What if you know a doctor made a mistake?

talaxandra · Jan 21, 2009

I would be really cautious about doing anything official, particularly as the amount of information you've supplied is so minimal. Factors to consider include: your level of experience (are you qualified to determine if an error was made?)how sure you are that a mistake was made, the severity of the alleged error, and any consequences for the patient.

I believe that it's not necessarily in anyone's best interests to fully disclose errors to families or patients, in part because they often have enough to deal with already, disclosure can decrease their faith and trust in the health care team, and distract them from things which may be more important.

In addition you could potentially put your own job (and possibly career) on the line by making an accusation that's not well founded, not to mention that of the doctor.

If you genuinely believe that an error was made I suggest you begin by discussing it with the practitioner involved, and with your manager, well before you think about going to another source, particularly (if I'm reading your pst correctly) an external organisation. I'd also question why you feel the need to do so anonymously, unless your institution has a history of imposing negative consequences on whistle-blowers.

In any case significantly more information (even without specifics) would help you get better advice tailored to your situation.

June1234 · Jan 21, 2009

There was a medication given that, based on other clinical evidence, was contraindicated to give. I know that, for a fact, was wrong. Consequently, the baby bled severely in the brain and is now highly brain damaged. Of course it can always be argued that the brain damage was not caused by the med. However, most likely it was. In any case, the medicine should not have been given. The parents have no clue why the baby is so damaged. I'm thinking they could greatly benefit from lawsuit money as they take this baby home.

talaxandra · Jan 21, 2009

I'm surprised that nobody else has picked up on this then - in addition to other safeguards (like other nursing and medical staff viewing the record), where I work a pharmacist checks over the drug chart every day, and in the event of something significant like the devastating event you describe charts are scrutinised even more thoroughly than normal.

I certainly understand your concern and desire to help the parents. I still think that speaking with staff in your immediate chain of command, beginning with your manager, is the best initial action to take. You can, after all, always go to more extreme lengths if needed, but there may aspects of the case or follow up that you're unaware of, and if there's any possibility of causing the parents further and unwarranted distress that should be avoided.

Mr Ian · Jan 21, 2009

In theory it should be easy to report clinical concerns - especially serious ones like this.

Unfortunately the realistic experience is not so good.

It's impossible to say the best approach without a dynamic awareness of your hospital, staff, systems, etc.

Do you have a 'whistleblowers' policy?

Either way, I would seek out the most trustable and approachable nurse manager I could find and get their advice.

I would also get advice from an independent source before you approach anyone - someone like a lawyer or trusted professional other so that you have an independent corroborator in case of political back lash.

If you have malpractice insurance they may have a service to assist.

These are just ideas and I would encourage you to take lots of advice from people who may be better informed than me.

June1234 · Jan 21, 2009

I'm surprised that nobody else has picked up on this then - in addition to other safeguards (like other nursing and medical staff viewing the record), where I work a pharmacist checks over the drug chart every day, and in the event of something significant like the devastating event you describe charts are scrutinised even more thoroughly than normal.
I certainly understand your concern and desire to help the parents. I still think that speaking with staff in your immediate chain of command, beginning with your manager, is the best initial action to take. You can, after all, always go to more extreme lengths if needed, but there may aspects of the case or follow up that you're unaware of, and if there's any possibility of causing the parents further and unwarranted distress that should be avoided.

Many other RNs, and I'm sure MDs, know of the situation. However, no one has done anything about it as of yet. In fact, the day the medication was given, the nurses in the patient's room asked the doctor not to give it, however she insisted.

I do think it is awful how there is no anonymous reporting program- just for someone to look at the incident in the chart. It's clear black and white that the med shouldn't have been given- there was a clear contraindication (one that pharmacy would not know because it was based on clinical findings of the patient.) If only someone outside of this unit could look at it.

allnurses Guide · Jan 21, 2009

You are usually obliged to use the chain of command. Can't you go to your manager and ask for advice?

Mr Ian · Jan 21, 2009

I had a similar incident with an intellectually impaired pt who assaulted a member of staff. The pt had his leafve restricted and charges were placed.

He two days later told me that the staff had assaulted him first with a meat tenderiser and showed me a fading pattern bruising that was consistent with his story.

I didn't work with the staff involved so that wasn't a major issue - but I simply reported it to the unit Consultant - who promptly ignored my concerns. Without his backing it wasn't going to go anywhere and I stood to create an unprovable situation that would have been bigger than Obama's inaugral speech (almost) so I had to drop it due to insufficient and inconclusive evidence to back the claim.

If the doctor you are conerned about was given multiple requests to not give the drug then the doctor knew full well that they were making an autonomous decision and, unfortunately, they must stand accountable for them - just as nurses do.

It is difficult because a thing like has already caused irreversible harm - and it's sometimes hard to accept the idea of more people being 'damaged' as a result, but this is the reality of the jobs we do.

I feel for the patient and the family - but I also feel for the doctor who made an error of clinical judgement. It may be clinically defensible, depending on the rationale she employed; but equally so - it may have been irresponsible.

The choice action should be to report it to your line manager and have them follow through the procedures for clinical errors and give you feedback on process and outcome.

The difficulty is not knowing what repercussions might follow and, albeit the ideal is there will be none as you're simply doing your job and doing it properly - the reality is these are real people involved with real issues at stake and a very uneven playing field.

In the absence of an anonymous or alternative process for reporting - the decision to report is yours and I certainly make no judgement on you as a nurse or person either way.

I hold myself to a very high ethical standard and I admit I would have problem with how to resolve the issue without placing myself or even others at risk of repercussions.

Another option might be to call the BoN anonymously and ask for professional advice on handling the matter. They should be supportive and understand the dilemma you are in. They would also be able to support you in your decisions and actions if you eventually identified yourself to them - tho they have no authority over your employers - but they would assure your license was protected.

Unfortunately another reason why nurses should be unionised.

oramar · Jan 21, 2009

Are you sure that you are seeing this situation correctly? I am using this just as an example but take blood thinners for example. Many, many patients have counter indications for blood thinners but have very strong indications for giving them. However, there is a down side to blood thinners and that is once in a while a patient will bleed, especially in the brain. Blood thinners are a damned if you do, damned if you don't medication. I know docs that have been sued for not giving them and docs that have been sued for giving them. I remember being a new nurse and wondering why so many post op patients got blood thinners. It is counter intuitive to give a medication that will make a person bleed to a person who has just been cut open. However, once I saw my first PE I never questioned it again.

lpnflorida · Jan 21, 2009

If it were me in this same situation. I would calmly and respectfully ask the Doctor in question what they felt caused the additional bleed into the brain.

Sometimes there are factors and conditions we are not fully aware of. With medication there is always the risk versus benefit. Doctors and nurses always pray for the outcome they desire, however this does not always happen. The outcome might have been different if the drug you have concerns over had not been given. But that outcome might not have been desirable either.

This is a very sad case.

cook1043 · Jan 21, 2009

It sounds as if the baby was very sick, as you said that the bleed could be questionably caused by the medication, leading me to believe that the baby could have had a bleed despite administering the medication. Most hospital risk management teams investigate these cases whether incident reports were filled out or not, you or your nurse manager may not even know it is being investigated. Was it documented that the med was given by the doctor? Did the doctor write an order for the medication? Was the medication contraindicated in this patient?? If you feel so uncomfortable, I would ask that doctor why she gave the medication, what was the indication? If you still do not feel comfortable with that, I would let your nurse manager know your feelings, and back it up with research, she can help you decide whether an incident report should be completed or not. Good luck, remember you are your patient's advocate.

BabyLady, BSN, RN · Jan 21, 2009

Many other RNs, and I'm sure MDs, know of the situation. However, no one has done anything about it as of yet. In fact, the day the medication was given, the nurses in the patient's room asked the doctor not to give it, however she insisted.
I do think it is awful how there is no anonymous reporting program- just for someone to look at the incident in the chart. It's clear black and white that the med shouldn't have been given- there was a clear contraindication (one that pharmacy would not know because it was based on clinical findings of the patient.) If only someone outside of this unit could look at it.

I'm a student, but I have seen a similar situation occur where a medication was contraindicated and the physician insisted on the administration.

I think a couple of things went wrong. First, the nurses should have refused to give it. Second, if the physician was going to administer the drug directly, then the charge nurse should have been notified upon discovery and sent it up the chain of command.

At our hospital, unless it's a life threatening emergency, once the charge nurse starts to take the complaint up the chain, the physician cannot proceed. Usually an answer comes from "upstairs" within a 2 to 3 hours and usually comes down from the Chief of that department.

This is the process that was followed when the nurses were faced with this at the hospital. He had four nurses that just looked at him and said, "No way. My name is not going to be attached to that."

Sometimes the nurses DO know better and anytime you are in the minority opinion, physician or not, if I was one, I would be a minimum, conferring with another physician to make sure I didn't get laid out on the lawsuit platter.