Miscellaneous: Patient Care

Adverse Events

• Adverse (Sentinel) Event: Injury from Medical Management
  • Overall Incidence: 10%
• Latent Error: Systemic (Organizational/Design) Conditions Which Contribute to Adverse Events
• Near-Miss Events: Event that Could Have Resulted in Injury but Was Corrected Before
• Never Events: Events that Should Never Happen in Surgery
  • Includes:
    • Wrong Site Surgery
    • Operating on the Wrong Patient
    • Retained Foreign Objects
  • Most Common Retained Object: Sponge
  • JCAHO Prevention Protocol:
    • Preoperatively Verify Patient & Procedure
    • Mark Operative Site
    • Preoperative Time-Out
• “Workaround”: A Plan or Method to Circumvent a Problem without Eliminating It

Duty to Report

• Definition: Mandatory Duty of a Physician to Report Certain Events
• Includes:
  • Intimate Partner Violence
  • Child Abuse or Neglect
  • Elder Abuse or Neglect
  • Colleague Impairment, Incompetence or Unethical Conduct

HIV Reporting

• Inform Public Health Department, Spouse & Partners Directly
• Inform Exposed Faculty (Needle Stick)
  • Unexposed Health Care Personnel Should Not Be Informed
• Surgeon with HIV Does Not Have to Disclose Infection & is Not Limited in Practice

Culture

• Best Interpreter: Professional Medical Interpreter
  • They Can Potentially Be Frustrating & Time Consuming but Provide the Best Source for Appropriate Communication
  • Family/Friends May Lack Medical Terminology or Mask Meanings
  • Bilingual Students and Nurses Should Not Be Used if they are Not Professionally Trained – They May Be Unable to Appropriately Convey Medical Concepts
  • Patients Who are Not Completely Fluent May Not Be Able to Understand Complex Medical Decisions
• Patients Have Unique Needs, Values & Preferences Regardless of Cultural Identification
  • Prior Experience Can Create Familiarity but Can Also Cloud the View
  • Surgeons Must Be Reflective & Open Minded