Clinical Risk and Negligence Flashcards
What is the cause of medical error?
- Fatigue
- Lack of knowledge
- Bad luck
- Distraction
- Lack of supervision
- System-based problems – Main One
What is important to get rid of?
- blame culture
- everybody makes mistakes
- get rid of blame culture so mistakes can be identified
- report to agencies
What are the outcomes of medical error- Who can take action against you as a HCP?
- 3 outcomes
- not mutually exclusive (so can go do 1 or all 3)
• NHS Complaints Procedure (vast majority)
o Service Provider
o Commissioner of Service
• General Medical Council
o Fitness to practice panel
• The Law
- A criminal action [rare]:
=Gross negligence/manslaughter [v. rare]
- A civil action:
How can the patient sue with civil action?
- Tort of negligence (NHS or private patient)
- Breach of contract (private patients only)
What 3 things need to be proven for a civil suit?
- Doctor had duty of care
- Duty of care was breached
- The breach of duty of care caused harm
What do you look at under duty of care?
- No “good Samaritan law”
- GMC -says you should help BUT if something goes wrong you can be found negligent
How do we evaluate if the duty of care was breached?
- Use Bolam test
- Bolitho – doctor is not guilty of negligence if his/her actions have a logical basis
What do we look into when looking at the breach of duty of care caused harm?
- “but for” test:
= “but for the defendant’s negligence, would the patients have suffered an injury?” - Omission (not doing anything about the patient’s problem)
- Law states an omission is not a cause but in the medical world not doing anything when you could have = negligence
What is the bolam test?
- doctor is not guilty of negligence
- if they act in accordance with practise accepted as proper
- by responsible body of medical people skilled in that particular ‘art’
What is the bolitho test?
- follow bolam test for professional negligence
- addresses interaction with concept of causation
- A doctor is not guilty of negliegence if his actions have a “logical basis”.
- Therefore, the rationale behind choices by doctors is s scrutinised.
What happens if negligence is proven?
- damages are awarded
- for physical and mental harm
- as well as loss of earnings
Why is keeping notes important?
- noted and records can be brought up in court
- assess quality of doctor
- Patient notes must be written appropriately
(Inclusion of consent, treatment, management and any changes, legibility, correctly dated etc.)
- so when patient needs to access notes
- there are no problems or complaints
What happens if you sign a prescription? Are you legally responsible for it?
If you sign a prescription (even on the advice of another) you are legally responsible
What is the four fold duty to check when signing a prescription?
- correct patient name
- correct drug name
- no contraindications
- correct dose given
- correct directions given
- make provision for appropriate monitoring
- follow up checks
- no allergies
What is the limitation period?
- action about negligence can be complained about within 3 years of claimant DISCOVERING damage
- for neonates, period does not start until 18 (until 21).
Guidelines by definition are not rules, however, if a doctor departs from them, they must be able to justify why.
