Avoiding Errors in Adult Medicine

Ian P. Reckless is Consultant Physician and Assistant Medical Director, Oxford University Hospitals NHS Trust

D. John M. Reynolds is Consultant Physician and Clinical Pharmacologist, Oxford University Hospitals NHS Trust

Sally Newman is a Solicitor and Head of Legal Services, Oxford University Hospitals NHS Trust

Joseph E. Raine is Consultant Paediatrician, Whittington Hospital, London

Kate Williams is Partner, RadcliffesLeBrasseur Solicitors, Leeds

Jonathan Bonser is Consultant in the Healthcare Department of Fishburns LLP, Solicitors, London, and former Head of the Claims and Legal Services, Department of the Leeds office of the Medical Protection Society

Preface

Abbreviations

Introduction

Part 1
 
Errors and their causes

A few words about error
 
Learning from system failures-the vincristine example

Evidence from the NHSLA Database

The patient consultation

Failure to identify a sick patient
 
Inability to competently perform practical procedures

Failure to check test results or act on abnormal findings

Prescribing errors

Sources of error in the case of vulnerable adults
 
References and further reading

Medico-legal aspects

Error in a legal context

Negligence

Clinical negligence
 
Issues around consent
 
An attorney refusing treatment

A patient without capacity refusing treatment
Emergency treatment
 
Deprivation of liberty safeguards

Part 2 Clinical cases

Introduction

Civil liability, Negligence and Compensation

Case 1 A Shaky Excuse

Case 2 Making Matters Worse

Case 3 Chase the Bloods

Case 4 Falling Asleep En-Route

Case 5 Bad Luck or Bad Judgment

Case 6 An Opportunity Missed

Case 7 Better Late than Never

Case 8 Man Down

Case 9 Cry Wolf

Case 10 Not a Leg to Stand On

Unexpected death – the Coronial System and Clinical Risk Management

Case 11 Doubly Bad Outcome

Case 12 Difficulty with Diarrhoea

Case 13 A Flu-like Illness

Case 14 Falling Standards

An Approach to Complaints

Case 15 A Woman with Chest Pain

Case 16 Clumsiness

Competence

Case 17 A Change in Plan

Case 18 Starving to Death

Case 19 An Irregular Presentation

Case 20 Irrational but not Incompetent

Restraint

Case 21 A Challenging Discharge

Case 22 Ruling Out the Organic

Case 23 Endless Wandering

Case 24 Can you Please Take these Handcuffs Off?

Case 25 Own Worst Enemy

Miscellaneous

Case 26 All Eggs in One Basket

Case 27 A Major Mix-up

Case 28 Under the Radar

Case 29 A Cantankerous Recluse

Case 30 Keep an Open Mind

Case 31 Healthcare Acquired Infection?

Case 32 Backing the Wrong Horse

Case 33 A Surprising Turn of Events

Case 34 Funny Turn

Part 3 Investigating and dealing with errors
Introduction

How hospitals try to prevent errors and their recurrence

The role of hospital staff
 
The role of external agencies

Hospital investigations

Legal advice – where to get it and who pays

External investigation of errors and incidents

The role of the doctor

Presenting oral evidence

Emotional repercussions

Conclusion

Further reading

Index

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