#7424 RW Medical Error: Definition, Commission, Prevention and Disclosure

Course overview

Regardless of whether they occur in health care, aviation, aerospace, energy, etc., all complex systems contain, by their very nature, the possibility of catastrophic failure. This presentation will provide an overview of how errors intermingle with system weaknesses to produce a lethal brew. Error will be defined and differentiated from the harm it sometimes (but not always) causes, and we will review how complex systems defend themselves against the possibility of catastrophic failure along with a series of recommendations bearing on maintaining safety and resilient systems. The presentation will conclude with recommendations on disclosing a medical error a patient-centered way but with special attention to certain errors that are known to occur in rehabilitation environments, such as medication errors, diagnostic error, improper technique, unnecessary treatment, and failure to use aseptic technique. Course instruction method includes: lecture, picture/graphs, videos, and question/answer.