Errors from fatigue/sleep deprivation

[InquisitiveGuy]

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Aside from fear, what has helped you personally prevent medical errors when you're not at the top of your game due to long hours/fatigue?

 

[JackADeli]

Aside from fear, what has helped you personally prevent medical errors when you're not at the top of your game due to long hours/fatigue?

Other members of the team that are well rested and experienced.

 

[McGillGrad]

Aside from fear, what has helped you personally prevent medical errors when you're not at the top of your game due to long hours/fatigue?

It helps that I'm perfect.

 

[Droopy Snoopy]

Lists with checkboxes

 

[turquoiseblue]

drink caffeine..or energy drinks when you are at your worst and most tired state in the middle of the night.. they can enhance memory, not to mention alertness. that way you rely on you, not others. 👍

 

[smq123]

drink caffeine..or energy drinks when you are at your worst and most tired state in the middle of the night.. they can enhance memory, not to mention alertness. that way you rely on you, not others. 👍

What do you mean by this?

 

[Droopy Snoopy]

drink caffeine..or energy drinks when you are at your worst and most tired state in the middle of the night.. they can enhance memory, not to mention alertness. that way you rely on you, not others. 👍

I like coffee as much as the next guy, and sure there's times when you need a pickup, but I've always thought of this approach to be counterproductive. Not only will it make getting to sleep difficult (if you actually get the chance) but it just prolongs and compounds the eventual crash.

Re the italics: it's common practice in my program for one intern to be presenting a patient, focused on management with the upper-level and attending, while the other is writing orders and doing the mindless legwork. Later on you go back with your lists and make sure everything's taken care of (goes double as a resident checking up on your interns), but it's normal and healthy to rely on others. That's why they call it a team, and it's good practice for the way medicine works out in the real world.

 

[JackADeli]

...that way you rely on you, not others...

As noted, it is "team". Even with fatigue, short of individual falling asleep with sharp object in hand and stabbing something, major errors or catastrophic failures are the result of multiple errors and team failure. If a surgical sponge remains in the abd., it is a multiple person, system error. The surgeon, fatigued or not is not keeping a running count of instruments, needles, sponges, etc... If a wrong side surgery is performed, it is with few exceptions an error propogated by numerous individuals.

In fact, in examing such things, it is often an error by one person resulting in subsequent individuals disregarding protocol and/or changing documents. I have seen surgical instruments and/or spong counts be wrong. Someone says they are "sure" the original/pre-op count is wrong and no item is lost. So, someone else changes the initial count and paperwork and presumes it is clerical. Then, sometimes an xray is shot. The film is shot of wrong portion of the body or if correct location and sponge issue, rads says no sponge on prelim under pressure from OR. If it is an instrument, again, maybe bad aim of film or rads calls instrument as being "outside the body for draping clamp" under pressure from OR.

No OR errors on the floor are also "team" errors. Medication dosing, etc... goes through nurses, pharmacy, etc.... An individual misreading an order and giving unusual doses and meds is a problem of team failure.

These things are rarely, rarely the result of one individual but rather a culmination of errors propogated and magnified. So, it is about team. You need a good and reliable team. Coffee, cocaine, amphetamines, etc, etc, etc, will not compensate for the perfect storm of fatigued physician with an incompetent team.

As far as wrong side stuff, the only exception I know that is ~80+% physician propogated is brain neurosurgical procedure. I have watched as neurosurgeons insist on putting fillms up "backwards" and this can confuse even the most experienced teams. Especially when teams are often shared with other disciplines that all read the films in an oposite manner then what neurosurgery does....

 

[Samoa]

I have never seen a neurosurgeon intentionally put a film up backwards. Supposedly there are one or two hospitals where this is the convention, but it's house-wide, not limited to neurosurgery.

 

[JackADeli]

I have never seen a neurosurgeon intentionally put a film up backwards. Supposedly there are one or two hospitals where this is the convention, but it's house-wide, not limited to neurosurgery.

Yeh, I have been at several hospitals with over half a dozen neurosurgeons for which it is their convention to put all brain scans up backwards/reverse. But, I have never seen where that practice translated accross all surgical specialties... never seen ortho, ent, gensurg/trauma, uro, gynonc, thoracic, cardiac, or anyone else do this. The neurosurgeons were always a ~unique solo practitioner of this convention.

I would be very surprised to see the backwards/reverse scan reading being house wide accross specialties. I think if it was house wide, the number of other specialties wrong side operations would increase. I know of no other specialties beyond these neurosurgeons that are trained with habitual reverse reading.

 

[Buzz Me]

I've also never seen that "backwards" convention happening before.