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Avoiding Errors in Adult Medicine

Avoiding Errors in Adult Medicine

Ian Reckless, D. John Reynolds, Sally Newman, Joseph E. Raine, Kate Williams, Jonathan Bonser

ISBN: 978-1-118-50886-2

Dec 2012, Wiley-Blackwell

184 pages



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.

Written for junior medical staff and consultants, and unlike any other clinical management title available, Avoiding Errors in Adult Medicine identifies and explains the most common errors likely to occur in an adult medicine setting - so that you won’t 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.

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

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

“My experience as an expert witness in clinical negligence cases, MPTS Panel chairman, medical adviser to a Public Inquiry and as a sometimes commissioned independent reporter on adverse incidents tells me that these are excellent books, valuable for all clinicians, not just those in high-risk specialties; and all NHS managers involved in maintaining or improving the quality of care. The case vignettes, alone, are useful source material for teaching medical trainees on what can go wrong and how to deal with it when it does.” (Harvey Marcovitch, Clinical Risk journal)