily, with almost no pain. Should that happen, within about a half day or so you'll begin to feel kind of drunk and happy. Over approx. the next day you will feel more and more 'stoned' until you become unconscious. Not long after that you will die. Do you understand what I am telling you?" My mom smiled and said, 'I hear you babe...thank you." Of course she was telling my mother how to kill herself when the pain became unbearable. That is medicine in a near perfect world. In a perfect world she would be allowed to do it for her. But that is another thread.)

For some reason you seem to believe that life altering/ending errors being hidden is the rule instead of the exception.

You think that providers/institutes are exposed to liability and possible financial consequences when reporting errors? It's not a drop in the bucket compared to the consequences of being discovered trying to hide them.

Running around reporting not yet understood issues is not good for anyone. Had the doctors simply said, "we made a misdiagnosis of your parents and now they are going to suffer more than necessary." it would have been a really bad things. Saying, "We've made some mistakes. We believe that those mistakes are going to cause these consequences. This is why those mistakes happened, and what we're doing to try and make sure that they never happen again. This is our plan to try and mitigate the errors that were made. We're truly sorry." There is a completely different outcome for that. One that was healthy, and understandable by our loved ones and their families.

But again. There are no heroes or whistle blowers here. No way for you to make the news for doing only what is responsible, so I can see where you find the current system unacceptable.

Dwayne

[DFIB]

(Side note. Maybe the most compassionate medicine I've ever seen came from this same doctor. She said, "Myrt, with your type of cancer, near the end of your life the pain will be terrible and almost impossible, if not impossible to manage.

You need to be very careful about the shunts that we've put in your ureters. They pull out very easily, with almost no pain. Should that happen, within about a half day or so you'll begin to feel kind of drunk and happy. Over approx. the next day you will feel more and more 'stoned' until you become unconscious. Not long after that you will die. Do you understand what I am telling you?" My mom smiled and said, 'I hear you babe...thank you." Of course she was telling my mother how to kill herself when the pain became unbearable. That is medicine in a near perfect world. In a perfect world she would be allowed to do it for her. But that is another thread.)

.

Dwayne

Dwayne,

Wow, That is a wonderful story that must be painful to share. There are some events that are personal and private, events that are “just for me”, until the proper time comes to share. Thank you for using your life experience as an example to help us understand that reporting is not always black and white. In an utopist world well intentioned mistakes would be understood as such. I am assuming the Dr. was an Oncologist. Oncologist have a very low tolerance for BS.

Thanks for sharing.

[DwayneEMTP]

Actually, though of course I wish the circumstances could have been changed, it's really an inspiring story for me when I share it.

Though there was no saving her life, she was blessed to have a provider that viewed her as a woman, a person, and someone afraid an in pain. That is not always the case for many I think.

Yeah...actually, I love that story, though those that have not been in a like position may not get that...

Dwayne

[flamingemt2011]

Great story dwayne, and I am sorry for your loss, but all I am advocating is that ems patients get the same. BY your own admission u appreciated the honesty and did not sue.

I would argue that your service has no QAQI if no patient has been notified chbare. And ruff if the lawyers make the decision I can promise no patient had been notified

Edited October 26, 2011 by flamingemt2011

[RaceMedic]

Great story dwayne, and I am sorry for your loss, but all I am advocating is that ems patients get the same. BY your own admission u appreciated the honesty and did not sue.

I would argue that your service has no QAQI if no patient has been notified chbare. And ruff if the lawyers make the decision I can promise no patient had been notified

You seem to have missed where the docs reported the mistakes they also had a plan to mitigate the effects, read the story again. They found the errors and formed a plan then came to the family. They did not just go off half cocked and say" opps we made a mistake, sorry" and walk away ... such as your suggesting we do.

Dwayne shared an incredibly personal story that touches home for me as well, Im just not ready to type it and share. Please have the courtesy to really read the story and take in what had been done, think on it and do not belittle it by picking out little snippets that you think support your point.

Thank you Dwayne for that insight and experience. touched home for me, maybe more than i realized. Burden of knowledge.... sucks at times ...

Race

[Just Plain Ruff]

I am not privy to that information so I can't say but again you make a blanket statement but you have absolutely no basis in fact to make that assumption.

Maybe no patients are notified. Sorry but I don't believe that.

AS a matter of fact, one of my favorite patients who I used to transport all the time told me that he was told of a error that a medic made.

He actually said "Don't give me that drug as I wasn't supposed to have it last time but one of your guys gave it to me anyway" so I am assuming that he was notified of that error.

I don't know who actually makes the final decision on when to tell the patient. AS far as I'm concerned I've done my due diligence by reporting the errors.

I mean really, nurses who make medication errors don't run off and tell the patient right away do they? I've worked with some really fine nurses who made mistakes but I've never seen them go directly to the patient and say "Oops, I made a medical error. I'm sorry" What I've seen is that the nurse goes to the doctor and the doctor decides if it's an error or if there was damage done.

The nurse reports the error to her supervisor as well.

That's the process at almost every facility I've worked at and it's also the policy at the hospital that I am currently contracted with as I asked the nursing director of the ER what their process was.

They scoffed when I said that there was someone who I was conversing with who said that if they made a medical error that they would report that error to the patient. The person I was talking with said this "I hope that person has good malpractice insurance if they are going to tell the patient first before going to their supervisor"

So flaming, I really do appreciate your advocacy of your patient and maybe you are right that we don't report medical errors to the patient but by your going against your services procedures and telling the patient of the error, no matter how altruistic you are trying to be, does not negate the fact that you are putting yourself out on a huge slippery slope in liability and you open yourself up to tremendous personal liability. I don't think you are really understanding that part.