Advice on preventing medical mistakes

[theanomalywithflaxenhaire]

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Hi friends,

I have made three different medication dose/timing errors during my clinical year thus far (I've reported all of them to residents/faculty and nothing bad happened). None of the patients had any bad reactions/injuries, but I cant help but feel awful about it. I make it a point to double check things but it still keeps happening to me. Whenever I talk to people about it they tell me not to beat myself up because mistakes are impossible to eliminate, but I think I'm making mistakes at a higher frequency than most. I keep trying to be more careful, but it keeps on happening and I hate it; not just for the patients but for myself too. I don't want to be this kind of doctor. Does anyone have any advice?

 

[pp9]

Hi friends,

I have made three different medication dose/timing errors during my clinical year thus far (I've reported all of them to residents/faculty and nothing bad happened). None of the patients had any bad reactions/injuries, but I cant help but feel awful about it. I make it a point to double check things but it still keeps happening to me. Whenever I talk to people about it they tell me not to beat myself up because mistakes are impossible to eliminate, but I think I'm making mistakes at a higher frequency than most. I keep trying to be more careful, but it keeps on happening and I hate it; not just for the patients but for myself too. I don't want to be this kind of doctor. Does anyone have any advice?

Rushing with this response so might come back with more thoughts:

When do you notice these mistakes? Particularly with the dosing. Timing errors I might need more context on.

General advice:
1. Slow down. If the animal is dead and there is panic, a difference of 10s vs 20s to give an epi dose (for example) truly won't matter, but for the latter you checked your math/syringe and know you're giving the intended dose. If the animal is not dead, why are we rushing?
2. Have someone else do the double checking. I'm trying to implement this very thing at my current workplace. A lack of checks/balances will always result in an animal receiving an incorrect dose at some point, it's inevitable.
3. Understand and get comfortable with the fact you are human, because you will make mistakes. If it is true that you are making repeated math/drawing up errors though, yes you need a new system. But you will never reach a 100% error-free state, you can only take measures to reduce the frequency as much as possible.

 

[pp9]

Came back with more rambling thoughts!

I am not sure what your background/experience is, but for some, fourth year is the first time they might be drawing up/giving injectable meds. Or at least as frequent as you often do during fourth year. Did I make mistakes during fourth year even though I came in with a pretty good level of experience? Yep (I can share them if you want!). Did I learn from them? Absolutely. I've also made a few mistakes throughout the six years of my career that stand out to me, I've coached interns through some really serious mistakes, and I've been a shoulder for colleagues who have made mistakes. It happens.

It is probably rare for someone to be able to honestly say they didn't make a single mistake during fourth year let alone out in practice. it's actually impossible to say that if you're being truthful and have some years under your belt. But again, the important thing is to reflect on the error, figure out exactly what went wrong to cause it, and come up with a fix to help make sure it doesn't happen again. If you are making the same/similar mistakes repeatedly, especially in such a short time frame, you aren't reflecting or coming up with a real fix and that's where you need to start.

You say you are double checking things but then still make these mistakes. Without hovering over your shoulder, I can't really tell where you are going wrong. What I'm not understanding is how you go from double checking things, deciding they are right, and then later realizing you did make a mistake after it's too late. I definitely need more context here. You are lucky that no patient has been ill-affected by these mistakes but one day it will cause a fatality. That's not to say you need to be mistake-free or to make you feel bad, far from it, but making this many of the same mistake in a short period of time indicates a problem within your 'system' of calculating, drawing up, and giving drugs that needs to be identified and resolved. You do need to figure this out. If you are comfortable sharing specifics and details (here or DM), I am happy to weigh in. My own work team just went through a devastating time after a medication error so I've got this on the forefront of my mind and am happy to talk about it.

 

[battie]

Whenever I talk to people about it they tell me not to beat myself up because mistakes are impossible to eliminate

These people are right. Perfection is impossible. So don't expect it. Your expectation is being better than your previous self.

but I think I'm making mistakes at a higher frequency than most.

Hard to quantify. But even now, I'll catch myself making a mistake here and there. The difference between you and me is that my catch is before the drugs are out the door.

 

[EB73674]

I think it's also worth trying to start really slowing down when you're doing things, and not fall into the pressure that's placed on you. The 30 seconds saved by not double-checking your math or your drug choices or the bag being physically handed to the client, truly isn't necessary in the long run. You absolutely will make mistakes, and you'll need to accept that to move forward...but addressing your workflow is also an important step!