Most people print off a copy of the post test and circle the answers as they read through the materials. Then, you can log in, go to "My Account" and under "Courses I Need to Take" click on the blue "Enter Answers" button. After completing the post test, you can print your certificate. Preventing Medical Errors: Best Practices for Mental Health Professionals -Revised 2013 Introduction Susan is a 63 year-old woman who had been in therapy with Dr. Klein for 6 months, dealing with issues of grief and loss due to the recent death of her husband. The relationship between Susan and her husband had been quite conflictual, and Susan described a pattern of somatic illnesses that allowed her to elicit care and concern from a generally unresponsive man. Prior to a scheduled appointment, Dr. Klein receives a call from Susan stating that she is experiencing chest tightness, shortness of breath and dizziness. Dr. Klein calms Susan down, stating that these symptoms are only anxiety, and encouraged her to keep her appointment. When Susan does not arrive for her appointment, Dr. Klein is slightly concerned, but he thinks that maybe the anxiety was too great to allow her to drive. He later gets a call from Susan’s son, indicating that he had taken her to the hospital and that she had suffered a mild heart attack. The saying “to err is human” is one that most people are familiar with, but some errors, such as the one described above, can have potentially tragic consequences. A 2000 report, To Err is Human: Building a Safer Health System by the Institute of Medicine, brought attention to the issue of preventable medical errors. This report focused primarily on medical settings. A striking statistic outlined in this report is that between 44,000 and 98,000 Americans die each year as a result of medical errors. According to the Center for Disease Control (nd), the lower estimate of 44,000 deaths, would make medical errors the 8th leading cause of death in the United States – more in 2005 than motor vehicles (43,521), suicide (32,629), or homicide (17,797) (http://webappa.cdc.gov/cgi- bin/broker.exe). “To err is human” provides the mandate that healthcare workers concentrate on reducing such errors. Five years after this landmark report, Leape & Berwick (2005) published a follow-up examining whether the report has had an impact on reducing medical ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com errors. They found that although the changes are not as sweeping as desired, attitudinal changes in organizations have occurred. There has also been focus on medical errors at a federal level, with Congress funding patient safety research through the Agency for Healthcare Research and Quality (AHRQ) (see http://www.ahrq.gov/). Another important result of “To err is human” has been changes in the practice of health care. In 2010, The Joint Commission and Accredited Health Care Organizations (JCAHO), the group that provides accreditation to U.S. hospitals and other health care facilities began requiring hospitals to implement 11 safety practices, including improving patient identification, communication, and "surgical site verification" (marking a body part to ensure surgery is performed on the correct part). These National Patient Safety Goals have been reviewed annually, and include mandates for behavioral health settings. The behavioral health goals and an example of each are listed below: Improving the accuracy of patient identification (such as by taking photographs of patients on admission to behavioral health settings) Improving the effectiveness of communication among caregivers (such as by eliminating confusing abbreviations in notes or orders) Improving the safety of using medications (care taken with medications that have similar names) Reducing the risk of health care-associated infections (such as through adequate handwashing procedures) Accurately and completely reconciling medications across the continuum of care (such as through providing discharge summaries with medications clearly indicated) Encouraging patients’ active involvement in their own care as a patient safety strategy Identifying safety risks inherent in its patient population (such as individuals at risk for suicide) Although many of these goals are more applicable to hospital rather than outpatient settings, goals such as encouraging patients to be active in their own care, increasing communication among treatment professionals and identifying risk factors are universal, as is the spirit of the Joint Commission recommendations. One principle commonly found in the ethical codes of counselors, social workers and psychologists is that of “beneficence and ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com nonmaleficence”. Simply put, these codes states that clinicians strive to “do no harm” to those with whom we work. The American Psychological Association (2002) Ethical Principles of Psychologists, for example, states that “in their professional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons, and the welfare of animal subjects of research.” It goes on to outline the areas that could potentially jeopardize psychologists’ ability to help those with whom they work. This course will examine the impact of medical errors on patients in mental health settings. It will reference best practices and ethical guidelines that can help to reduce and prevent medical errors. The 2011 version of this document includes updated references that will allow you to seek additional clarification on important points when needed. Objectives: After finishing this course, the participant will be able to: - Discuss the Joint Commission’s National Patient Safety Goals for behavioral health - Define “Medical Errors” - Recognize approaches to prevent medical errors - Utilize Root Cause Analysis process to evaluate medical errors - Identify medical errors common in medical health - Review ethical guidelines related to competence (including multicultural competence), informed consent, confidentiality and mandated reporting - Discuss the Health Insurance Portability and Accountability Act (HIPAA) - Discuss trends in assessment of suicide - Describe assessment of medical conditions that present as psychological problems - Describe reasons that accurate differential diagnosis is needed Definition of Medical Errors How do we define medical errors? Medical errors are mistakes made by mental health professionals within the normal work of their practice and which result in harm to the patient” (http://medical-dictionary.com/). All errors constitute a failure in service delivery have consequences for people at a time in which they are vulnerable (National Academy of Sciences, nd). Medical errors range from relatively minor ones that do not have lasting results or can be easily rectified, such as misdiagnosing an adjustment disorder as a depressive disorder, to those ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com with more serious consequences such as failing to act to attain help when a client threatens self-harm. Corey, Corey & Callanan (2007) suggest that one framework for studying errors is to break them down by type. They identify two types of errors: acts of commission and acts of omission. Clinicians commit acts of commission when they make mistakes, such as incorrectly diagnosing someone. Clinicians commit acts of omission when they fail to act in some way, such as a failure to report child abuse. Although it is not necessary to specifically identify medical errors using this schema, it provides a useful set of questions for the mental health professional: Am I doing everything I can within best practice guidelines? Have I missed doing something I could do? In addition to the National Patient Safety Goals, JCAHO defines the most acute medical errors, which they term “sentinel events.” JCAHO’s Sentinel Events Policy was revised in 2007. Sentinel events are “unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof” (http://www.jointcommission.org/SentinelEvents/ ). The phrase, "or the risk thereof" suggests that should such an event recur, it would carry a significant chance of an adverse outcome. Such events are called "sentinel" because they signal the need for immediate investigation and response. The terms “sentinel event” and “medical error” are not synonymous; not all sentinel events occur because of an error and not all errors result in sentinel events. Although not all of these events apply to mental health settings, the list below reflects the seriousness of what can go wrong in medical settings. (http://www.jointcommission.org/SentinelEvents/Statistics/) Top sentinel events through second quarter, 2012: ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com Many of the errors listed above do not apply to the majority of mental health clinicians or apply only to those individuals working in an inpatient hospital setting. Perhaps a more realistic idea of medical errors that impact mental health professionals can be gleaned from malpractice data. Most malpractice suits are similar to medical errors in other fields as they involve a situation in which the treatment provider deviates in some way from accepted standards of practice and this deviation results in harm to the client. The majority of malpractice cases do not stem from unforeseeable