Research Paper, Ethics Medical errors

Project description
Question is
What procedures do hospitals have in place for the ethical disclosure of the scope and timing of medical

errors in intensive care units?
*NO Introduction and Conclusion
* Endnotes are required, it should be around 100
* use quotations as many as you can
* please follow outlines in my file

1- What procedures do hospitals have in place for the ethical disclosure of the scope and timing

of medical errors in intensive care units?

I. The Ethical Obligation and Significance of Disclosure

A.   Obligation of Honesty to the Patient
1.   Western Cultural Expectations in Medical Errors
a)   Confession
b)   Repentance
c)   Forgiveness
d)   What Happened?
e)   Apology
f)   Medical =/- financial compensation
g)   What is being done to prevent future errors?

2.   What Patients Desire After Medical Errors
a)   What happened?
b)   Apology
c)   Medical +/- fiscal plan
d)   What is being done to prevent future errors?

3.   The Disclosure and Apology
a)   Effects of Non-Disclosure
* When patients learn of error from practitioners other than their physician they feel:
1.   Anger
2.   Bitterness
3.   Betrayal
4.   Sense of humiliation
5.   Loss of trust
6.   Suspicion of cover-up

b)   Apology
1. Disclosure
a)   Ethical obligation
b)   Informed consent
c)   Truth telling
d)   Involves telling what happened

2. Apology
a)   Therapeutic obligation
b)   Allows patient healing
c)   Allows doctor healing
d)   Allow patient to recognize our humanity
e)   Involves expressing you are sorry

4.   The Disclosure and Apology Gap
a)   Most doctors feel they should disclose error. Nearly all
patients want to be told about errors
b)   Disclosure and Apology only occurs 30% of the time
c)   Why the disclosure gap
1.   Apology is hard to do
2.   Medical errors are often complex
3.   Lack of physician training in this special
communication skill
4.   Fear of loss of reputation
5.   Fear of causing emotional damage to the patient
6.   Fear of increasing liability/lawsuits

5.   Medical Error Disclosure Process
a)   Prepare of the meeting
b)   Disclose the error
c)   Apologize
d)   Establish a medical +/- fiscal plan
e)   Outline how future similar errors will be prevented

6.   Proper notification and documentation process
a)   Get the facts straight
b)   Discuss significant errors with colleagues who can
assist
c)   Notify liability carrier
d)   Set the scene –
a.   Private
b.   Give patient option for support to be present
c.   Interruption free
d.   Maintain “open body language”
e.   First give warning
f.   Simply state the error in layman’s terms
g.   Stop talking and let the patient react
h.   Answer the patient’s questions
i.   Touch patient – “hands – elbows area”
j.   Make a sincere apology
k.   Take responsibility
l.   Do not make excuses, finger point, blame others
m.   Establish medical plan
1. How will the harm be treated?
2. Empower the patient
3. Financial plan
4. Open the door for another meeting
n.   How will future mistakes be prevented? And once mistakes are made, how can the negative

outcomes be minimized?

B. Disclosure Protocols
1. Disclosure protocol based on scope and scale of error
a. Major error (palpable consequences)
b. Minor error (no palpable consequences)
2. Disclosure protocol based on ethical acceptance of responsibility
a. Personal responsibility
b. Responsibility of hospital
c. Responsibility of outside organizations
d. Responsibility of patient
e. Areas of non-responsibility
3. Disclosure protocol based on type of information
a. Technical processes, protocols, and procedures
descriptions
b. Outcome in layman’s language
c. Options for patient
4. Disclosure protocol based on anticipated risk management
a. Anticipated preexisting hold-harmless agreements
b. Anticipated backup procedures
c. Unanticipated, uncovered protocol
5. Disclosure timing protocol
a. Predisclosure of expectations of all parties
b. Immediate disclosure
c. Term disclosure over time based on peer review
d. Term disclosure over time based on outside review
6. Disclosure to stakeholders protocol – confidentiality, type of info
a. Patient
b. Patient’s family
c. Hospital
d. Colleagues, associates, medical team
e. Insurance and regulators
7. Informal and formal acknowledgment and apologies protocol
8. Compensation protocol
a. Procedures
b. Types of compensation
c. Limits

C.   Systemic Endeavor to Diminish Medical Error
1. Prevention plan protocols
a. Prophylactic procedures – checklists, overlap, backup
1. Execution, medical management error
2. Planning error, medical management error
3. Diagnostic error, medical intervention error
4. Treatment error, medical intervention error
5. Medication error, medical intervention error
b. Monitoring procedures
c. Preventable adverse procedures – how to reduce:
1. Events
2. Near misses
3. Slips
4. Lapses
5. Mistakes
6. Omission errors
7. Commission errors
d. Communication protocols
1. External
2. Internal (between medical team, admin, specialists)
e. Medication protocols
f. Equipment failure protocols
g. System failure protocols
2.   Tort reform + Disclosure of medical error
a)   Policy reform, legislative reform
b)   Hospital administrative reform
c)   Educational reform at the level of medical schools, and nursing schools.

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