Here’s how to admit you made a mistake
Here’s how to admit you made a mistake
If a mistake was made in your ED, what would your first plan of action be? If you’re like many ED managers, your instincts might be to downplay, overlook, or attempt to conceal the error, but those are major mistakes, says Steven J. Davidson, MD, MBA, chair of the department of emergency medicine at Maimonides Medical Center in Brooklyn, NY.
Instead, you must own up to the problem and state the truth immediately, urges Davidson. "Then you must say what you are doing about it," he advises. "Even if you can’t fix the specific occurrence, you must specifically state what you are going to do so that it doesn’t happen again."
Who should you tell?
Here are ways to acknowledge and address an error:
• Don’t make a public apology. Hospital administrators and risk managers advise against making public acknowledgments of mistakes, says Davidson. "In medicine, we are not accustomed to acknowledging mistakes publicly," he notes.
Regardless of the usual prohibition on "going public," one still must own up to the problem internally, he says. "It is extremely important to notify others in the hospital as soon as the mistake is discovered."
Notify risk management, the patient’s current treating physician, the chief operating officer or chief executive officer, and the hospital’s public relations department, Davidson says.
• Have a plan to correct the problem. Tell those you notify what you’ve discovered and what its effect on the patient is or might have been, advises Davidson. "Then tell them what you are going to do about it in your area," he says, suggesting the following as an example of what to say:
"We are investigating. We are scheduling a critical incident review meeting with physicians, nursing, and the consulting services on this date: _____ at _____ a.m./p.m. From that meeting, we will develop our corrective actions and we will plan for the implementation and monitoring of those corrective actions. We will report the case for review at the next housewide performance improvement meeting and the medical staff executive committee."
It is always better to be in the position of reporting a mistake with your own first impressions and recommendations for actions, says Davidson. "It’s much harder to be in the position of reacting to accusations from others, especially when those accusations are valid," he notes.
• Don’t apologize for missing a diagnosis if your care was appropriate. Disease is not always easy to define, says Gregory L. Henry, MD, FACEP, vice president of risk management for Emergency Physicians Medical Group in Ann Arbor, MI. "Not all patients will be diagnosed in one shot during an ED visit, but that doesn’t mean you haven’t done the right things," he explains.
• Be as candid as possible. Never attempt to hide a mistake, Henry advises. "It’s how you package the product and the face you put on it," he explains. "If you say, We know the following things, but this part of disease has not yet declared itself,’ most people can handle that kind of honesty."
The idea is to be honest without being inflammatory, Henry says. For example, a patient was supposed to be given a shot of Solu-Medrol (Sanofi Winthrop Pharmaceuticals, Morrisville, PA), an anti-inflammatory steroid for a severe inflammatory throat that was causing swelling, and mistakenly was given a shot of Demerol (Abbott Laboratories, Abbott Park, IL), Henry recalls. "That was a clear error. However, the truth is, he needed pain relief anyway, although it wasn’t what the nurse intended to give," he says.
Henry explained to the patient that the steroid is usually given first, but he happened to get his pain medication first. "There was no harm done. Don’t build in the mind of the patient something that didn’t happen. What you want is the facts and no editorializing."
• Meet with the patient and/or family. If an obvious error is made, you should meet directly with the family to explain it, recommends Henry. "The meeting should not be held with risk managers. It should be a doctor, not necessarily the one who had the problem, meeting with the family to explain what happened."
• Consult with risk management. You might fear that if you apologize to a patient, you’ll be promoting a malpractice lawsuit, says Stephen Colucciello, MD, FACEP, assistant chair and director of clinical services for the department of emergency medicine at Carolinas Medical Center in Charlotte, NC. To reduce that risk, consult with risk management before you speak to the patient, he advises. However, Colucciello stresses that it’s always the clinician’s call whether to accept or reject that advice. "They may tell you to give minimal information, but you may think that’s wrong," he says. "But even in that case, they may give you help in understanding how to say something."
• Document mistakes and how they were handled. When an error is made, document it immediately, says Henry. "Everybody makes mistakes. It does happen. The question is, did you try and correct it?"
Henry suggests the following as an example of good documentation: "Medication X was given instead of medication Y. The patient was informed and re-examined. The nature of the medication is not expected to have side effects, but we will monitor the patient.’ That is a very clear statement that hides nothing," he says. "It shows that when you found out about something, you took steps to ensure the patient’s safety."
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