# How does your agency deal with med errors?



## abckidsmom (Jul 17, 2011)

If you were to make a mistake and administer the wrong medication, or the wrong dose of the right medication, how would it be addressed by your agency?

Is there a penalty for self-reporting?   Are there systems in place to determine whether there's a problem with the setup of the drug box, or with the supplier of medications?

How would it go for you if you accidentally administered a medication that caused the patient temporary, though not permanent, harm?

Would you self-report if you discovered you'd administered the wrong drug, but there was no apparent adverse reaction?


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## STXmedic (Jul 17, 2011)

I'm sure I'd report it if it happened to me. Here, depending on the severity, we'd either get a QI session (most likely) or deauthorized as a medic for 4 or 5 shifts and have to ride 3rd with an FTO (if we killed somebody)


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## johnrsemt (Jul 17, 2011)

The hospital that I used to work at the medics would get demoted or fired and the nurses would get told "oops  don't do that anymore"..    no matter how slight or serious.


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## abckidsmom (Jul 17, 2011)

johnrsemt said:


> The hospital that I used to work at the medics would get demoted or fired and the nurses would get told "oops  don't do that anymore"..    no matter how slight or serious.



That's definitely what I see.  Medics I know who've had med errors are pulled right in to the medical director's office for a smackdown, but the mindset in nursing is totally different:  they want the errors reported, and know that being human, you're going to make errors, so they set up a system that will not kick you in the pants for admitting a mistake.

Now, whether it was a reckless mistake or one that's easily explained, each situation should be evaluated individually.  But still, the difference in the professional mindset can be staggering, honestly.


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## silver (Jul 17, 2011)

johnrsemt said:


> The hospital that I used to work at the medics would get demoted or fired and the nurses would get told "oops  don't do that anymore"..    no matter how slight or serious.



who's in charge of medics and who's in charge of nurses? Generally medicine/nursing has adopted a just culture mentality. Don't know if that has made it to EMS (even hospital based).

It could be that as a profession EMS doesn't quite understand continuous quality improvement. QA/QI doesn't mean reviewing PCRs. To start EMS would be greatly enhanced if every organization did peer review on providers, reviewed outcome measures, and performed root cause analyses on adverse events (or anything that seemed fishy).


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## usalsfyre (Jul 17, 2011)

Lack of REAL, non-punitive QA is a consistent issue in EMS. The "aluminum trucks and iron men" mentality persist in many managers and refuses to acknowledge the role of engineering controls, fatigue, continuing education, self-reporting and root-cause analysis in error prevention. 

One more place EMS is behind the times and holding ourselves back.


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## silver (Jul 17, 2011)

usalsfyre said:


> Lack of REAL, non-punitive QA is a consistent issue in EMS. The "aluminum trucks and iron men" mentality persist in many managers and refuses to acknowledge the role of engineering controls, fatigue, continuing education, self-reporting and root-cause analysis in error prevention.
> 
> One more place EMS is behind the times and holding ourselves back.



exactly.

There is also a huge industry that does quality improvement just for healthcare. Some organizations are also very specific like the ISMP (http://www.ismp.org/), which focuses solely on medication errors. EMS needs to take more advantage of resources like it.


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## shfd739 (Jul 17, 2011)

For us it all depends on the severity. I know of a few more serious errors where the medic had to do a peer review with the FTO and QI manager. No one was fired. IIRC the last few firings for patient care related stuff was for people acting out of level i:e basics doings IVs, intubating etc. 


Sent from my electronic overbearing life controller


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## medicdan (Jul 17, 2011)

silver said:


> who's in charge of medics and who's in charge of nurses? Generally medicine/nursing has adopted a just culture mentality. Don't know if that has made it to EMS (even hospital based).
> 
> It could be that as a profession EMS doesn't quite understand continuous quality improvement. QA/QI doesn't mean reviewing PCRs. To start EMS would be greatly enhanced if every organization did peer review on providers, reviewed outcome measures, and performed root cause analyses on adverse events (or anything that seemed fishy).



^^ This. We need to move away from the punitive processes of the fire service, towards the root cause analyses of hospitals, and towards designing our work environments to match how we practice our skills. Whether that means making vitals of 1:1,000 and 1:10,000 epi completely different colors (or carry epi-pens on ALS trucks), or not allowing IV dripsets to connect to G-Tubes, then it must happen.


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## MrBrown (Jul 17, 2011)

Error, risk management and human factors are something Brown has considerable professional experience in within the aviation industry.

The Ambulance Service here has a root cause analysis program but it is very new and getting on its feet still.  

It is stated we have an acceptable medical error rate of 0.1%


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## usalsfyre (Jul 17, 2011)

MrBrown said:


> Error, risk management and human factors are something Brown has considerable professional experience in within the aviation industry.
> 
> The Ambulance Service here has a root cause analysis program but it is very new and getting on its feet still.
> 
> It is stated we have an acceptable medical error rate of 0.1%



EMS could learn a hell of a lot from the aviation industry.


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## abckidsmom (Jul 17, 2011)

silver said:


> exactly.
> 
> There is also a huge industry that does quality improvement just for healthcare. Some organizations are also very specific like the ISMP (http://www.ismp.org/), which focuses solely on medication errors. EMS needs to take more advantage of resources like it.



This was a good article.


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## Melclin (Jul 18, 2011)

I don't understand the process extensively but here is what I understand.

Med errors are investigated by a CSO (senior intensive care paramedic with a role in clinical guidance, governance, auditing, teaching etc). After that, what happens depends on the severity of the breach and the cause. 

They tell us that if a mistake is reported, we won't get in trouble but there will be clinical breach proceedings geared at helping us reduce the likelihood of future "performance gaps", where as if we make a mistake and don't report it, its grounds for immediate termination. I get the impression though that there is a stage (depending on past mistakes/gravity of situation/attitude or you clinical skill) when performance management stops being about helping you and starts being the path they force you down before terminating you.


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## MrBrown (Jul 18, 2011)

It seems (not just in EMS) in the US employers are very quick to just *click fingers and sack you .... whereas here (and in Australia) it is much more difficult and we (employers) want to keep people around even if they need a bit of remedial work


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## DrParasite (Jul 18, 2011)

johnrsemt said:


> The hospital that I used to work at the medics would get demoted or fired and the nurses would get told "oops  don't do that anymore"..    no matter how slight or serious.


and it's this exact mentality that leads to people trying to cover-up the mistake or falsify documentation, instead of admitting the mistakes.

Plus the mentality of "well, if I don't admit to the mistake, than it didn't really happen or I won't get penalized for it" is prevalent in EMS (and other industries), especially with some agencies demanding perfection from their employees, and those who are not perfect will be removed and replaced with those who can be perfect (until they screw up, and the cycle continues).


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## firecoins (Jul 18, 2011)

what types of mistakes are we talking about?  I carry my protocols and other material with dosage info so I can look it up as need be.


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## mycrofft (Jul 18, 2011)

*Our situation was "special".*

Until the state's pharmacy board came by and threatened fire and brimstone, a very few peple were pouring hundreds of doses an hour using tattered (by the end of the month) paper med admin records (MAR's), and no worksheet or form for emergency response medication (eventually went right into the chart as an anecdotal). Until the computers became documentary, the following seemed to apply to med errors:
1. If it reflects badly on the system, sweep it under or blame the individual and fire them with legal threats to keep quiet.
2. If it was not a critical mistake, or no ill came of it, either ignore it (if you liked the worker) or fire them as above (if they bothered you).
3. If there was a language issue, try to find them another job in the system and cover it up. Ditto MD's or supervisors working out of class (i.e., couldn't keep thier hands off a patient even though they are managers and not line people).
The people who helped fix this (somewhat, I left while it was stumbling into fixedness) the best were our pharmacists, who called in the Pharmacy Board air strike.
The patient population was so litigious and abusive of the grievance system that thair input was sought only when you wanted to burn someone, and suppressd otherwise.


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## shfd739 (Jul 18, 2011)

Melclin said:


> I don't understand the process extensively but here is what I understand.
> 
> Med errors are investigated by a CSO (senior intensive care paramedic with a role in clinical guidance, governance, auditing, teaching etc). After that, what happens depends on the severity of the breach and the cause.
> 
> They tell us that if a mistake is reported, we won't get in trouble but there will be clinical breach proceedings geared at helping us reduce the likelihood of future "performance gaps", where as if we make a mistake and don't report it, its grounds for immediate termination. I get the impression though that there is a stage (depending on past mistakes/gravity of situation/attitude or you clinical skill) when performance management stops being about helping you and starts being the path they force you down before terminating you.



This is similar to our process and explains better than what I said. 

If someone is honest and speaks up it's less of an issue. The ones that lied or tried to hide it were the ones that quickly felt the hammer.

There is a stage for us that after repeated hand holding, re-education, scenarios etc. that if a paramedic is still getting it wrong they are restricted to functioning at a BLS level with Basic pay. Management cant take the risk of something else happening and after a few months the restriction is reevaluated to see if it can be lifted.. I wouldnt say its a path to termination as the person can stay employed forever-theyll just have less responsibility and make less money. At times the person quits rather than be restricted-- which in some cases is the desired outcome.


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## Medic2409 (Jul 20, 2011)

At the service I used to work at, it all depended on who you knew, and how good of friends you were with them.


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## AJ Hidell (Jul 21, 2011)

johnrsemt said:


> The hospital that I used to work at the medics would get demoted or fired and the nurses would get told "oops  don't do that anymore"..    no matter how slight or serious.


LOL!  That's so true.  Although, there are some reasons for that disparity.  Medics generally have a drug list of 20 or so, with half of them being prefills.  And they are also usually only administered under very specific, cookbook protocols.  There are darn few legitimate excuses for screwing that up.

I am not aware of ever making a med error in 30 years of medic practice.  But I've made my share in 20 years as a nurse.  I have always self-reported, and never been punished in any way, just had to write an incident report once.


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## Fish (Aug 9, 2011)

We Self report, and undergo training if needed. Obviously, if you really mess up then thats a different story and will go to peer review and so on.


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## jjesusfreak01 (Aug 15, 2011)

You call the medical director (immediately), he initiates any immediate action necessary (calling the hospital if you didn't notice the error until after the call) and starts the process of investigating the error to determine if there are ways to prevent it happening in the future. There is no penalty for self reporting, and near immediate dismissal if it looks like you lied or were trying to hide something.


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