Disclosing Harmful Medical Errors to Patients

Gallagher, Thomas H.; Levinson, Wendy

doi:10.1001/archinte.165.16.1819

Cited by 101 publications

(72 citation statements)

References 58 publications

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“…Professionals may question this; the most noteworthy gap is the absence of prospective evidence about whether disclosure indeed improves patient satisfaction [6], [29].…”

Section: Discussionmentioning

confidence: 99%

Measuring Professionalism in Medicine and Nursing: Results of a European Survey

et al. 2014

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BackgroundLeveraging professionalism has been put forward as a strategy to drive improvement of patient care. We investigate professionalism as a factor influencing the uptake of quality improvement activities by physicians and nurses working in European hospitals.ObjectiveTo (i) investigate the reliability and validity of data yielded by using the self-developed professionalism measurement tool for physicians and nurses, (ii) describe their levels of professionalism displayed, and (iii) quantify the extent to which professional attitudes would predict professional behaviors.Methods and MaterialsWe designed and deployed survey instruments amongst 5920 physicians and nurses working in European hospitals. This was conducted under the cross-sectional multilevel study “Deepening Our Understanding of Quality Improvement in Europe” (DUQuE). We used psychometric and generalized linear mixed modelling techniques to address the aforementioned objectives.ResultsIn all, 2067 (response rate 69.8%) physicians and 2805 nurses (94.8%) representing 74 hospitals in 7 European countries participated. The professionalism instrument revealed five subscales of professional attitude and one scale for professional behaviour with moderate to high internal consistency and reliability. Physicians and nurses display equally high professional attitude sum scores (11.8 and 11.9 respectively out of 16) but seem to have different perceptions towards separate professionalism aspects. Lastly, professionals displaying higher levels of professional attitudes were more involved in quality improvement actions (physicians: b = 0.019, P<0.0001; nurses: b = 0.016, P<0.0001) and more inclined to report colleagues’ underperformance (physicians – odds ratio (OR) 1.12, 95% CI 1.01–1.24; nurses – OR 1.11, 95% CI 1.01–1.23) or medical errors (physicians – OR 1.14, 95% CI 1.01–1.23; nurses – OR 1.43, 95% CI 1.22–1.67). Involvement in QI actions was found to increase the odds of reporting incompetence or medical errors.ConclusionA tool that reliably and validly measures European physicians’ and nurses’ commitment to professionalism is now available. Collectively leveraging professionalism as a quality improvement strategy may be beneficial to patient care quality.

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“…Professionals may question this; the most noteworthy gap is the absence of prospective evidence about whether disclosure indeed improves patient satisfaction [6], [29].…”

Section: Discussionmentioning

confidence: 99%

Measuring Professionalism in Medicine and Nursing: Results of a European Survey

et al. 2014

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“…The need for patient notification is best assessed in consultation with the local or state health department and guided by information gathered about mechanisms of diversion (e.g., was tampering involved?) and results of the implicated healthcare professional’s bloodborne pathogen testing 9,32,33 . In addition, other forms of disclosure or reparations may be warranted (e.g., to ensure that patients and their insurance companies were not improperly billed for medications that were never administered) 34,35 .…”

Section: Discussionmentioning

confidence: 99%

Outbreaks of Infections Associated With Drug Diversion by US Health Care Personnel

Schaefer

Perz

2014

Mayo Clinic Proceedings

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Objectives To summarize available information about outbreaks of infections stemming from drug diversion in U.S. healthcare settings and describe recommended protocols and public health actions. Patients and Methods We reviewed records at the Centers for Disease Control and Prevention related to outbreaks of infections from drug diversion by healthcare personnel in U.S. healthcare settings from January 1, 2000, through December 31, 2013. Searches of the medical literature published during the same period were also conducted using PubMed. Information compiled included healthcare setting(s), infection type(s), specialty of the implicated professional, implicated medication(s), mechanism(s) of diversion, number of infected patients, number of patients with potential exposure to bloodborne pathogens, and resolution of the investigation. Results We identified six outbreaks over a ten year period beginning in 2004; all occurred in hospital settings. Implicated healthcare professionals included three technicians and three nurses; one of whom was a nurse anesthetist. The mechanism by which infections were spread was tampering with injectable controlled substances. Two outbreaks involved tampering with opioids administered via patient-controlled analgesia pumps and resulted in gram-negative bacteremia in 34 patients. The remaining four outbreaks involved tampering with syringes or vials containing fentanyl; hepatitis C virus (HCV) infection was transmitted to 84 patients. In each of these outbreaks the implicated healthcare professional was infected with HCV and served as the source; nearly 30,000 patients were potentially exposed to bloodborne pathogens and targeted for notification advising testing. Conclusions These outbreaks revealed gaps in prevention, detection, and response to drug diversion in U.S. healthcare facilities. Drug diversion is best prevented by healthcare facilities having strong narcotics security measures and active monitoring systems. Appropriate response includes assessment of harm to patients, consultation with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies.

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“…This also helped the physician's personal healing. It has been noted that full disclosure is successful in decreasing legal action and fees [4,5].…”

Section: Commentmentioning

confidence: 99%

To forget is human: the case of the retained bulb

Sakhel

Hines²

2009

J Robotic Surg

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The scenario of a forgotten instrument or foreign body has plagued surgical procedures from the early days. It has been estimated that the incidence of retained foreign bodies is around one in every 1,000-1,500 intra-abdominal operations and can be expected to occur at least once per year in hospitals where 8,000-18,000 major surgeries are performed annually. We report a case of a forgotten asepto bulb in the vagina following a robot-assisted total laparoscopic hysterectomy.

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Disclosing Harmful Medical Errors to Patients

Cited by 101 publications

References 58 publications

Measuring Professionalism in Medicine and Nursing: Results of a European Survey

Measuring Professionalism in Medicine and Nursing: Results of a European Survey

Outbreaks of Infections Associated With Drug Diversion by US Health Care Personnel

To forget is human: the case of the retained bulb

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