Medication Error Reporting Policy - no discipline

[TopCare]

Hello,

I am interested in putting together a policy that allows paramedics that self-report medication errors to be immune from disciplinary action by their employer.

A few questions:

1) Does your agency have a written policy regarding this concept?

2) Do readers of this post believe that this is a good policy to have? What if the error leads to grave harm or death, should the paramedic still be immune from employer discipline?

3) Is putting the paramedic on a required improvement or education plan because of a medication error considered a form of discipline, or one of education?

4) Even if self-reporting, how about a paramedic that continues to make errors?


Perhaps sentinel events and continuing errors (by one individual) are handled by the county or state, leaving a provider policy to be true to its non-disiplinary policy, but allowing for a greater authority to step in when a truly problem-paramedic is recognized?

In nursing there is a concept called "Patient Safety and the Just Culture" that seems to support non-disiplinary action for self-reported errors in order to benefit employees and patients by strengthening the system as a whole. I like the idea and concept but wanted to solicit opinions. The ultimate goal of this policy would be to improve paramedic performance and increase patient safety.

I have looked at the County of Ventura's policy, but that is seemingly for an EMS Authority, not a provider agency. I believe it is a good starting point. Unfortunately I cannot post a link because I am a new poster here, but if you Google "medication error reporting no discipline policy" the second result is Ventura's.

I look forward to any responses.

Thanks,
TC

 

[mycrofft]

It has to be in accordance with applicable laws.

As for nursing, if things are the same now as in the past, if an egregious and serious error is made, the employer will fire you or pressure you to quit, which pretty well tells you it's time to go. That way when they are sued they say "Hey, we fired that troublemaker, sue her/him".

Don't know what to tell you except make sure what you aim for is legal first.

 

[Veneficus]

I think if you look up the different types of medical errors, you will be able to come up with better answers.

Also, giving a medication that is not indicated is a medical error, so providers using protocol based medicine will inevitably be forced to commit medication errors.

There are also an ethical and in many jurisdictions, legal obligation to report errors, so if a provider is not reporting errors they could find that employer discipline is the least of their worries, especially in the event of serious harm or death to a patient.

 

[VFlutter]

In nursing there is a concept called "Patient Safety and the Just Culture" that seems to support non-disiplinary action for self-reported errors in order to benefit employees and patients by strengthening the system as a whole. I like the idea and concept but wanted to solicit opinions. The ultimate goal of this policy would be to improve paramedic performance and increase patient safety.

I think it is a great idea but I am not sure if it will really catch on in EMS. It works great in nursing but it is a different culture and mentality. In EMS you have to deal with the common theme of "What happens on the truck stays on the truck", reluctance to admit mistakes, and the fear of disciplinary action. (Not that this does not occur in other professions)

The exact same situation is usually treated very differently by the two professions. If a nurse makes a medication error, aside from blatant neglect, there is formal process to figure out why and how to prevent it in the future. If a medic makes the same mistake there is usually no such emphasis on why it happen but instead blame falls solely on the medic who is then disciplined. ~ At least in my limited experience with EMS, it may be different in other areas.

We have an anonymous website used for event reporting and it is frequently used resulting in improvements in policy and procedure. For example maybe the 1:1,000 and 1:10,000 bottles of epi look identical and I accidentally draw up the wrong concentration. I could report the incident and hopefully the vial labels would be improved to better differentiate between the two. I would have no disciplinary action against me (Unless I actually administered the wrong dose and the patient had an adverse event) but it would be more of "education" then punishment.

There should be no way to track who makes what mistakes and how often. It will only lead to less honest reporting

 

[bigbaldguy]

A similar program exists in the airline industry. It's been incredibly effective at improving safety protocols.


One important part of the program is that just because you admit to an error doesn't necessarily let you off the hook if it is found out. It does however mitigate and in some cases eliminate any penalties if the mistake is discovered.

 

[Aidey]

The airline industry has also done a great job looking at responsibility vs fault. Most people in EMS that I talk to treat those as the same thing.

 

[Handsome Robb]

I've had two medication errors and reported both of them, both without any disciplinary action taken against me. Had a sit down with clinical direction after the second one to review the call.

One was a medication by a route widely accepted, however not accepted by my protocols. The other wasn't harmful to the patient but it was a lesson that I will never forget and a mistake I will never make again. Also changed the way I layout the drugs in my medication bag.

I've never heard of a medic here being reprimanded or fired for a medication error here unless it was habitual or wasn't reported and was discovered.

 

[AlphaButch]

If we self report and it wasn't an error due to malfeasance, it is addressed through reduction of skills until completion of in house retraining and sometimes being sent to outside courses.

If it was an error that can be resolved system wise (such as different vials, etc), there is generally no discipline (other than perhaps being the one to teach everyone else what the change is).

If you don't learn from the mistake and it happens a second time, you're out.
If you don't report something, you're out.