Avoiding Errors in Adult Medicine E-Book

Ian Reckless

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: AVE - Avoiding Errors
• Sprache: Englisch

Seitenzahl: 427

Veröffentlichungsjahr: 2012

Beschreibung

Avoiding Errors in Adult Medicine

Some of the most important and best lessons in a doctor’s career are learnt from mistakes. However, an awareness of the common causes of medical errors and developing positive behaviours can reduce the risk of mistakes and litigation

Written for junior medical staff and consultants, and unlike any other clinical management title available, Avoiding Errors in Adult Medicine identifies and explains the most common errors likely to occur in an adult medicine setting - so that you won’t make them.

The first section in this brand new guide discusses the causes of errors in adult medicine. The second and largest section consists of case scenarios and includes expert and legal comment as well as clinical teaching points and strategies to help you engage in safer practice throughout your career. The final section discusses how to deal with complaints and the subsequent potential medico-legal consequences, helping to reduce your anxiety when dealing with the consequences of an error.

Invaluable during the Foundation Years, Specialty Training and for Consultants, Avoiding Errors in Adult Medicine is the perfect guide to help tackle the professional and emotional challenges of life as a physician.

For more information on the Avoiding Errors series, please visit: www.wiley.com/go/avoidingerrors

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More titles in the Avoiding Errors series Avoiding Errors in Paediatrics Raine et al. 2013 9780470658680 Avoiding Errors in General Practice Barraclough et al. 2013 9780470673577 This title is also available as an e-book. For more details, please see www.wiley.com/buy/9780470674383 or scan this QR code:

Leseprobe

Contents

Cover

Title Page

Copyright

Contributors

Preface

Abbreviations

Introduction

References and further reading

Part 1

Section 1: Errors and their causes

A few words about error

Learning from system failures – the vincristine example

Evidence from the NHSLA database

The patient consultation

Failure to identify a sick patient

Inability to competently perform practical procedures

Failure to check test results or act on abnormal findings

Prescribing errors

Sources of error in the case of vulnerable adults

References and further reading

Section 2: Medico-legal aspects

Error in a legal context

Negligence

Clinical negligence

Issues around consent

An attorney refusing treatment

A patient without capacity refusing treatment

Emergency treatment

Deprivation of Liberty Safeguards

Part 2: Clinical cases

Introduction

Section 1: Civil liability, negligence and compensation

Case 1: A shaky excuse

Expert opinion

Legal comment

References and further reading

Case 2: Making matters worse

Expert opinion

Legal comment

Specific to the case

General points

Case 3: Chase the bloods

Expert opinion

Legal comment

Specific to the case

General points

Case 4: Falling asleep en-route

Expert opinion

Legal comment

Specific to the case

General points

Case 5: Bad luck or bad judgement

Expert opinion

Legal comment

Specific to the case

General points

Reference

Case 6: An opportunity missed

Expert opinion

Legal comment

General points

Case 7: Better late than never

Expert opinion

Legal comment

Specific to the case

General points

Further reading

Case 8: Man down

Expert opinion

Legal comment

Specific to the case

General points

Case 9: Cry wolf

Expert opinion

Legal comment

General points

Case 10: Not a leg to stand on

Expert opinion

Legal comment

General points

Section 2: Unexpected death: the coronial system and clinical risk management

Case 11: A doubly bad outcome

Expert opinion

Legal comment

Specific to the case

General points

Further reading

Case 12: Difficulty with diarrhoea

Expert opinion

Legal comment

Specific to the case

General points

Further reading

Case 13: A flu-like illness

Expert opinion

Legal comment

Specific to the case

General points

Reference and further reading

Case 14: Falling standards

Expert opinion

Legal comment

General point

Reference

Section 3: An approach to complaints

Case 15: A woman with chest pain

Expert opinion

Legal comment

Specific to the case

General points

Case 16: Clumsiness

Expert opinion

Legal comment

General points

Section 4: Competence

Case 17: A change in plan

Expert opinion

Legal comment

Specific to the case

General points

Case 18: Starving to death

Expert opinion

Legal comment

General points

Case 19: An irregular presentation

Expert opinion

Legal comment

Specific to the case

General points

Further reading

Case 20: Irrational but not incompetent

Expert opinion

Legal comment

General points

Section 5: Restraint

Case 21: A challenging discharge

Expert opinion

Legal comment

Specific to the case

Case 22: Ruling out the organic

Expert opinion

Legal comment

Case 23: Endless wandering

Expert opinion

Legal comment

Case 24: Can you please take these handcuffs off?

Expert opinion

Legal comment

General points

Case 25: Own worst enemy

Expert opinion

Legal comment

Section 6: Miscellaneous

Case 26: All eggs in one basket

Expert opinion

Legal comment

References and further reading

Case 27: A major mix-up

Expert opinion

Legal comment

Reference

Case 28: Under the radar

Expert opinion

Legal comment

Reference and further reading

Case 29: A cantankerous recluse

Expert opinion

Legal comment

Case 30: Keep an open mind

Expert opinion

Legal comment

Further reading

Case 31: Healthcare acquired infection?

Expert opinion

Legal comment

Case 32: Backing the wrong horse

Expert opinion

Legal comment

Case 33: A surprising turn of events

Expert opinion

Legal comment

Case 34: Funny turn

Expert opinion

Legal comment

Part 3: Investigating and dealing with errors

1 Introduction

2 How hospitals try to prevent adverse errors and their recurrence

3 The role of hospital staff

4 The role of external agencies

5 Hospital investigations

6 Legal advice – where to get it and who pays

7 External investigation of errors and incidents

8 The role of the doctor

9 Presenting oral evidence

10 Emotional repercussions

11 Conclusion

References

Index

This title is also available as an e-book. For more details, please seewww.wiley.com/buy/9780470674383 or scan this QR code

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Library of Congress Cataloging-in-Publication Data

Avoiding errors in adult medicine / Ian P. Reckless … [et al.]. p. ; cm. Includes bibliographical references and index. ISBN 978-0-470-67438-3 (pbk. : alk. paper) I. Reckless, Ian. [DNLM: 1. Great Britain. National Health Service. 2. Medical Errors–legislation & jurisprudence–Great Britain–Case Reports. 3. Medical Errors–prevention & control–Great Britain–Case Reports. 4. Adult–Great Britain. 5. Liability, Legal–Great Britain–Case Reports. 6. Malpractice–Great Britain–Case Reports. 7. State Medicine–legislation & jurisprudence–Great Britain–Case Reports. WB 100] 610.28′9–dc23 2012031979

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Contributors

Joanne Haswell Barrister Director, InPractice Training LondonPart 3: The role of hospital staff, Externalinvestigators, Hospital investigations, The role of the doctor

Alistair Hewitt Partner, Radcliffes LeBrasseur LeedsPart 3: Coroner's court, Criminal matters

Kate Hill Solicitor, Radcliffes LeBrasseur Managing Director, InPractice Training LondonPart 3: The role of hospital staff, Externalinvestigators, Hospital investigations, The roleof the doctor

Preface

Medical errors in their broadest sense represent a major problem for modern society. It has been estimated that approximately 1 in 10 patients admitted to hospital in the developed world is the victim of an error, and approximately 1 in 300 patients admitted to hospital dies as a result of such an error.

Healthcare professionals tend to act in good faith and medical error has many victims – patients, families, those very medical professionals (and their families)…

The spheres of law and medicine overlap increasingly often: human rights; corporate responsibility; NHS standards; rising patient expectations; increasingly complex and ethically challenging interventions; clinical negligence and medical error; and, a compensation culture all collectively create a large amount of work at the medico-legal interface. Physicians and lawyers have each created a language, impenetrable from the outside, with which to conduct their trade – many relatively simple concepts can be lost in translation.

This book aims to help doctors to understand the legal language and concepts, to avoid the major medico-legal traps, and to act promptly and responsibly when errors occur or legal difficulties arise. We hope we have avoided using impenetrable jargon and have been able to present the information in a way that is accessible to all.

The contents of this book inevitably draw on the experience of the authors but by and large, the cases are not directly factual accounts. Where cases do bear relation to real patient stories, any details have been changed sufficiently to fully protect the identities of all involved, other than in the rare case where the information is already firmly within the public domain.

Ian RecklessD John M ReynoldsSally Newman

Abbreviations

ACAAnterior Cerebral ArteryAFAtrial FibrillationAMUAcute Medical UnitBNFBritish National FormularyBPBlood PressureCEMDConfidential Enquiry into Maternal DeathCNSCentral Nervous SystemCNSTClinical Negligence Scheme for TrustsCO2Carbon DioxideCOPDChronic Obstructive Pulmonary DiseaseCPRCardiopulmonary ResuscitationCQCCare Quality CommissionCRPC-Reactive ProteinCSFCerebrospinal FluidCTComputed TomographyCT1Core Trainee (year 1)CT2Core Trainee (year 2)CTPAComputed Tomography Pulmonary AngiogramDNARDo Not Attempt ResuscitationDVLADriver and Vehicle Licensing AuthorityECHREuropean Convention on Human RightsECGElectrocardiogramEDEmergency DepartmentEMGElectromyogramEPAEnduring Power of AttorneyFY1Foundation Trainee (year 1)FY2Foundation Trainee (year 2)GMCGeneral Medical CouncilGPGeneral PractitionerHSVHerpes Simplex VirusICASIndependent Complaints Advocacy ServiceIMCAIndependent Mental Capacity AdvocateISQIn Status QuoITUIntensive Therapy UnitIVFIn Vitro FertilisationIVIGIntravenous ImmunoglobulinJVPJugular Venous PressureKPaKilopascalLBBBLeft Bundle Branch BlockLPALasting power of AttorneyLFTsLiver Function TestsM&MMorbidity and MortalityMCAMiddle Cerebral ArteryMCAMental Capacity Act 2005MDTMultidisciplinary TeamMRIMagnetic Resonance ImagingMRSAMethicillin Resistant Staphylococcus AureusNHSNational Health ServiceNHSLANational Health Service Litigation AuthorityNICENational Institute for Health and Care ExcellenceNICENational Institute for Health and Clinical ExcellenceOGDOesophagogastroduodenoscopyPaO2Partial pressure of oxygen in arterial bloodPCRPolymerase Chain ReactionPCTPrimary Care TrustPHSOParliamentary and Health Service OmbudsmanSHAStrategic Health AuthoritySHOSenior House OfficerSIRI Serious Incident Requiring InvestigationSOBShortness of BreathSpRSpecialist RegistrarST5 Specialty Registrar, year 5TFTsThyroid Function TestsTIATransient Ischaemic AttackTOETransoesophageal echocardiogramUTIUrinary Tract InfectionVPVentriculo-peritonealVTEVenous Thromboembolism

Introduction

In 2000, a committee established by the Department of Health, chaired by the then Chief Medical Officer, Professor Sir Liam Donaldson, published its report An Organisation with a Memory. The report recognized that the vast majority of NHS care was of a very high clinical standard and that serious failures were uncommon given the volume of care provided. However, when failures do occur their consequences can be devastating for individual patients and their families. The healthcare workers feel guilt and distress. Like a ripple effect, the errors also undermine the public's confidence in the health service. Last, but not least, these adverse events have a huge cumulative financial effect. Updating the figures provided in the report, in 2010/11, the NHS Litigation Authority (NHSLA, the Special Health Authority body that manages clinical negligence claims against NHS Trusts in England) paid out nearly £863 400 000 for clinical negligence claims (these figures take no account of the costs incurred by claimant and defendant solicitors). The report commented ruefully that often these failures have a familiar ring to them; many could be avoided ‘if only the lessons of experience were properly learned’.