Saudi Commission for Health

Specialties

Professionalism and Ethics Education for

Residents (PEER)

Medical
Errors
Dr. Ghaiath M. A. Hussein

Asst. Prof., Dept. of Medical Ethics

King Fahad Medical City Faculty of Medicine
King Saud Bin Abdul-Aziz University for Health

Outline
Definitions of terminology related to Medical Error
(ME)
Levels of severity of medical error
Types & Examples of medical errors
Causes of ME
Disclosure of ME
Prevention of Medical Error

Definitions of Medical
Error

The failure of a planned action to be completed as

intended, or
as the use of a wrong plan to achieve an aim.
A preventable adverse effect of care, whether or not
it is evident
or harmful to the patient.
This might include an inaccurate or incomplete
diagnosis or
treatment of a disease, injury, syndrome, behavior,
infection, or
other ailment.

More Definitions
ME: An act or omission that would have been
judged wrong by knowledgeable peers at the time
it occurred
Adverse Event: An unplanned or unusual
deviation in the patient care
Sentinel Event : An event which has resulted in
an unanticipated death or major permanent loss of
function, not related to the natural course of the
patient's illness or underlying condition.

Levels of Severity of ME
Level 1: An event occurred that resulted in the need for
increased
patient assessments, but no change in
vital signs and
no patient harm.
Level 2: An event occurred that resulted in the need for
treatment
and/or intervention and caused temporary
patient harm.
Level 3: An event occurred that resulted in initial or
prolonged
hospitalization, and caused temporary
harm.

Levels of Severity of ME
Cont
Level 4: An event occurred that resulted in permanent patient
harm
or near death event, such as anaphylaxis.
Level 5: Any set of circumstances (exclusive of the disease or
condition in which the patient is being treated) which
significantly increases the likelihood of a serious
adverse outcome.
Level 6: An event occurred that resulted in patient death.
*Levels 3 through 6 shall be discussed with patient or
families.

Types and Examples of

Medical Errors
EXAMPLE

Missed diagnosis

ERROR

Diagnosis or evaluation

Inappropriate or premature
discharge

Medical decision-making

Waiting when treatment is

indicated

Treatment

Incorrect dosage

Medication

Failure to review treatment plan

Inadequate supervision

Failure to convey information

Faulty communication

Faulty technique

Procedural complications

Inappropriate or premature
discharge

Medical decision-making

*Wu AW, McPhee SJ, and Christensen JF. Mistakes in Medical Practice, Chapter 32 in Behavioral Medicine
in Primary
Care. 1997 Appleton and Lange, Stamford, CT. Edited by MD Feldman and JF Christensen.
*Adapted, with permission, from Wu AW at al: Do house officers learn from their mistakes? JAMA 1991;
265:2089. American Medical Association

Common Causes of Medical

Mistakes

Ignorance
Inexperience
Faulty judgment
Hesitation
Fatigue
Job overload
Breaks in concentration
Faulty communication
Failure to monitor closely
System flaws

*Wu AW, McPhee SJ, and Christensen JF. Mistakes in MedicalPractice,Chapter 32 in Behavioral Medicine in Prim
1997
Appleton and Lange, Stamford, CT. Edited by MD Feldman and
JF Christensen.

Simple Truths about

Medical Mistakes
1. Errors will happen. Since no human is infallible,
errors are bound to happen, and this includes
physicians.
2. Since errors can be expected, systems must be
designed to prevent and absorb them.

Simple Truths about Medical

Mistakes Cont.
3. Errors are not synonymous with negligence.
Medicines ethos of infallibility leads, wrongly, to a
culture that sees mistakes as an individual problem
and remedies them with blame and punishment
instead of looking for root causes and fixing problems
by improving systems.
4. Creating a culture supportive of errors reporting is
the starting point in reducing future medical errors.

Disclosing Error to
Patients
Notify your professional insurer and seek assistance
from those who might help you with disclosure
(e.g., unit director, risk manager)
Disclose promptly what you know about the event.
Concentrate on what happened and the possible
consequences.
Take the lead in disclosure; dont wait for the
patient to ask.

Disclosing Error to Patients

Cont.
Outline a plan of care to rectify the harm and
prevent recurrence.
Offer to get prompt second opinions where
appropriate.
Offer the option of a family meeting and the option
of
having lawyers present.
Document important discussions.

Disclosing Error to Patients

Cont.
Offer the option of follow-up meetings.
Be prepared for strong emotions.
Accept responsibility for outcomes, but avoid
attributions of blame.
Apologies and expressions of sorrow are
appropriate.

Hbert PC, Levin AV, and Robertson G. CMAJ 2001:164; 509-513

Prevention of Medical
Errors
Examples in medical
Error prevention
practice
Checklists, flow sheets,
tickler systems
Handheld computer,
electronic medical records
Fail-safe to avoid
prescribing two drugs that
interact fatally
Office formularies,
guidelines synthesis
Staff in services.

measures include
Reduced reliance on
memory
Improved information
access
Error-proofing systems.

Standardization
Training on error
identification and prevention

Questions for Discussion

How do I decide whether to tell a patient about an error?
Do physicians have an ethical duty to disclose information
about medical mistakes they, or their colleagues, did to their
patients?
Won't disclosing mistakes to patients undermine their trust in
physicians and the medical system?
By disclosing a mistake to my patient, do I risk having a
malpractice suit filed against me?
What if I see someone else make a mistake?
http://depts.washington.edu/bioethx/topics/mistks.html

THANKS FOR
YOUR ATTENTION