Avoiding errors in adult medicine / created by Ian P. Reckless .D. John M. Reynolds, Sally Newman, Joseph E. Raine, Kate Williams and Jonathan Bonser

Includes bibliographical references and index.

Part 1 Section 1: Errors and their causes 1 A few words about error 1 Learning from system failures the vincristine example 1 Evidence from the NHSLA database 8 The patient consultation 10 Failure to identify a sick patient 12 Inability to competently perform practical procedures 13 Failure to check test results or act on abnormal findings 14 Prescribing errors 14 Sources of error in the case of vulnerable adults 16 References and further reading 18 Section 2: Medico-legal aspects 19 Error in a legal context 19 Negligence 19 Clinical negligence 20 Issues around consent 23 An attorney refusing treatment 27 A patient without capacity refusing treatment 27 Emergency treatment 28 Deprivation of liberty safeguards 29 Part 2 Clinical Section 1: Civil liability negligence and compensation 36 Case 1 A shaky excuse 37 Case 2 Making matters worse 40 Case 3 Chase the bloods 43 Case 4 Falling asleep en-route 45 Case 5 Bad luck or bad judgement 48 Case 6 An opportunity missed 51 Case 7 Better late than never 53 Case 8 Man down 56 Case 9 Cry wolf 58 Case 10 Not a leg to stand on 60 Section 2: Unexpected death: the coronial system and clinical risk management 62 Case 11 A doubly bad outcome 63 Case 12 Difficulty with diarrhoea 66 Case 13 A flu-like illness 69 Case 14 Falling standards 72 Section 3: An approach to complaints 74 Case 15 A woman with chest pain 75 Case 16 Clumsiness 78 Section 4: Competence 80 Case 17 A change in plan 81 Case 18 Starving to death 85 Case 19 An irregular presentation 88 Case 20 Irrational but not incompetent 90 Section 5: Restraint 92 Case 21 A challenging discharge 93 Case 22 Ruling out the organic 96 Case 23 Endless wandering 99 Case 24 Can you please take these handcuffs off? 101 Case 25 Own worst enemy 103 Section 6: Miscellaneous 105 Case 26 All eggs in one basket 106 Case 27 A major mix-up 108 Case 28 Under the radar 110 Case 29 A cantankerous recluse 113 Case 30 Keep an open mind 115 Case 31 Healthcare acquired infection? 117 Case 32 Backing the wrong horse 120 Case 33 A surprising turn of events 122 Case 34 Funny turn 125 Part 3 Investigating and dealing with errors 1 Introduction 127 2 How hospitals try to prevent adverse errors and their recurrence 127 3 The role of hospital staff 132 4 The role of external agencies 134 5 Hospital investigations 137 6 Legal advice where to get it and who pays 141 7 External investigation of errors and incidents 143 8 The role of the doctor 160 9 Presenting oral evidence 162 10 Emotional repercussions 164 11 Conclusion 164 References 164 Index 167

Some of the most important and best lessons in a doctor s career are learnt from mistakes. However, an awareness of the common causes of medical errors and developing positive behaviours can reduce the risk of mistakes and litigation.