Avoiding Errors in Adult Medicine

Some of the most important and best lessons in a doctors 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

Written for junior medical staff and consultants, and unlike any other clinical management title available,Avoiding Errors in Adult Medicineidentifies and explains the most common errors likely to occur in an adult medicine setting - so that you wont make them.

The first section in this brand new guide discusses the causes of errors in adult medicine. The second and largest section consists of case scenarios and includes expert and legal comment as well as clinical teaching points and strategies to help you engage in safer practice throughout your career. The final section discusses how to deal with complaints and the subsequent potential medico-legal consequences, helping to reduce your anxiety when dealing with the consequences of an error.

Invaluable during the Foundation Years, Specialty Training and for Consultants, Avoiding Errors in Adult Medicine is the perfect guide to help tackle the professional and emotional challenges of life as a physician.

For more information on the Avoiding Errors series, please visit:www.wiley.com/go/avoidingerrors

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More titles in theAvoiding Errors seriesAvoiding Errors in Paediatrics Raine et al. 2013 9780470658680Avoiding Errors in General Practice Barraclough et al. 2013 9780470673577 This title is also available as an e-book. For more details, please seewww.wiley.com/buy/9780470674383 or scan this QR code:

Ian P. Reckless is Consultant Physician and Assistant Medical Director, Oxford University Hospitals NHS Trust

D. John M. Reynolds is Consultant Physician and Clinical Pharmacologist, Oxford University Hospitals NHS Trust

Sally Newman is a Solicitor and Head of Legal Services, Oxford University Hospitals NHS Trust

Joseph E. Raine is Consultant Paediatrician, Whittington Hospital, London

Kate Williams is Partner, RadcliffesLeBrasseur Solicitors, Leeds

Jonathan Bonser is Consultant in the Healthcare Department of Fishburns LLP, Solicitors, London, and former Head of the Claims and Legal Services, Department of the Leeds office of the Medical Protection Society

Contributors  viii

Preface  ix

Abbreviations  x

Introduction  XI

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 cases v

Introduction  35

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