Disclosure of Medical Errors: Ethical Considerations for the Development of a Facility Policy and Organizational Culture Change

George Mason University, Fairfax, Virginia, USA.
Policy Politics &amp Nursing Practice 06/2005; 6(2):127-34. DOI: 10.1177/1527154404272611
Source: PubMed


The Institute of Medicine report, To Err Is Human: Building a Safer Health System, has spurred public concern over hospitals' ability to deliver safe care. The health care industry continues to struggle to address these concerns. These efforts have driven the growing expectation that health care practitioners or systems disclose unanticipated outcomes to patients and family members. Although the tort system has been cited as an impediment to medical error disclosure, some organizations and systems have successfully implemented policies calling for full disclosure of errors and unanticipated outcomes. However, most organizations have yet to develop policies concerning error disclosure. This article provides an overview of error disclosure and a model framework for an error disclosure policy. The ethical principle of respect for patient autonomy is emphasized as the driving force in developing an institutional disclosure policy and changing the organizational culture to one that supports development and implementation of such a policy.

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    • "These can be translated into what one could term the ethics of the organization and can either contribute to or help prevent errors. A presentation given at Georgetown University ethics conference likened organizational ethics and healthcare as dual systems that would undergo systems changes, one simultaneously affecting the other (Henry, 2005). However, regardless of the healthcare error terminology or philosophy employed, when nurses act outside the boundaries of the law and nursing profession, it is expected that they will be disciplined (Johnstone & Kanitsaki, 2005). "

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    ABSTRACT: A theory of lying is presented. A lie is to believe one thing and to express another. The liar must be aware that the belief and statement are different. On this new definition: A lie is not the same as making a false statement. A lie is not the same as not telling the objective truth. A lie in itself is neither good nor bad, but just a contradiction between belief and statement. There are consequences of lying: We gain faulty information on which to base decisions. We fail to understand what or how the liar really thinks and feels which is especially important in medicine. Communication is undermined as well as relationships, which are based on communication. Trust is undermined. Lying promotes more lying and encourages others to lie. A lie (or truth) may benefit all in the short run, but not in the long run, or vice versa. We may not realize or be able to know in advance the harmful consequences that even the smallest lie may have.
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    ABSTRACT: Background: The Joint Commission accreditation manual contains standards in improving organization performance related to report and review of patient care issues causing unexpected harm. In spite of regulations mandating reporting, it remains inconsistent, varying by provider type and hospital. Our purpose was to determine current attitudes, knowledge, and practice of error reporting among emergency department (ED) providers. Methods: We administered a survey assessing ED staff practice regarding error reporting. Questions involved reporting of errors in which the practitioner was directly involved, errors the practitioner observed, and general awareness of reporting mandates. We also questioned individuals regarding fear of repercussions for reporting. Results: Fifty-two surveys were returned. For most errors, providers were more likely to tell their supervisor about the issue than to tell the patient. Seventeen percent of respondents did not think that referring errors for review was their job. Only 31% of respondents were aware of standardized institution-wide pathways to report errors. Any respondent who was aware of the institution-wide pathway also felt responsibility for error reporting. Thirty-three percent of the respondents were concerned about negative repercussions from reporting errors. In querying the hospital reporting system, 263 cases were referred for quality issues over the previous year, 51% of them were referred by nurses, 27% by medical technicians (MTs), 2% by mid-level providers (MLPs), 1% by physicians, and 19% by other personnel. Conclusion: Although most of the ED staff are responsible for patient safety, most are not aware of systems available to assist in reporting, and even many do not utilize those systems.
    01/2012; 3(4):261-4. DOI:10.5847/wjem.j.1920-8642.2012.04.004

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