Medical Mistake Research Articles

The role of standardized quality systems in the management of a healthcare provider

Review Article, Pol J Public Health, Vol. 134 (2024): 69-72 Daria Żuraw, Paulina Oleksa, Mateusz Sobczyk, Kacper Jasiński, Mikołaj Porzak, Alicja Sodolska, Monika Żybowska, Anna Rzewuska-Fijałkowska Student Scientific Association at the Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Poland DOI_disc_logo 10.12923/2083-4829/2024-0015 © 2024 Author(s). This is an open access article distributed under the Creative Commons Attribution-NonComercial-No Derivs licence (http://creativecommons.org/licenses/by-nc-nd/3.0/) Abstract Since the 1940s, the healthcare sector in Poland has been in constant evolution and requires constant improvement in the quality of services provided and customer-patient satisfaction. To facilitate quality management, systems dedicated to healthcare entities have been developed over the years, and others have been adapted to medical facilities. These methods are based on efficient, planned, repeatable, documented procedures based on current medical knowledge. The key is to choose the right system, tailored to the way the entity operates. A quality management system defines: organizational structure, available resources, procedures and processes to be implemented, the way information and documents communicate and flow, and the responsibility for quality assurance care and compliance. Creating awareness and a pro-quality attitude in the field of medical services makes it possible to learn about instruments and solutions aimed directly at healthcare provider, as well as those that can be adapted and subsequently implemented. Keywords: ISO standards, accreditation standards, total quality management, adverse events, medical mistake, management.

Literature Review of Burnout Syndrome in Intensive Care Unit (ICU) Staffs During The COVID-19 Pandemic

Introductions: Burnout syndrome becomes a special concern for health workers during COVID-19 pandemic that has been exposed to increased workload and intense working hours with COVID-19 patients, stating having a high risk of getting infected with COVID-19 as well. Methods: This literature review paper reviewed scientific journals with prevalence and burnout syndrome profile data. The journals were obtained through the search engines GoogleScholar, the MEDLINE (PubMed) database and PsychINFO. From the search, there are 13 articles in total that meet the required data criteria. Results: Prevalence of burnout syndrome were found severely high in ICU settings, it reached more than 50% from most of the survey. Burnout syndrome rate can be influenced by working conditions, age and gender, time of work and working experience. Burnout syndrome can manifest as higher fatigue level and decrease of cognitive function that can increase the risk of medical mistake. Conclusions: High prevalence and severity of burnout syndrome oblige us to pay attention to symptoms that can affect professional intensive care unit staff and its service to patients. Further research should review prevention therapy and how to apply to health workers and also the prevalence of prevention that has been done in other studies.

Perception of Medical Error Among Resident Doctors at the University College Hospital (Uch), Ibadan

To enhance the standard of patient care, it is necessary to look into the complex issue of resident doctors' perceptions of medical error at tertiary hospitals. To foster a culture of safety in medical practice, medical mistake must be addressed in Nigeria, where it is a major contributor to patient mortality and morbidity. Therefore, this study aimed to determine the perception of medical error among resident doctors in the University College Hospital, Ibadan. In order to choose a sample of 302 resident doctors from a pool of 515 at the University College Hospital (UCH), a two-stage sampling approach was used. The research methodology used in this study was a cross-sectional survey employing a pretested self-administered semi-structured questionnaire. At the 0.05 level of significance, data were analyzed using descriptive statistics as well as inferential statistics like chi-square 228 (75.5%) of the responders were men, and 74 (24.5%) were women. Approximately 33.4% of the respondents were pre-part 1, 64.9% of resident doctors were post-part 1, and 1.7% were post-part 2 of their fellowship tests. The majority of responders (82.1%) had between one and three years of resident doctor experience. A majority (70.2%) of the respondents reported that misdiagnosis generally often occur in a medical setting. About 40.4% of the respondents said that delayed diagnosis is the most common type of medical error in the institution. There was a statistical significant association between the frequency of occurrence of delayed diagnosis and the departments of the resident doctors (X²=16.892, P<0.001). A majority (62.3%) of respondents reported that high work load, ill-equipped facility, work environment, patient factor and institutional factors influence their daily medical practice. Most (88.1%) of the respondents believed prevention of medical error is very crucial in the healthcare system. About 31.5% of the respondents indicated that continuous education on preventing and managing medical error was not adequately provided for resident medical doctors. The institution needs to invest in better-equipped facilities that will support high-quality patient care, continue medical education to advance medical knowledge and skills related to medical error, deploy more medical personnel to lessen the burdensome workload on current staff members, and establish proactive error avoidance strategies for the management of medical malpractice. This will thus improve the quality of healthcare delivery and reinforce possible standards of care that are evidence-based against medical error.

Изучение биоэтики методом кейсов: случай неправильного лечения экстрофии мочевого пузыря

Background: The principles of bioethics proposed by Beechamp and Childress are difficult to apply to the specific ethical dilemmas that arise in clinical practice. The scientific literature has suggested other ways of analyzing them. Methods: We use the Moscop's case study method to analyze a case of inappropriate treatment of bladder exstrophy, a rare con-genital condition associated with a high chance of medical error during treatment. Results: The analysis of the present case of a medical mistake considers ethical aspects such as the doctor-patient relationship, the reaction of physician-colleagues and the patient to the medical mistake, and the disclosure of the medical mistake. As a result of the bioethical analysis of the case, the following recommendations have been formed: 1) Despite the objective difficulties of treatment in a low-profile regional center and bureaucratic mechanisms of referral of the patient to another institution, the doctor should respect the autonomy of the patient and his relatives, for which full information about possible risks and treatment alternatives should be provided; 2) Disclosure of the true causes of medical error and apology can help to build trusting relationships with the patient and reduce subse-quent conflicts. Short-term psychological discomfort of disclosure will be compensated by long-term positive results of interaction with patients; 3) Criticism of previous treatment should take into account possible difficulties of diagnostics at regional level and lack of experience in treatment of rare pathologies. Achieving an advantage over one's colleagues through pointing out their medical error without knowing the real reasons for the prior treatment is ethically unjustified. Conclusion: An important function of disclosing medical errors is to warn colleagues against such errors. Most authors are of the opinion that it is the professional duty of a doctor who witnesses an adverse event to assist in the disclosure of an error and help in minimizing its consequences, however, in a medical environment with strong corporate ties and cultivating a spirit of solidarity, this principle has not become widespread in practice.

The Art of the Apology

I’m sorry is one of the most-used phrases in any language. Most of us don’t think twice about offering an apology when we unintentionally bump into a stranger on the sidewalk. However, when we have made a medical mistake, which most of us have in our medical careers, apologies seem to get stuck in our throats and become difficult or impossible to articulate.

ANA Criticizes Criminal Prosecution of Medical Mistake in Negligent Homicide Guilty Verdict

ANA Criticizes Criminal Prosecution of Medical Mistake in Negligent Homicide Guilty Verdict

Men with Sickle Cell Disease Show Significant Concerns over Safety While Being Treated for Vaso-Occlusive Crises: Preliminary Observations from the Escaped Trial

Men with Sickle Cell Disease Show Significant Concerns over Safety While Being Treated for Vaso-Occlusive Crises: Preliminary Observations from the Escaped Trial

Seventeen-Year Medical Professional Liability Experience in a Level III University Hospital.

In recent decades, the number of medical professional liability disputes has grown exponentially, becoming a well-studied aspect of public healthcare. Legal medicine is an essential tool in managing this phenomenon. This article reports the results of the analysis of disputes for medical professional liability in a Level III University Hospital in Italy. The study covers the time period from 01.01.2003 to 31.12.2019. About 33% of claims have been compensated. Those claims fall within the following categories: 37% in the surgical field, 17% in the field of internal medicine, and 35% in the emergency care field. As for the types of a medical mistake, compensation was awarded in 30% of diagnostic error cases, 26% of therapeutic error cases, 47% of execution error cases, and 55% of organizational deficiency cases. The difference in the rate of compensation between the various medical fields or types of error depends on specific medico-legal characteristics. The aim of advanced healthcare systems is to prevent medical liability disputes by analyzing this phenomenon and improving clinical risk management programs. In particular, according to our study, events related to organizational deficiencies are the most preventable. In addition, through the use of a dedicated reporting procedure, medico-legal analysis of malpractice cases may be the key to risk reduction. Every major hospital should set up a medico-legal watchdog responsible for collecting and analyzing information on professional medical liability disputes in order to prevent and manage such events.

Medical mistakes in the dental practice: a view from the inside

The purpose of the study was revealing the subjective opinion of doctors of various dental medical specialties about the experience of making medical mistakes. Methods: a single semi-structured interview method, qualitative deductive content analysis of the content of recorded interviews for encoding and categorizing text units using the OpenCode 4.02 program. Results: it was found that all respondents associated the concept of "medical mistake" with incorrect actions or inaction of the doctor, which led to negative consequences in the treatment of the patient. Thirty percent of respondents admitted to making manipulative and diagnostic mistakes in their dental practice. Analysis and ranking of factors indicated by dentists to commit a medical mistake showed that these are 1) objective factors of a subjective nature related to the personal characteristics of the doctor: insufficient knowledge and lack of experience, fatigue, arrogance; 2) objective factors related to the shortcomings of the organization of dental care in a medical institution; 3) objective factors of a subjective nature related to individual characteristics of patients. Conclusions: Continuous improvement of the training system for future dentists, residents, and doctors based on modern achievements in the field of dentistry, as well as the widespread use of simulation technologies for practicing manipulative skills, and the introduction of the "standardized patient" method for developing communication skills in order to effectively interact with patients are preventive measures aimed at preventing medical mistakes in dental practice. Awareness of the factors of medical mistakes and their analysis at the personal level will minimize their number and, consequently, improve the quality of dental care provided to the population.

The Law Aspects in Health Management: A Bibliometric Analysis of Issues on the Injury, Damage and Harm in Criminal Law

The paper presents the analysis of the approaches to define the areas of research on the injury, damage and harm to human health in criminal law. The obtained results proved that crimes, connected to drugs abuse, their legislation become an essential part of the issues. At the same, developing of government control, medical standards, improving quality of medical education balancing the «medical mistake – injury to human’s health – jurisprudence consequences» triangle in the tendency of the injury, damage and harm in criminal laware becoming very important to the healthcare system due to increasing requirements of regulators, customers and shareholders. The paper aimed to analyse the tendency in the literature on the injury, damage and harm in criminal law, which published in books, journals, conference proceedings etc. to identify future research directions. The methodological tools are VOSviewer, Scopus and Web of Science (WoS) software. This study covers 1072 papers from Scopus and WoS database. The time for analysis were 1970-2020. The Scopus and WoS analyse showed that in 2012-2019 the numbers of papers on the injury, damage and harm in criminal law issues began to increase. However, the topics changed from general issues to the problem of decriminalisation of drug trafficking, and the corresponding paradigm shift in the punishment of some crimes, increasing interest in punishing corporations for violating environmental regulations. In 2017 the number of documents dedicated to injury, damage and harm in criminal law was increased by 667% compared to 2012. The main subject areas of analyses of the injury, damage and harm in criminal law were the next: Law, Public environmental, occupational health, Criminology penology, Substance abuse, Psychiatry, Medicine. The biggest amount of investigations of the injury, damage and harm in criminal law was published by the scientists from the USA, United Kingdom, Australia and Canada. In 2019 such journals with high impact factor as International Journal of Drug Policy, International Journal of Law and Psychiatry, The Lancet etc. published the number of issues, which analysed of the injury, damage and harm to human health in criminal law. Such results proved that theme on the injury, damage and harm to human health in criminal law is actually in the ongoing trends of the modern jurisprudence and regulation. The findings from VOSviewer defined 6 clusters of the papers which analysed the injury, damage and harm to human health in criminal law from the different points of views. The first biggest cluster (with the biggest number of connections) merged the keywords as follows: criminal justice, law enforcement, public health, health care policy, harm reduction, drug legislation, drug and narcotic control, substance abuse, homelessness etc. The second significant cluster integrated the keywords as follows: criminal behaviour, crime victim, adolescent, violence, mental health, mental disease, prisoner, young people, rape, police etc. The third biggest cluster concentrated on criminal aspects of jurisprudence, criminal law, human right, legal liability, social control, government regulation etc. The obtained results allow concluding that balancing the triangles «medical mistakes – criminal – education» and «drugs – criminal – justice» and «abortion – criminal – women/children» form an important part of the injury, damage and harm in criminal law issues. Keywords injury, damage, harm, human health, criminal law, management, governance.

Textiloma mimicking soft tissue tumor: an uncommon complication of posterior lumbar surgery

Textiloma (from Greek textile and ome = tumour) also called gossypiboma (from Latin Gossypium = cotton and Swahili boma = hiding place) is defined as the inadvertent retention of textile foreign body after surgical intervention leading to various symptoms. It is probably the oldest and most obvious error in surgery. Since the first case was reported in 1884 by Wilson, hundreds of cases have been reported. According to those publications its incidence varies from 1/833 to 1/32.672. The true incidence of this medical mistake is certainly higher since fear of litigation prevents many practitioners from reporting. Therefore, it is important to be aware of patients who present with a paraspinal soft-tissue mass and unusual or atypical symptoms. Imaging is helpful for arriving at the correct diagnosis. Here, we describe a case of textiloma in which the patient presented with low-back pain 18 years after laminectomy and lumbar discectomy. Spinal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mass lesion in the posterior paravertebral region.

Analysis of methods for quantitive evaluation of facial skeleton injuries applicable in forensic dental practice

Continuous improvement of the medical care in Ukraine substantiates the need for development appropriate approaches for evaluating the quality of the iatrogenic interventions and rehabilitation measures. The success of treatment mostly depends on the adequacy of the primary diagnosis of the patient or the victim and the corresponding registration of present functional and structural violations at the time of admission. This stage of complex rehabilitation, in addition, plays an important role during forensic examinations that aimed at identifying the fact of a medical mistake, establishing conformity of medical care provision taking into account the initial clinical conditions and quantifying the effectiveness of treatment and prevention measures at the stage of long-term post-therapy monitoring. During provided retrospective analysis of publications, the following systems (algorithms) of the quantification of maxillofacial injuries were identified: Cooter-David Score, ISS, AIS, TRISS, MFISS, FFSS, ZS, AO/ASIF, FLOSID. The conducted analysis of the systems for quantitative assessment of the injuries parameters at the maxillofacial region indicates about the variability of the above described approaches in terms of topographical distribution of region of interest, criteria for assessing the severity of functional and structural violations, as well as in the terms of corresponding filling registration cards or computerized forms in relation to the specifics of methodological algorithm.

الأخطاء الطبية بين إهمال الطبيب في التشخيص والصيدلي في صرف الدواء - دراسة مقارنة في الفقه والقانون العراقي

The research discusses the problem of medical mistakes amongst the negligence of the physician’s diagnosis and pharmacist’s prescription. As it follows up closely the responsibility arisen from such mistakes in terms of law and jurisprudence and detects the responsible person by means of determining the cases of mistakes’ incidence and the causes such as negligence. Consequently, there will be a liability of compensation upon the person who is in charge. In addition to indicate the aspects of responsibility such as the eligibility of the pharmacist or the physician including a study that involves the discussion over various opinions according to law and jurisprudence. Research Key: Medical mistake is a mistake that occurs throughout the practice of medical professions due to the lack of experience or efficiency of the physician or of his co-workers as a result of exercising modern methods of treatment, an emergency which requires speed at the expense of accuracy or due to the nature of a complex treatment.

Setbacks in Medical Education: How Does Mindset Play a Role in Support After a Medical Mistake or Adverse Event?

Setbacks in Medical Education: How Does Mindset Play a Role in Support After a Medical Mistake or Adverse Event?

Abstract C10: IT-enabled clinical cognitive support for differential diagnosis improvement, treatment planning and medical mistake mitigation

Abstract (a) This poster describes background, purpose, scope, structure and function of the Cloud Healthcare Appliance Real-Time (CHART) solution as a service; which is a conceptual suite of information technology (IT) analytics and middleware software, deployed in “the cloud” (i.e. - an Internet-accessible and professionally managed data center) and accessible by licensed healthcare provider subscriber subject matter experts via a secure portal; for the purpose of designing, developing and deploying automated use cases for cognitive support of medical practice and healthcare delivery (e.g. -- differential diagnosis and treatment planning, medical technology alarm/alert fatigue mitigation, patient course-in-treatment management) with minimal cost and complexity. (b) The procedure consists of use case automation design (including definition of required complex event monitoring, natural language-based case/evidence acquisition, Bayesian similarity and predictive analysis, Boolean decision rules, process flow including activities and staff/system actors, and key performance indicator-based process monitoring and continuous improvement enablement) using non-programming techniques such as drag-and-drop; development (including process connectivity to existing provider electronic health records a.k.a. EHRs and other Internet-accessible data sources and services using software-defined networking and HIPAA-compliant encryption/de-identification) with minimal IT professional assistance; and deployment via desktop and mobile digital data devices. The included software already is production-proven in other industries worldwide, so the typical high cost and risk associated with software development projects is avoided. The proposed poster will describe the implementation and utilization of the vendor-agnostic CHART; and how the clinical cognitive support it provides will improve accuracy and speed of oncology diagnosis, will mitigate medical mistakes, will facilitate progress from iterative to sequential treatment through integration of the clinical care and medical learning processes (re Bohner RMJ, “Designing Care …,” Harvard Business Press, Boston, 2009, pp. 128-150), and will ensure much-improved economy, efficiency and effectiveness and for healthcare providers. (c) All available data/information re CHART is available at the web site (www.chartsaas.org) or in the form of presentations (e.g. -- http://bit.ly/28St6MM) and other collateral such as grand rounds solution sheets re central line acquired blood stream infection (CLABSI) and white papers. For example, the benefit of CHART vis a vis the hand-off/sign-out problem (http://1.usa.gov/28UVuAA), is described in our recent Becker's Hospital Review article (http://bit.ly/24k0zov). (d) The urgent need for IT-enabled clinical cognitive support for differential diagnosis improvement, treatment planning and medical mistake mitigation (and most other healthcare provider challenges) can be rationalized as follows: BECAUSE .25M U.S. patients die every year from medical mistake mitigation (http://bit.ly/1rtW6Sa); AND medical mistakes happen because healthcare complexity creates cognitive overload (http://1.usa.gov/291u3mr); THEREFORE cognitive overload requires cognitive support for healthcare providers (http://1.usa.gov/1JXulDM , in particular the testimony of Tejal Gandhi, MD, MPH and Peter Pronovost, MD, PhD); AND healthcare providers need the cognitive support that only information technology (IT) can provide for information management, decision support and process improvement as provided by the CHART solution as a service. Although CHART is only a concept at this point in time, its structure and function have been realized for the most part by commercial off the shelf (COTS) cloud-based intelligent business process management suites (CiBPMS, re http://gtnr.it/28RSLE1). Note: This abstract was not presented at the conference. Citation Format: John Peter Melrose. IT-enabled clinical cognitive support for differential diagnosis improvement, treatment planning and medical mistake mitigation. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C10.

The legal understanding of intentional medical error

The paper is devoted to doctor, a professional and humanist who dedicated himself to medicine and is committed to lifelong learning, ethics and assistance to victims, even against their express consent. The theme is focused on the problem of intentional medical error in order to negate it in the context that the conscientious doctors should be protected from tort and free of moral burden. This paper seeks to answer the question, if the error represents a doctor's failure to the detriment of the user (patient), how should we treat his attempt, made professionally and with the best intentions, regardless of the fatal outcome? In addition, medical-legal theory and practice beside intentional medical mistake mention also the unintentional, whose formation does not require any kind of responsibility because the doctor's behavior in that case was not inconsistent with medical ethics, standards and rules. In this regard, the author's research was based on the following questions: is there a deliberate medical error, who is ready to knowingly endanger the patient by doing medical procedures contrary to the rules (neglect, avoidance of assistance, misdiagnosis, improper treatment, indifference, discrimination), who is competent to qualify the taken action as an error (intentional, unintentional) and what evidences are required for the brutal attack on the integrity of top experts, that will be charged and prosecuted? Literature abounds with assertions that medical errors are as old as medicine, which is not true. Also, it is incorrect to say that it had appeared for the first time in the middle of the nineteenth century. That would be a roughly canceling of ancient medical marking, bearing in mind that even before the mentioned period, there had been a very successful medicine with high quality doctors and their brilliant achievements, but also with illnesses and dead persons. As far the data on the exact occurrence of medical errors are considered, the numerous authors claim that it does not have to be communicated, since it is placed in the field of history, that unlike many science is not exact, and should not always be considered as reliable. Any medical error makes a multiple interests, firstly of the researchers in the true sense of the word, and secondly, of the sensationalist columnists. The latter see the culprit only in the doctor, because many of them never presented the scene when defeated doctor leaves the Service ambulance, clinic, emergency room or any other health care area, because the most terrible thing in the profession has happened -the lost of a patient. Sensationalists are rarely present when despair and tears are being replaced by joy, smile and exaltation. They do not understand that it is impossible to meet the doctor who will be prepared to deliberately violate the profession, ethical values, Hippocratic oath, to directly endanger the health or life of the patient, or make a deliberate mistake and commit an offense.

Insurance of Medical Personnel Professional Responsibility as a Form of Legal and Social Responsibility

Medical professionals are not protected from patients` action in the case of medical negligence or mistake. Anytime patient can file a medical malpractice claim against medical professional. Nowadays medical negligence claims and mistakes are increasing. The progress of medical law shows, that patients more often use the rights and legal options to protect their interests and fundamental rights. The scope of the freedom of medical professionals is limited. They have to act in accordance with certain standards or an artificially created frame and in the best interests of their patients and protect constitutional rights of each patient. In case when medical professionals make mistakes and the patients are harmed due to that claims can be brought. Medical professionals must have insurance or indemnity to protect themselves, but patients also need it. Patients' rights and possibility to compensate damage depends on how good and qualitative the medical professional liability insurance or indemnity is. Furthermore, medical professional's mistake is his or her own ethical, prestige and social responsibility in front of the patients' issue. In order to protect medical professionals and patients the medical professional insurance system has to cover healthcare practice and provide professional protection against the financial consequences of legal liability, as well as possible moral compensation. The objective of the paper is to present a summary of medical professional insurance system in Latvia. The article will provide information about what legal mechanisms shall be improved in order to optimize medical professionals` insurance system and patients' rights to receive compensation. DOI: 10.5901/ajis.2016.v5n3s1p320

Examination of Nurses’ State Anxiety and Their Tendency to Medical Error at Different Working Hours

Objective: This prospective, descriptive and cross-sectional study was implemented with the aim of comparing the state anxiety of nurses and their tendency for nursing medical error during day working and night shifts. Methods: The study was conducted between 30 November 2012 and 30 May 2013 with 317 nurses in four different state hospitals. Data were collected using an Individual Identification Form, the Trait Anxiety Inventory and the Nursing Medical Mistake Scale. Results: The Trait Anxiety Inventory and the Nursing Medical Mistake Scale were applied to the same nurses during their day and night shifts. It was determined that nurses experienced state anxiety during both day and night shifts. Work units, antidepressant use and caring for children affected the state anxiety experienced by nurses during day and night shifts. It was determined that the error tendency of most of the nurses was related to the administration of medication and transfusion, nosocomial infections and patient monitoring and equipment safety more during the night shift than during the day shift. It was found that the tendency of approximately half of the nurses to make mistakes in communication was twice as much on the night shift as on the day shift. Conclusion: There was a difference in medical error tendencies and state anxiety between the day and night shifts. State anxiety and error tendencies were higher during the day shift.

Examination of Nurses’ State Anxiety and Their Tendency to Medical Error at Different Working Hours

Objective: This prospective, descriptive and cross-sectional study was implemented with the aim of comparing the state anxiety of nurses and their tendency for nursing medical error during day working and night shifts. Methods: The study was conducted between 30 November 2012 and 30 May 2013 with 317 nurses in four different state hospitals. Data were collected using an Individual Identification Form, the Trait Anxiety Inventory and the Nursing Medical Mistake Scale. Results: The Trait Anxiety Inventory and the Nursing Medical Mistake Scale were applied to the same nurses during their day and night shifts. It was determined that nurses experienced state anxiety during both day and night shifts. Work units, antidepressant use and caring for children affected the state anxiety experienced by nurses during day and night shifts. It was determined that the error tendency of most of the nurses was related to the administration of medication and transfusion, nosocomial infections and patient monitoring and equipment safety more during the night shift than during the day shift. It was found that the tendency of approximately half of the nurses to make mistakes in communication was twice as much on the night shift as on the day shift. Conclusion: There was a difference in medical error tendencies and state anxiety between the day and night shifts. State anxiety and error tendencies were higher during the day shift.

Analysis of Negligence in field of Neonatology in Medical Commissions Office in Tehran, Iran

Background : Despite progression of medical’s science, patient’s complaints are increased. Analysis of risk factors cause to decrease complaints. Methods: This research is a retrospective study of medical malpractice cases in neonates’ from 2012 to2014 in Medical Commissions Office in Tehran province. Results: Among 171 cases were studied, 53 cases were in neonatal period. 30.1% was announced medical malpractice. Ages of most infants were 0-10 days (88.6%), 66% of babies were male, 69.8% had full-term gestation, 62.2% APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score of neonates was above 7 and 73.5% of cases were the first child of the family. Most babies had cerebral palsy and asphyxia (20.7%), then respiratory distress syndrome (11.3%), furthermore shoulders dystocia and brachial plexus damage (7.5%). Ages of most plaintiffs (parents of neonates) were 30-39 years. Most of them were male, and their levels of education were high school and lower. The most cause of parent’s claim was medical mistake. Conclusion: Levels of parents’ education may relationship with complaints and increasing their awareness can effect to decrease these.