How to avoid medical errors, how to respond and relate to them: a review of the scientific monograph «Defects in the provision of medical care»

Currently, the number of judicial proceedings on real and alleged offenses and disputes in area of provision of medical care has been exponentially increased. Some of such proceedings become publicly disclosed, but many more of them remain unnoted in mass media and civilian society as a whole. Increasing number of medical doctors has been accused of criminal offenses, being more often sentenced to real terms of imprisonment, showing a clear tendency to increase gravity of responsibility applied to medical doctors. This publication represents a peer-reviewed response of paramount importance to the book by A.A. Ponkina and I.V. Ponkin «Defects in the provision of medical care» raising ontological, value and technical issues for negative outcome of medical care – by the fault or in the absence of the fault of the doctor. The book puts the scientific basis beneath changes so much awaited by the Russian public health in relation to medical doctors, their social importance, objective limitlessness of their opportunities and capabilities in curing sick people and saving their lives.

Conflicts and Challenges of Truth-Telling in Dentistry: A Case-Based Ethical Analysis

Objectives: The basis of truth-telling is respecting the autonomy of patients and developing an ability to make informed decisions with valid consent. The purpose of this study was to ethically analyze the conflicts about truth-telling in dentistry. Materials and Methods: This case analysis focused on the issues of truth-telling in medicine and dentistry. The challenges encountered by dentists with respect to ethical issues related to truth-telling were discussed and analyzed by the research team. Results: The literature review showed that the issue of truth-telling in dentistry has been addressed from three aspects: Truth-telling about other dentists’ medical errors, truth-telling about dangerous, refractory, or incurable diseases, and truth-telling to children or incompetent individuals for decision-making. Conclusion: When the duty of the dentist in truth-telling is conflicted with some other moral obligations, the conflict between the prima facie duties arises. The principle-based ethical theories provide a suitable conceptual framework for moral judgement in such conflicts. In cases of conflicts related to truth-telling, a balance should be maintained between principles and rules such as fidelity, respect for autonomy, maintaining trust in dentist-patient relation, and best interest of patients. The decision in truth-telling should be made individually for each patient based on the specific contextual conditions.

How will state medical boards handle cases involving disclosure and apology for medical errors?

Surveys were sent to 68 American state medical boards, including territories of the United States, inquiring how they handle—or will handle—cases involving disclosure and apology after medical errors. Surveys were not sent to specialty boards. Thirty-eight state medical boards ( n = 38, 56%) responded to the survey, with 31 completing the survey (46% completion rate) and seven boards ( n = 7) providing explanations for nonparticipation and other thoughts; 30 boards did not respond in any manner. Boards that completed the survey indicated that disclosure and apology and other positive post-event behavior by physicians are likely to be viewed favorably and disclosing physicians will not be easy targets for disciplinary measures, though boards also stressed they view each case on the merits and patient safety is their top priority. Recommendations are made for policy makers and other stakeholders.

Medical errors — causes and contradictions

Studying and improving the theory of errors of doctors has always been important, and today it has become especially relevant.The article lists the main provisions of the advanced version of the theory of errors of doctors. The main content of the articleis devoted to four important aspects of the problem of physician errors. The article states the main contradiction of the problemof errors in medicine. The structure of general objective and subjective causes of medical errors is shown. The main optionsfor doctors to experience errors that complicate doctors’ mutual understanding in this problem are formulated. For the fi rsttime, the reasons for the denial of errors by doctors are summarized. These aspects and conclusions on them are the result ofan analysis of publications on the problem of errors in medicine, repeated discussions of the problem on professional medicalsites. The content of these aspects was based on its own material on error analysis and observation from practice. The aboveaspects and their conclusions need not so much to be confi rmed by special studies, but rather to refl ect on their role and placein the problem of errors. The general objective and subjective reasons for the occurrence of medical errors are shown inconnection with their possible "guilt". Lack of experience is presented as the most common cause of medical errors. Variousoption for doctors to experience errors are presented as a reason that makes it diffi cult for doctors to understand this problem.

Penggunaan Metode SBAR untuk Komunikasi Efektif antara Tenaga Kesehatan dalam Konteks Klinis

Abstract—Interprofessional collaboration is a collaboration in health services between health professionals from diverse backgrounds. One of the most important aspects of collaborative practice in health services is the communication between health professionals. Lack of communication can cause a delay in treatment and medical errors. Ineffective communication can also represent a lack of coordination. SBAR method is an effective communication technique for health professionals. The SBAR method is useful to improve team communication in general, improve communication skills in certain situations, and also helpful during shift handover. Keywords: interprofessional collaboration, communication, SBAR method Abstrak—Kolaborasi interprofesional merupakan suatu kerja sama dalam pelayanan kesehatan antara profesional kesehatan yang memiliki latar belakang pendidikan berbeda. Dalam pelayanan kesehatan, salah satu hal terpenting dari praktik kolaborasi yaitu komunikasi antara tenaga kesehatan. Kurangnya komunikasi dapat menyebabkan terjadinya keterlambatan dalam melayani pasien dan kesalahan dalam menangani pasien. Komunikasi yang kurang efektif juga dapat menggambarkan koordinasi tenaga kesehatan yang kurang baik. Teknik komunikasi efektif yaitu SBAR ditetapkan sebagai standar komunikasi antara tenaga kesehatan yang berfokus terhadap pasien. Metode SBAR bermanfaat untuk meningkatkan komunikasi tim secara umum, meningkatkan keterampilan komunikasi saat situasi tertentu, dan juga berguna pada saat operan dinas. Kata kunci: kolaborasi interprofesional, komunikasi, metode SBAR

MEDICAL ERRORS: ANALYSIS, CAUSES, WARNING

Изучение и совершенствование теории ошибок врачей всегда было важно, а сегодня это стало особенно актуальным. В статье указаны три разные позиции во врачебной среде в отношении ошибок врачей. Показаны последовательные изменения в уголовном кодексе в отношении «причинения вреда здоровью» и тенденция криминализации врачебных ошибок. Приводятся сравнение проблемы ошибок в западных странах и СНГ, и меры контроля ошибок. Аргументируется положение о том, что теория врачебных ошибок - отдельный раздел науки. Указаны причины отсутствия теории врачебных ошибок как отдельной науки. В статье перечислены основные положения разработанного варианта теории ошибок врачей. Studying and improving the theory of doctors' mistakes has always been important, and today it has become especially relevant. The article indicates three different positions in the medical environment regarding the mistakes of doctors. Consistent changes in the Criminal Code in relation to "harm to health" and the tendency to criminalize medical errors are shown. A comparison of the problem of errors in Western countries and the CIS, and error control measures are given. The position that the theory of medical errors is a separate branch of science is argued. The reasons for the absence of the theory of medical errors as a separate science are indicated. The article lists the main provisions of the developed version of the theory of doctors' errors.

Changes Made to Orders Placed by Overnight Admitting Residents on Teaching Rounds the Next Day

OBJECTIVES: Increased focus on health care quality and safety has generally led to additional resident supervision by attending physicians. At our children’s hospital, residents place orders overnight that are not explicitly reviewed by attending physicians until morning rounds. We aimed to categorize the types of orders that are added or discontinued on morning rounds the morning after admission to a resident team and to understand the rationale for these order additions and discontinuations. METHODS: We used our hospital’s data warehouse to generate a report of orders placed by residents overnight that were discontinued the next morning and orders that were added on rounds the morning after admission to a resident team from July 1, 2017 to June 29, 2018. Retrospective chart review was performed on included orders to determine the reason for order changes. RESULTS: Our report identified 5927 orders; 538 were included for analysis after exclusion of duplicate orders, administrative orders, and orders for patients admitted to non-Pediatric Hospital Medicine services. The reason for order discontinuation or addition was medical decision-making (n = 357, 66.4%), change in patient trajectory (n = 151, 28.1%), and medical error (n = 30, 5.6%). Medical errors were most commonly related to medications (n = 24, 80%) and errors of omission (n = 19, 63%). CONCLUSIONS: New or discontinued orders commonly resulted from evolving patient management decisions or changes in patient trajectory; medical errors represented a small subset of identified orders. Medical errors were often errors of omission, suggesting an area to direct future safety initiatives.