Medical Mistakes Research Articles

The importance of simulation in nursing education

Nursing education involves a practice-oriented curriculum in which emphasis is placed on both theoretical knowledge and psychomotor skills. In skill-based education, where learning through practice occupies a central role, it is important to ensure the integration of theoretical knowledge into practice. In this context, simulations represent an innovative teaching method that stimulates a number of senses at the same time among learners. Simulation is a method which can be designed to reflect real-life conditions, and which provides the opportunity to work in contexts that are closer and more representative of real settings. Depending on the clinical situation or scenario; the simulation method will involve a student or a group of students performing a number of patient care activities on a manikin, player or standardized patient. The simulation method allows students to repeatedly practice their clinical skills until they develop a sense of proficiency; to learn at their own pace; and to freely make mistakes. Simulations is an educational process that can replicate clinical practices in a safe environment. Nursing students who take part in education programs involving simulations perform less medical mistakes in clinical settings, and are able to better develop their critical thinking and clinical decision-making skills. For these reasons, we recommend that simulations, which represent an interactive learning method, are rendered more common in institutions providing nursing education. Keywords: Simulation; nursing education; nursing students

To Err is Human: Can American Medicine Learn from Past Mistakes?

The history of medicine includes many errors. Some persisted for decades and caused great harm. Several are highlighted in this article, including the mythical thymic diseases: thymic asthma and status thymicolymphaticus. Some medical mistakes, such as the diet-heart hypothesis of Ancel Keys, continue to cause harm. To avoid future errors and their associated harm, I suggest a cultural shift encouraging professional humility and greater questioning of medical dogma. Medical education focused on teaching students this history may help with this cultural shift.

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

Implementing Team-Based Care: It's Our Duty

Implementing Team-Based Care: It's Our Duty

Medical mistakes in the diagnosis of intoxications and poisonings in the Pediatric Unit of Hospital Juárez de México from year 2007–2012

Medical mistakes in the diagnosis of intoxications and poisonings in the Pediatric Unit of Hospital Juárez de México from year 2007–2012

Artificial intelligence: Neural network model as the multidisciplinary team member in clinical decision support to avoid medical mistakes

ObjectiveThe continuous uninterrupted feedback system is the essential part of any well-organized system. We propose aLYNX concept that is a possibility to use an artificial intelligence algorithm or a neural network model in decision-making system so as to avoid possible mistakes and to remind the doctors to review tactics once more in selected cases. MethodaLYNX system includes: registry with significant factors, decisions and results; machine learning process based on this registry data; the use of the machine learning results as the adviser. We show a possibility to build a computer adviser with a neural network model for making a choice between coronary aortic bypass surgery (CABG) and percutaneous coronary intervention (PCI) in order to achieve a higher 5-year survival rate in patients with angina based on the experience of 5107 patients. ResultsThe neural network was trained by 4679 patients who achieved 5-year survival. Among them, 2390 patients underwent PCI and 2289 CABG. After training, the correlation coefficient (r) of the network was 0.74 for training, 0.67 for validation, 0.71 for test and 0.73 for total. Simulation of the neural network function has been performed after training in the two groups of patients with known 5-year outcome. The disagreement rate was significantly higher in the dead patient group than that in the survivor group between neural network model and heart team [16.8% (787/4679) vs. 20.3% (87/428), P = 0.065)]. ConclusionThe study shows the possibility to build a computer adviser with a neural network model for making a choice between CABG and PCI in order to achieve a higher 5-year survival rate in patients with angina.

Cancer of the Throat: A Physician's Experience as a Patient.

The author, a practicing physician, was diagnosed with throat cancer and lost his vocal cords. He endured the side effects of radiation, repeated surgeries, and the effects of prolonged hospitalizations; confronted medical mistakes and discrimination after losing his vocal cords; and struggled to regain his speech and find new meaning and purpose for his life. Facing the hardship and trials of becoming a laryngectomee illustrated to him how dependent and helpless a patient can become. Being unable to speak, eat, and breathe normally, while dealing with a potentially terminal illness, makes the patient very vulnerable, both physically and emotionally. A skillful, competent, error-free, empathetic, and caring approach that recognizes what the patient is experiencing can expedite recovery and well-being and help the patient return to a productive and meaningful life.

The Legal Responsibility of Nurses in Administration of Prescriptions

<p>Patient safety is one of the main issues in health care services. Medical mistakes are common potential dangers for patients that can be treated as a measure of patient safety. Medication errors are the most common errors in the nursing profession, which can be potentially dangerous for patients. In this study, the main purpose was evaluation of criminal responsibility of nurses in administration of prescriptions using descriptive and analytical approach. Since for medical professionals legal aspects of such cases are beyond their duty, we wish to determine the criminal liability for medical care personnel (e.g. nurses) and associated professionals</p>We will look at penal provisions for this matter closely. Obviously, lack of medical community responsibility for such errors will diminish cases of criminal prosecution. While specific rules in Medicine provide the possibility to call upon relevant incumbents, yet, criminal responsibility has not been assigned to this issue. In the legal responsibility of medical superintendents, nursing faults are divided into two categories, general criminal liability and specific criminal liability. Recent responsibility requires that necessary coordination exists between prosecution laws and specific laws in medicine.

Analysis of medical malpractice in modern conditions (according to the materials of commissional forensic medical examinations)

Professional occupation of a doctor is quite often followed by different imperfections, which end up negatively for the patients. Every case of inadequate medical care becomes an object of investigation which can’t be implemented without the conclusion of commissional forensic medical examination. This problem is not enough studied in contemporary Ukrainian forensic medicine. That’s why the research on structure, occurrence and peculiarities of medical malpractice become the goal of the research.
 Materials and methods. The study analyzes archival materials (reports of forensic medical commission examinations) handled in Ternopil regional Bureau of forensic medical examination during 2007-2014 years. The research results are summarized and processed with general statistical methods.
 Results of the research. It is defi that during studied period 112 examinations concerned to medical malpractice were imple- mented which was 9,05% from the general quantity of all commissional examinations. Different medical mistakes were defi in 82,1%. Among of them physicians’ malpractice at providing emergency medical care equaled (74,1%), in hospital department (19,6%). Medical malpractice was administered almost with the same frequency on pre-hospital and hospital levels (45,5% against 49,1%). The bigger half of this malpractice on hospital level was revealed during patients approach to the polyclinic (56,9%).
 According to physician specialties, medical errors are present in: anesthesiologists (39,3 % of all cases), therapist (21,4 %), obstetri- cians and gynecologists (18,7 %), pediatricians (17,8 %), surgeons (14,3 %).
 The most frequent medical errors were diagnostic ones, what is confi in 61,1% of cases, errors in medical records – 46,4%, treatment errors – 40,2%, organizational – 27,7%, deontological – 21,4%. Wrong actions of physicians were rarely unitary and had as- sociation with each other.
 The diagnostic errors were insuffi clinical, laboratory and instrumental examination of a patient; underestimation of clinical features of the disease, baselessness of clinical diagnosis, absence of needed special methods of diagnostics and examination.
 Treatment defects were associated with mistakes in drug prescription, particularly: excessive dosage, insuffi or excessive infusion volume, unreasonable prescription of big amount of drugs at the same time (polypragmasy).
 Among other wrong actions there were the absences of indications for surgery, absences of patients monitoring data, underestimation of patient condition, no predictions of following complications and incorrect prognosis.
 Among organizational errors there were the absences of concilium, incorrect hospitalization, violations of rules of patients’ hospitalization, absences or equipment malfunction, insuffi control of diagnostic and treatment process.
 The errors among medical records were the absence of rate of pulse, respiratory rate, temperature, absence or insuffi
 of additional methods of clinical examination, absence of informed consent, inappropriate diagnosis which didn’t correspond with International Classifi of Diseases.
 Among the deontological errors was the incorrect behavior of medical staff with patients or relatives and concealment of anamnesis data by patient.
 In one fourth of all cases, the defects were a combination of insuffi and late medical care.
 Among the objective reasons of medical errors it was defi the following: the severity of patients status and presence of comor- bidities (32,1% of cases); late appeal for medical care or fast course of the disease (21,4%); diffi of diagnostics or atypical course of the disease (13,4%); patients’ or relatives’ refusal for admission to hospital department (8,0%); patients’ non-adherence of treatment (2,7%). The subjective reasons included incorrect professional actions of medical personnel (9,8%) and its poor quality. The violations were followed by severe consequences such as: the death of a patient (70,6%); severe injuries (2,2%); moderate injuries (8,7%).
 Direct or indirect connection between incorrect actions of medical staff and negative consequences was found in 9,8% of cases. Generally, medical errors were combined, specifi during the diagnostics, treatment and keeping medical records. The majority of cases (80%) of medical malpractice was caused by the objective reasons.

Medical Harm: Patient Perceptions and Follow-up Actions.

Much research has been conducted to describe medical mistakes resulting in patient harm using databases that capture these events for medical organizations. The objective of this study was to describe patients' perceptions regarding disclosure and their actions after harm. We analyzed a patient harm survey database composed of responses from a voluntary online survey administered to patients by ProPublica, an independent nonprofit news organization, during a 1-year period (May 2012 to May 2013). We collected data on patient demographics and characteristics related to the acknowledgment of patient harms, the reporting of patient harm to an oversight agency, whether the patient or the family obtained the harm-associated medical records, as well as the presence of a malpractice claim. There were 236 respondents reporting a patient harm (mean age, 49.1 y). In 11.4% (27/236) of harms, an apology by the medical organization or the clinician was made. In 42.8% (101/236) of harms, a complaint was filed with an oversight agency. In 66.5% (157/236) of harms, the patient or the family member obtained a copy of the pertinent medical records. A malpractice claim was reported in 19.9% (47/236) of events. In this sample of self-reported patient harms, we found a perception of inadequate apology. Nearly half of patient harm events are reported to an oversight agency, and roughly one-fifth result in a malpractice claim.

2016: Creating a Culture of Safety in Oncology.

Nurses play vital roles in preventing errors and improving the quality of care for patients. However, in the breakthrough Institute of Medicine (IOM) reports, To Err Is Human: Building a Safer Health System (IOM, 1999) and Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001), it was estimated that about 44,000-98,000 Americans die each year as a result of medical errors. Gibson and Singh's (2003) book, Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans, shared real-life stories of medical mistakes to help raise awareness and create a sense of urgency for the issues surrounding healthcare errors. Gibson and Singh (2003) also included aspects of the human side of errors-the perceptions of the healthcare providers regarding their errors and the responses of patients who had been harmed. .

Workload, burnout, and medical mistakes among physicians in China: A cross-sectional study

The purpose of this study is to determine the prevalence of burnout among different grade hospitals and to examine if a relation exists between burnout and medical mistakes. A multi-center cross-sectional survey was conducted. Physicians were interviewed in hospitals from 10 provinces in China. Burnout was measured using the Chinese version of the Maslach Burnout Inventory-General Survey. Overall, 1,537 physicians were included in this study. Of these, 76.9% reported some burnout symptoms or serious burnout symptoms and 54.8% reported committing medical mistakes during the last year. 39.6%, 50.0%, and 59.5% of the respondents in primary, secondary, and tertiary hospitals respectively reported having made mistakes over the course of the previous year. Multivariate analysis demonstrated that being female was protective against medical mistakes (OR = 0.72, 95% CI: 0.58-0.89), whereas physician-reported 60 or more work hours per week (OR = 1.65, 95% CI: 1.22-2.22), and physicians who reported serious burnout (OR = 2.28, 95% CI: 1.63-3.17) were independently associated with higher incidence of medical mistakes. In conclusion, Chinese physicians reported high workloads, high rates of burnout and high medical mistakes. Physicians in tertiary hospitals were especially overworked and suffered the most serious burnout. Longer work hours per week, and burnout were the independent risk factors for medical mistakes.

Medical mistakes in tactics of management of patients with atopic dermatitis associated with opportunistic yeast microflora infection

Medical mistakes in tactics of management of patients with atopic dermatitis associated with opportunistic yeast microflora infection

Besieged fortress syndrome? Occupational group of physicians and medicine students and the problem of social reception of health care system in Poland

The paper refers to the problem of decline in public confidence in health care system in Poland. Impartial reports prove that mass media are keen on showing medical mistakes, corruption as well as other thrilling news. The memorable case of “skin-hunters” from Lodz seems to be a good example. This may create the critical public opinion on functionaries of health care system (especially on physicians). Surveys by CBOS show that many of Poles reckon that doctors are incompetent, do not interested in their work and unfair when treating patients. Malevolent public opinion and “scandal-oriented” media coverage should create an hostile environment for functioning of specific occupational groups in health care system. Does it lead to besieged fortress syndrome (meaning consolidation and mobilization of an own professional group, described as not guilty, but unfairly treated by inimical social/institutional surrounding)? In the paper – in the formula of case study – results of own survey among group of 151 physicians from Lodz and 228 students of Faculty of Military Medicine at Medical University of Lodz are investigated. The aim of the research was to identify opinions of physicians and medicine students on how medical occupations were perceived by Polish society. The collected empiric material allowed (at least partially) to verify the hypothesis of besieged fortress syndrome.

Narrative Texts and Issues in Medical Humanities

AbstractMedical Humanities began in the late 1970s as an attempt to supplement the emphasis on technology and science in medical education with renewed attention to the role of personal care. Today, more than 80% of all medical schools offer courses in Medical Humanities. Most of these courses emphasize fiction and nonfiction by physicians and patients that depict the experience of disease and care. This essay surveys foundational works in the field as well as relevant recent narratives of physicians, patients, caregivers, and families. The agenda of Medical Humanities is to explore how these interrelated and competing narratives can improve health care. Narrative is regarded as a necessary tool in medical practice, supplementing other components of evidence‐based medicine. The field has begun to be theorized by physicians who use narrative to describe how physicians and patients think and feel and how they reflect on their experience. Texts described in this essay address major issues in medicine, including multicultural medicine, access to care, death and dying, pain, empathy, medical mistakes, and physician impairment.

Criminalisation of medical mistakes

Mistakes in medicine carry a more profound significance than in other professions.

Learning safely from error? Reconsidering the ethics of simulation-based medical education through ethnography

ABSTRACT‘Human factors’ is an influential rationale in the UK national health service to understand mistakes, risk and safety. Although there have been studies examining its implications in workplaces, there has been little investigation of how it is taught, as a form of professional morality. This article draws on an observational study of human factors teaching in four hospital simulation centres in London, UK. Its main argument is that the teaching of human factors is realised through an identification and positive evaluation of ‘non-technical skills’ and the espousal of ‘non-judgemental’ pedagogy, both of which mean that mistakes cannot be made. Professional solidarity is then maintained on the absence of mistakes. We raise questions about the ethics of this teaching. The study is situated within a history of ethnographic accounts of medical mistakes, to explore the relationship between claims to professional knowledge and claims about failure.

What are the legal implications of ignoring hospital policies and procedures?

Hospital policies and procedures are designed to help prevent patients being harmed during the course of their treatment. The same principles apply as they do in business: by implementing a process-driven approach to ensuring that every component of the product is manufactured to the highest possible specification, customer satisfaction and safety can be secured. The more safety conscious the business, such as aerospace engineering, the tighter the procedures and controls. Hospitals should be no different; they are dealing with life and death and, as such, straightforward, fully tested procedures that are put in place to eliminate medical negligence mistakes should not be ignored. So why, as medical negligence lawyers, do we still see failures by both hospitals and health professionals to follow well-established procedures resulting in serious harm to patients? And particularly when such failures can and do lead to legal sanctions resulting not only in the loss of reputation and livelihood but also, in extreme cases, to liberty? In this article, which is a personal view, I explore some of the reasons why some medical practitioners fail to follow procedures and policies and outline the sanctions, both civil and criminal, for that failure.

Application of "Four Inspections and Eight Verifications" in preventing intravenous medical mistakes

Objective To investigate the effect of Four Inspections and Eight Verifications on preventing clinical nursing errors. Methods On the basis of the analysis about the nursing errors from our department of nursing in 2009, based on the request of the ten safety goal, Four Inspections and Eight Verifications was set up and carried out. Four Inspections and Eight Verifications was executed into practice in clinical care operations,into which one Inspection and Verification was added on the basis of Inspections and Seven Verifications. That was, the patients or their families participating to the survey, drug quality and validity are added. The rate of error occurrence and error correction were observed. Results Compared to the control group of Inspections and Seven Verifications, the nursing error rate dropped from 0.23%to 0.13% (χ2=7.89,P<0.01),the error rate of drug release decreased from 0.05%to 0.12%(χ2=8.29,P< 0.01),the error rate of correction increased from 0.01%to 0.04%(χ2=4.24,P<0.05). There was statistical significance between these two groups, which could guarantee the further implementation of the nursing safety measures. Conclusions It has superiority and feasibility, and is worthy of wide application compared with Three Inspections and Seven Verifications. Key words: Four Inspections and Eight Verifications; Prevention; Nursing error

Medical malpractice, defensive medicine and role of the “media” in Italy

Background: For many years until now, Italy has been subjected to an inconsistent and contradictory media campaign. On one hand the “media” present us with bold and reassuring messages about the progress of medical science; on the other hand they are prone to kneejerk criticism every time medical treatment does not have the desired effect, routinely describing such cases as glaring examples of “malasanità”, an Italian word of recent coinage used to denote medical malpractice. Newspaper reports of legal proceedings involving health treatment are frequently full of errors and lack any scientific basis.&#x0D; Data sources: The published data confirm the unsustainably high number of lawsuits against doctors and medical structures, accompanied by demands for compensation arising from true or alleged medical errors or mistakes blamed on the work of health structures.&#x0D; Conclusions and implications: Currently Italian citizens have a greater awareness of their right to health than in the past, and patients’ expectations have risen. A discrepancy is emerging between the current state of medical science and the capacities of individual doctors and health structures. Lastly, there is a need for greater monitoring of the quality of health care services and a greater emphasis on health risk prevention.