Preventing Medical Errors in Physical Therapy

In recent decades the U.S. healthcare system has made great strides toward restoring and maintaining the health and well-being of patients nationwide. Even so, medical errors remain a significant problem. Such errors may include problems in practice, products, procedures and systems, and the Institute of Medicine (IOM) lists medical errors as the eighth leading cause of death in the country.

Following a 1998 report by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry in which medical errors were identified as one of the four major challenges our nation faces in attempting to improve the quality of its healthcare, a Quality Interagency Coordination (QuIC) Task Force was established to address the problem.

A Growing Concern

In response to greater access to reports and initiatives, Americans have become increasingly concerned about medical errors and patient safety. Nearly half of all participants in a recent National Patient Safety Foundation study believed they, a friend, or a relative had been affected by a medical error, and 32 percent believed the error had a permanent negative effect on the patient’s health. Further, almost three fourths of Americans were concerned about receiving the wrong medicine, according to a 2002 study by the American Society of Health-System Pharmacists.

Medical errors can occur in any clinical setting—including surgical errors; medication/pharmacy errors; diagnostic errors (e.g. misinterpretation of test results or failure to act on abnormal results); equipment failure; blood transfusion-related errors; and misinterpretation of medical orders, such as allowing the wrong weight-bearing status or using improper upper body joint protection techniques. Errors specific to physical therapy may include:

• Treatment of the wrong limb
   
• Use of defective equipment
   
• Misinterpretation of medical orders
   
• Documentation or treatment of the wrong patient

Where Are Medical Errors Occurring?

Although many people believe medical errors are the result of failures by individual providers, studies indicate they typically result from several factors, and that most are related to systems and not attributable to individual negligence or misconduct.  Because research shows the majority of medical errors are preventable, it is important to understand where these errors are occurring.

Transitions:

In one study officials at Luther Hospital and Midelfort Clinic in Eau Claire, Wisconsin discovered 56 percent of their medication errors occurred when a patient was being admitted, transferred, or discharged. Such errors can be prevented by verifying the individual’s medication regimen upon transition—including dosage, frequency, and when the medication was last taken.

During transfers, nurses involved at either end should review the patient’s medication records, and therapists should ensure that posted notices regarding patient treatment or precautions are transferred with the patient. Upon discharge to a hospital, long-term care facility, or a private residence, physician discharge orders must be clearly understood by each member of the patient care team, and therapy professionals should verify that orders for the necessary home programs are written and understood by the patient and/or care provider.

Documentation:

The American Health Information Management Association suggests that the best way to prevent documentation errors is to “reduce the number of handwritten entries in the medical record,” especially “essential reports such as discharge summaries”. Therapists may wish to consider dictation, typing their notes, or utilizing one of the many software programs now available specifically for therapists. Regularly scheduled peer audits of medical records can uncover legibility problems and ensure prompt correction. In a rehab setting, cross-discipline audits can prove helpful with regard to ensuring readability.

Physical Therapy, Assistive Devices, and Modalities:

At the National Summit on Medical Errors, Secretary of the Arthritis Foundation Robert Meenan recommended research on medical errors should be broadened in its scope. “People with chronic illnesses are treated with a variety of modalities including physical therapy, alternative medicine and assistive devices,” Meenan stated. “While errors related to the use of surgery and prescription drugs pose clear risks for patient safety, errors associated with other forms of treatment may also have substantial relevance for patient safety and outcome.” Further, experts stressed that the focus of medical errors prevention should not be limited to inpatient settings, as many outpatient errors occur each year.

Outpatient visits often involve multiple practitioners who are, for the most part, not located in proximity to one another. Because lapses in communication can be detrimental to patients, physical therapists—with their background in team treatment—are uniquely positioned to set treatment coordination standards in their own practice and promote the necessary communication and coordination to prevent medical errors.

When Errors Occur: Notifying Patients and Family Members

The National Patient Safety Foundation (NPSF) encourages all healthcare professionals to honestly address medical errors. When and if an error occurs, healthcare professionals should first contact the facility’s administration or risk management department in order to determine the best way to approach the patient or the family. The NPSF emphasizes that when a healthcare injury occurs, the patient and family or representative: is entitled to a timely explanation of the reason the injury occurred and its effects; should receive an honest and considerate explanation of the error and treatment options or other remedies that are available; and should be told what steps will be taken to reduce the likelihood of similar incidents. Keep the following guidelines in mind as you prepare:

• Be honest. If you don't tell a patient about an error, someone else—possibly an attorney—certainly will.
• Act immediately to correct treatment errors and to change policies and procedures to prevent the opportunity for another error.
   
• Stick with the facts you know to be true.
   
• Express sympathy for the outcome.
   
• Promise to keep the patient or family informed as you investigate.

Finally, consider involving a social worker or chaplain, and always try to include the family.

Apologizing Appropriately

It is perfectly appropriate to tell a patient or family member you are sorry an incident occurred. However, avoid legal terms such as ‘negligence’ as well as language that implies blame. This includes words such as “accident,” “mistake,” “error,” or “incorrect” unless there is very little doubt that a mistake caused an injury. At that point liability is clear, and avoiding the admission would make it appear you are hiding something. Avoid also words such as “terrible” or “devastating,” which may stir emotions and encourage a patient or family member to pursue legal action. Finally, avoid blaming anyone else—even if others share responsibility for the mistake.

Better Care through Awareness, Integrity and Action

QuIC defines a medical error as “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim”. Although a problem, medical errors are preventable, and physical therapy professionals are in a unique position to make a difference. Observing best practices will reduce the likelihood that you will cause or contribute to a medical error, and promptly and honestly reporting errors will enable your facility to take appropriate actions to prevent recurrence.

For a more detailed at how to prevent medical errors in practice and ensure optimal patient outcomes, view our comprehensive 3-hour course Medical Errors Prevention for PT.

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