Labeling of medications in anesthesia: colors and letters that save lives

Medication errors are the cause of severe lesions and complications, particularly with regards to injectable medications. During anesthesia, several drugs are administered simultaneously and quite easily the wrong medication may be administered, leading to morbidity and mortality. Different strategies have been devised to reduce error, including the use of color and letters to facilitate the identification of the various medications and improving safety in anesthesia.

Los errores asociados a la administración de medicamentos son una causa de graves lesiones y complicaciones sobre todo con los medicamentos inyectables. En un acto anestésico se administran distintos medicamentos y de manera simultánea, en el que fácilmente se puede administrar un medicamento errado causando morbilidad y mortalidad. Se han establecido diferentes estrategias para disminuir el error, entre estas el uso de colores y letras para facilitar su identificación y mejorar la seguridad en anestesia.

Communication of medical errors in a simulated clinical scenario. Experience with a pediatric residency group / Comunicação de erros médicos em cenário clínico simulado. Experiência com residentes em Pediatria

ABSTRACT Objective: To determine the performance of groups of pediatric residents from a Buenos Aires hospital, in terms of correct recognition and communication of a medical error (ME), in a high-fidelity simulation scenario. To describe the reactions and communication attempts following the ME and the self-perception by the trainees before and after a debriefing. Methods: Quasi-experimental uncontrolled study conducted in a simulation center. First- and third-year pediatric residents participated. We designed a simulation case in which an ME occurred and the patient deteriorated. During the simulation, participants had to provide information on communicating the ME to the patient's father. We assessed communication performance and, additionally, participants completed a self-perception survey about ME management before and after a debriefing. Results: Eleven groups of residents participated. Ten (90.9%) identified the ME correctly, but only 27.3% (n=3) of them reported that a ME had occurred. None of the groups told the father they were going to give him important news concerning his son's health. All 18 residents who actively participated in this communication completed the self-perception survey, with an average score before and after debriefing of 5.00 and 5.05 (out of 10) (p=0.88). Conclusions: We observed a high number of groups that recognized the presence of a ME, but the communication action was substantially low. Communication skills were insufficient and residents' self-perception of error management was regular and not modified by the debriefing.

RESUMO Objetivo: Determinar o desempenho de grupos de residentes pediátricos de um hospital de Buenos Aires, em termos de reconhecimento e comunicação correta de um erro médico (EM),em cenário de simulação. Descrever as reações e tentativas de comunicação após o EM e a autopercepção pelos estagiários antes e depois de um questionário. Métodos: Estudo quase experimental não controlado realizado em centro de simulação. Participaram residentes pediátricos do primeiro e terceiro anos. Concebeu-se um caso de simulação em que ocorreu um EM com deterioração de um paciente. Durante a simulação, os participantes tiveram que fornecer informações relacionadas à comunicação do EM ao pai do paciente. Avaliou-se o desempenho da comunicação e, adicionalmente, os participantes completaram um inquérito de autopercepção sobre a gestão da EM, antes e depois de um questionário. Resultados: Onze grupos de residentes participaram. Dez (90,9%) identificaram corretamente o EM, mas apenas 27,3% (n=3) deles comunicaram que havia ocorrido o EM. Nenhum dos grupos disse ao pai que iria dar notícias importantes sobre a saúde do seu filho. Todos os 18 residentes que participaram ativamente da comunicação completaram o questionário de autopercepção com uma pontuação média antes e depois do questionário de 5,00 e 5,05 (máximo: 10 pontos) (p=0,88). Conclusões: Observamos elevado número de grupos que reconheceram a presença de um EM, mas a ação de comunicação foi rara. A capacidade de comunicação foi insuficiente e a autopercepção da gestão de erros por parte dos residentes foi regular, não sendo modificada pelo debriefing.

Success factors for evidence-based healthcare practice adoption

Background: Evidence-based health policies are widely acknowledged as being essential for attaining ongoing improvements in health outcomes. This study represents a theoretical model to test and identify to identify the key drivers for adopting evidence-based healthcare practice (EBHP). Objectives: The goal of this study was to investigate the critical success factors for the adoption of evidence-based healthcare at a South African public hospital. Methods: Medical healthcare professionals were surveyed using a questionnaire developed by the researcher. The results were analysed with SPSS 23 and AMOS. A hypothetical model based on updated (D&M) IS Success Model, Technology, Organization and Environment framework (TOE) as well as Technology Acceptance Model (TAM) was developed and analysed using structural equation modelling (SEM). Results: The findings of this study indicate that EHR is crucial and the main construct influencing the adoption of EBHP. The findings of this study indicated a positive relationship between the construct electronic health records (EHR) with medical error reduction (MER), information quality (IQ) and knowledge quality (KQ), all showed a strong positive correlation towards the adoption of EBHP. Conclusions: Better coordination of patient care (BCP) typically results in lower health care costs. The results also show that using EBHP improves the accuracy of disease diagnosis and treatment, which lowers the burden of disease. Contribution: The developed framework will help healthcare systems that are strapped for money, particularly in developing countries.

Seguro de responsabilidade civil médica não garante segurança do paciente / Medical liability insurance does not guarantee patient safety

O presente ar tigo, pautado no método hipotético-dedutivo, tratou do seguro de responsabilidade civil médica no Brasil diante do aumento das ações judiciais relacionadas à saúde. A partir de uma pesquisa com abordagem qualitativa e utilização de procedimentos bibliográficos e documentais, objetivou-se descobrir se a contratação de seguros profissionais teria um possível efeito preventivo de proteção ao médico e ao paciente contra danos durante a assistência. Para tanto, apresentaram-se noções introdutórias sobre esse tipo de seguro e os principais desafios contemporâneos relacionados a sua utilização para, finalmente, se avaliarem as prováveis consequências dele frente às ações indenizatórias. Verificou-se que a contratação do seguro de responsabilidade civil médica ainda não alcançou números expressivos no país, e que a inexistência de imposição legislativa e a ausência de incentivo pelo conselho profissional competente podem ser fatores que contribuem para esse cenário. Com desafios pré-existentes semelhantes, a experiência nos Estados Unidos demonstrou efeito contrário à prevenção, com o crescimento de ações indenizatórias e o surgimento de uma nova crise. Por fim, os resultados apontaram para a solidificação da segurança do paciente em detrimento das adversidades decorrentes da adesão ao seguro.

The present article, based on the hypotheticaldeductive method, dealt with medical liability insurance in Brazil in view of the increase in health-related lawsuits. From a research with a qualitative approach and the use of bibliographic and documental procedures, the objective was to discover whether the contracting of professional insurance would have a possible preventive effect of protecting the doctor and the patient against damages during care. To do so, introductory notions about this type of insurance and the main contemporary challenges related to its use were presented, and finally, the probable consequences of this type of insurance Against indemnity claims were evaluated. It was verified that the contracting of medical liability insurance has not yet reached expressive numbers in the country, and that the inexistence of legislative imposition and the absence of incentive by the competent professional council may be factors that contribute to this scenario. With similar pre-existing challenges, the experience in the United States has demonstrated the opposite effect to prevention, with the growth of indemnity suits and the emergence of a new crisis. Finally, the results pointed to the solidification of patient safety at the expense of the adversities arising from insurance adherence.

El error en la práctica médica / Error in Medical Practice

Introducción: El error está presente en cualquier actividad humana y la práctica de la medicina no es una excepción. Debido al aumento de los conocimientos sobre la salud y las enfermedades, la posibilidad de error, relacionada con la atención de estas últimas, disminuye, pero no se ha eliminado en su totalidad. Objetivo: Exponer las experiencias de los autores acerca del error en la práctica médica. Métodos: Revisión bibliográfica entre los años 2000 y 2020. Se localizaron y consultaron fuentes bibliográficas validadas en: Medline, PubMed y SciELO, a las que se accedió a través de la biblioteca virtual de salud. Se utilizaron para la búsqueda las palabras clave error médico, iatrogenia, responsabilidad penal del médico, método clínico. Se revisaron también tres bibliografías anteriores que se consideraron de utilidad para el artículo y tres capítulos de libros con temas afines, además de las resoluciones del Ministerio de Salud Pública de Cuba que tratan acerca del error médico. Al final se seleccionaron 21 bibliografías en idiomas español e inglés. Conclusiones: Existen grandes posibilidades de errores en el proceso del diagnóstico y tratamiento de los enfermos. El desarrollo de la tecnología y la mejoría en la construcción de guías y protocolos disminuyen las probabilidades de equivocaciones, pero no las eliminan. El perfeccionamiento en la formación de recursos humanos, unido al uso correcto del método clínico es una estrategia eficaz para disminuir los errores en la práctica médica(AU)

(AU)ntroduction: Error is present in any human activity; the medical practice is not an exception. Due to an increase in knowledge about health and diseases, error possibility related to disease management is decreasing, but has not been totally eliminated. Objective: To expose the authors' experiences regarding error in medical practice. Methods: A bibliographic review was carried out, covering the years between 2000 and 2020. Validated bibliographic sources were located and consulted in Medline, PubMed and SciELO, accessed through the Virtual Health Library. The following keywords were used for the search: error médico [medical error], iatrogenia [iatrogenic error], responsabilidad penal del médico [physician criminal liability] and método clínico [clinical method]. Three previous bibliographies considered useful for the article and three book chapters with related topics were also reviewed, in addition to the resolutions of the Ministry of Public Health of Cuba dealing with the topic of medical error. Finally, 21 bibliographies in Spanish and English were selected. Conclusions: There are great possibilities of errors in the process of patient diagnosis and management. The development of technology, as well as the improvement in the construction of guides and protocols, decreases the probabilities of errors, but do not eliminate them. The improvement in the training of human resources, together with the correct use of the clinical method, is an effective strategy to reduce errors in medical practice(AU)

O erro médico nos tribunais: uma análise das decisões do Tribunal de Justiça da capital brasileira / Medical error in the courts: an analysis of the decisions of the Court of Justice of the Brazilian Federal District

Resumo Neste artigo buscou-se a ocorrência de erros médicos e sua resposta pelo Poder Judiciário, no âmbito do Tribunal de Justiça do Distrito Federal e dos Territórios (TJDFT), situado na capital da República brasileira, entre os anos de 2002 e 2019. Trata-se de pesquisa documental, retrospectiva com análise qualitativa das peças processuais dos processos judiciais tramitados nas varas cíveis do TJDFT e estatística descritiva. Foram levantadas as variáveis: especialidade médica da ocorrência, tipo de dano causado, vínculo do médico, se público ou privado, tipo de pedido do autor(a), decisão judicial e valor da indenização, dentre outros. O número de ações sobre erro médico está em crescimento no tribunal estudado e há uma tendência dos juízes em condenar com valores mais altos os médicos de instituições públicas. Mais da metade dos processos analisados tiveram a decisão judicial final desfavorável ao autor da demanda e mesmo os procedentes tiveram redução de aproximadamente 30% no valor da indenização pedida. Os pedidos de indenização por dano moral e dano material são de maior frequência. Os processos julgados ao longo dos últimos 17 anos pelo TJDFT em matéria de erro médico tiveram crescimento exponencial, caracterizando-se como uma nova forma de judicializar a saúde.

Abstract This study aimed to analyze medical errors and the response of the Court of Justice of the Federal District and Territories (TJDFT) from 2002 to 2019. This is a documentary, qualitative, and retrospective study performed using procedural documents of the lawsuits subjected to the TJDFT. The following variables were considered: medical specialty, type of damage caused, public or private health professional, type of the plaintiff's claim, court decision, amount of compensation, and others. Data were obtained from the TJDFT website-which provides full case files-and analyzed by descriptive statistics. The number of lawsuits involving medical error increases in the studied court and judges tend to sentence higher compensations to public professionals. The final court decision of most cases analyzed was unfavorable to the plaintiff and even those that were successful showed a reduction of about 30% in the amount of compensation requested. Claims for moral and material damages were the most common. The number of lawsuits involving medical error judged over the last 17 years by the TJDFT increased exponentially and became a new way to judicialize health.

La responsabilidad jurídica del médico, conceptos que se debaten entre dos ciencias / The Physician's Legal Responsibility, Debatable Concepts between two Sciences

La exigencia de responsabilidad jurídica a los profesionales de la salud ha experimentado, a pesar de su antigüedad, un auge en las sociedades contemporáneas. En el artículo se reflexiona sobre conceptos médicos y jurídicos que permitan clarificar los presupuestos de intervención del Derecho en el ámbito de la Medicina, en función de la determinación de la responsabilidad médica jurídicamente relevante(AU)

In spite of being demanded since long ago, legal responsibility from health professionals has experienced a boom in contemporary societies. This article reflects on medical and legal concepts that make it possible to clarify the assumptions for involving law in the field of medicine, based on the determination of legally relevant medical responsibility(AU)

Operational performance, concordance, and coincidence between passive and active safety event reporting systems in the surgery service in a teaching hospital in Colombia / Desempeño operativo, concordancia y coincidencia entre sistemas pasivos y activos de reporte de incidentes en el servicio de cirugía de un hospital universitario en Colombia

Abstract Introduction: Reporting systems (RSs) are the first step to improve patient safety in health institutions, consequently determining their performance is relevant. Objective: To determine the performance in terms of positive predictive value (PPV), the concordance, and the coincidence of passive and active RSs in the detection of true clinical incidents and reportable events with unwanted effects (REUWEs), in a teaching hospital in Bogotá, Colombia. Methods: Cross-sectional study, assembled in a retrospective cohort, consisting of hospitalized patients (>12hours) in the surgery service, between May and July 2017. The PPV was calculated for the detection of patients with clinical incidents or REUWE in both RS. Concordance and coincidence between RS were determined. Results: The incidence of REUWE from the passive RS was lower than the incidence from the active RS (2% vs 11.8%), the PPV for the identification of patients with clinical incidents and REUWE was similar (PPV patients with clinical incidents: passive 95% confidence interval [CI] 34.6-66.2 vs active 95% CI 45.1-71.7; and PPV patients with REUWE: passive 95% CI 36.8-65.4 vs active 95% CI 29.3-54.9). Concordance was acceptable (Kappa 0.38) and the coincidence of patients and their REUWEs was 15.38%. Conclusion: In the active and passive RSs, the detection of true clinical incidents and REUWE (PPV) was similar and the concordance in the detection of subjects with REUWE was acceptable. However, the coincidence between the REUWEs in the patients detected by each RS was substantially different and should be considered when analyzing the information coming from one or another RS.

Resumen Introducción: Los sistemas de reporte (SR) son el primer paso para mejorar la seguridad del paciente en las instituciones de salud y de allí la importancia de determinar su desempeño. Objetivo: Determinar, en términos de valor predictivo positivo (VPP), el desempeño, la concordancia y la coincidencia de SR pasivos y activos en la detección de incidentes clínicos verdaderos y de eventos reportables con efectos no deseados (EREND) en un hospital de enseñanza de Bogotá, Colombia. Métodos: Estudio de corte transversal ensamblado en una cohorte retrospectiva constituida por pacientes hospitalizados (> 12 horas) en el servicio de cirugía, entre mayo y julio de 2017. Se calculó el VPP para la detección de pacientes con incidentes clínicos o EREND en ambos SR. Se determinó la concordancia y la coincidencia entre los SR. Resultados: La incidencia de EREND a partir del sistema pasivo de reporte fue menor que la incidencia a partir del sistema activo (2% vs. 11,8%). El VPP para la identificación de pacientes con incidentes clínicos y EREND fue semejante (VPP para pacientes con incidentes clínicos: pasivo, IC 95%; 34,6-66,2 vs. activo, IC 95%; 45,171,7; y VPP para pacientes con EREND: pasivo, IC 95%; 36,8-65,4 vs. activo, IC 95%; 29,3-54,9). La concordancia fue aceptable (Kappa 0,38) y la coincidencia entre pacientes y sus EREND fue de 15,38%. Conclusiones: En los SR activo y pasivo la detección de incidentes clínicos verdaderos y EREND (VPP) fue semejante, y la concordancia en la detección de sujetos con EREND fue aceptable. Sin embargo, la coincidencia entre EREND en los pacientes detectados por cada sistema de reporte fue sustancialmente diferente, lo cual se debe tomar en consideración al analizar la información derivada de uno u otro SR.

Estratégias de apoio aos trabalhadores de saúde envolvidos em eventos adversos: revisão integrativa da literatura / Support strategies for health workers involved in adverse events: Integrative literature review

Introdução: quando um paciente é acometido por um evento adverso muitos são os envolvidos e afetados; sendo o paciente e seus familiares, a instituição, bem como os trabalhadores da saúde que estiveram diretamente envolvidos no evento, tornandose se as "segundas vítimas". As instituições de saúde devem empenhar-se em proporcionar apoio constante e eficiente depois da ocorrência desses eventos, visando reduzir o sofrimento dos trabalhadores e a ocorrência de novos eventos adversos. Objetivo: identificar e analisar as evidências científicas disponíveis na literatura sobre as estratégias utilizadas pelas instituições de saúde para apoiar os trabalhadores de saúde envolvidos em eventos adversos (segundas vítimas). Método: estudo de revisão integrativa de literatura; as buscas ocorreram nos meses de setembro e outubro de 2019 nas bibliotecas virtuais: LILACS, PubMed, SCOPUS, WEB of SCIENCE e CINAHL. Identificou-se 18.036 publicações potencialmente elegíveis, sendo que 374 eram duplicadas e foram excluídas. Do restante (n=17.662), após aplicação dos critérios de seleção, foram excluídos 12.800 estudos e dos 4.862 selecionados após leitura do título e resumo, 97 foram selecionados para leitura na íntegra. Após leitura, a amostra da revisão integrativa foi composta de 21 estudos primários. Resultados: Os dados foram analisados e posteriormente divididos em seis categorias, sendo, apoio jurídico, apoio psicológico, apoio de pares, cultura de segurança do paciente, programas de apoio institucionais e sem estratégias de apoio às segundas vítimas. Conclusão: A presente revisão integrativa é relevante para a área da saúde no sentido que avança no conhecimento das segundas vítimas, visto que traz por meio de evidências científicas as diferentes formas de manejo dos eventos adversos a nível nacional e internacional principalmente. As estratégias voltadas aos trabalhadores de saúde envolvidos nesses eventos (segundas vítimas) são de fundamental importância na gestão de qualquer instituição de saúde. Os resultados sugeriram um papel importante da cultura organizacional na estruturação e implementação de estratégias de apoio às segundas vítimas, que auxilia na criação de processos mais seguros não só para os pacientes, mas também para os trabalhadores que nelas atuam.

Introduction: When a patient is affected by an adverse event, many people are involved and affected; the patient and their family members, the institution, as well as the health workers who were directly involved in the event, becoming the "second victims". Healthcare institutions should strive to provide constant and efficient support after the occurrence of these events, with a view to reducing workers' suffering and the occurrence of new adverse events. Objective: To identify and analyze the scientific available evidence in the literature on used strategies by health institutions to support the workers involved in adverse events (second victims). Method: integrative literature review study; the searches took place in September and October 2019 in the virtual libraries: LILACS, PubMed, SCOPUS, WEB of SCIENCE and CINAHL. It was identified 18,036 potentially eligible publications, which 374 were duplicates and were excluded. The remainder was (n = 17,662), after applying the selection criteria, and then 12,800 studies were excluded and finally 4,862 were selected after reading the title and abstract, after that 97 were selected for full reading. After reading the 97 ones, the integrative review sample consisted of 21 primary studies. Results: The data were analyzed and further divided into six categories: legal support, psychological support, peer support, patient safety culture, institutional support programs and no strategies to support second victims. Conclusion: This integrative review is relevant for health in the sense that it advances in the knowledge of second victims, and it brings through scientific evidence the different ways of handling the adverse events according to the national and mainly the international level. The strategies aimed to the involved health workers in these events (second victims) are with fundamental importance in the management in any health institution. The results suggested an important function of the organizational order in the structuring and implementation of strategies to support second victims, which helps to create safer processes not only for patients, but also for everybody who work with them.

Medical error: concept, characterization and management / Erro médico: conceito, caracterização e gestão

Abstract The objective of this study is to better understand the tensions involved in the fear of making an error due to the harm and risk this would pose to those involved. This is a qualitative study based on the narratives of the experiences lived by ten acting physicians in the state of São Paulo, Brazil. The concept and characterization of errors were discussed, as well as the fear of making an error, the near misses or error in itself, how to deal with errors and what to do to avoid them. The analysis indicates an excessive pressure in the medical profession for error-free practices, with a well-established physician-patient relationship to facilitate the management of medical errors. The error occurs but the lack of information and discussion often leads to its concealment due to fear of possible judgment by society or peers. The establishment of programs that encourage appropriate medical conduct in the event of an error requires coherent answers for humanization in Brazilian medical science.

Resumo O objetivo deste estudo é compreender as tensões presentes no medo de errar por conta dos riscos e danos que tal erro causaria aos envolvidos. Este é um estudo qualitativo baseado nas narrativas das experiências de 10 médicos atuantes no estado de São Paulo, Brasil. O conceito e a caracterização do erro foram discutidos, bem como o medo de cometê-lo, a proximidade com o erro, como lidar com ele e como evitá-lo. A análise aponta pressões excessivas no tocante a práticas sem erros na profissão médica, considerando a existência de uma relação médico-paciente bem estabelecida de forma a facilitar a gestão de erros médicos. Erros médicos ocorrem, mas a falta de informação e discussão sobre o tema costuma levar ao seu encobrimento, uma vez que médicos temem o possível julgamento feito pela sociedade e por seus pares. O estabelecimento de programas que encorajem a conduta médica apropriada caso um erro ocorra requer respostas coerentes para a humanização da ciência médica no Brasil.

Patient safety issues in rehabilitation for person with locomotor disabilities: a review

Since the publication of the Institute of medicine report, To Err Is Human: Building a safer health system, notes that errors in health care are a significant cause of death and injury and the emphasis on patient safety has steadily increased. The rehabilitation professionals engaged for the management of patient with locomotor disabilities should incorporate elements of patient safety into their practices and also to stimulate research associated with prevalence of analysis of error/harm which occurs during the rehabilitation phase and also to develop and validate certain specific measuring tools and instruments for patient safety issues.

Criminalization of medical error and medical regulatory authority

This study aimed to suggest the justification for a self-regulatory body for medical licenses in Korea by reviewing recent cases of physician arrests for medical accidents in Korea. A number of recent cases of medical mistakes have been criminalized by courts in Korea, leading to widespread concern and fear throughout the healthcare community. Without a profession-led self-regulation system ever having been introduced in Korea, there is no alternative method for disciplining doctors other than through criminal tort law. It is expected that the volume of malpractice lawsuits will increase rapidly in Korea as the government ambitiously expands its plans for universal health coverage. Instead of facing criminal charges, however, doctors must put forth an effort to introduce a contemporary form of medical regulation, with more advanced disciplinary measures against substandard practice. The Korean Medical Association has undertaken the challenging mandate of establishing a new professional regulatory body to provide a tribunal and disciplinary system for the medical profession. It has proven difficult to persuade doctors of its purpose and value, as the majority do not yet fully grasp the very foreign concept of self-regulation. Moving forward, however, it will eventually become the responsibility of doctors to persuade society, lawmakers, government, and patient interest groups of the necessity and viability of self-regulation, which may also prove challenging. Despite these predictable challenges, it is imperative that Korean doctors solve the issue of creating a new, modern regulatory body capable of effective self-regulation and acceptable disciplinary measures, within the near future.

Importância e desafios do treinamento simulado em saúde / Importance and challenges of simulation training in healthcare

O uso da simulação no ensino em saúde amplia as oportunidades de aprendizagem, contribuindo de forma relevante para a prevenção de erros durante a atividade profissional. Entretanto, são vários os desafios para alcançar um treinamento simulado eficiente, incluindo a necessidade de adaptar o conhecimento produzido em diferentes contextos. Como deve ser organizado um centro de simulação? Como levar em conta as peculiaridades dos estudantes na aplicação do conceito de debriefing? Os instrumentos de avaliação foram validados para a população na qual estão sendo aplicados? Quais elementos devem ser incluídos no ensino baseado em simulação para melhorar a aquisição e/ou a retenção de habilidades, conhecimentos e atitudes? Em que momento do currículo introduzir cada possibilidade de treinamento simulado, de modo a tornar o investimento válido? Neste editorial, os autores assinalam a importância do treinamento simulado em saúde e a necessidade de pesquisas que objetivem entender as diferentes situações e fornecer respostas a estas questões.

The use of simulation in health education expands learning opportunities, contributing in a relevant way to the prevention of errors during professional activity. However, there are several challenges to achieving efficient simulated training, including the need to adapt the knowledge produced in different contexts. How should a simulation center be organized? How to take into account the peculiarities of the students in applying the concept of debriefing? Have the evaluation tools been validated for the population in which they are being applied? What elements should be included in simulation-based teaching to improve acquisition and/or retention of skills, knowledge, and attitudes? At what point, in the curriculum, should every possibility of simulated training be introduced in order to make the investment valid? In this editorial, the authors point out the importance of simulation training in healthcare and the need for research aimed at understanding the different situations and providing answers to these questions.

Análise Idiossincrática dos Discursos proferidos nas decisões judiciais sobre Erro Médico no TJDFT: um estudo qualitativo / Idiosyncratic analysis of the Discourses pronounced in the judicial decisions on Medical Error in the TJDFT: a qualitative study / Análisis idiosincrático de los discursos pronunciados en las decisiones judiciales sobre error médico en el TJDFT: un estudio cualitativo

Objetivo - Conhecer os argumentos utilizados nas decisões judiciais procedentes sobre erro médico que foram julgadas no TJDFT. Metodologia - Optou-se por uma metodologia qualitativa com análise idiossincrática do discurso com a finalidade de conhecer pressupostos classificados como: legal, processual e material. Resultados ­ Há uso diferenciado da legislação para o julgamento de casos de erro médico de forma distinta para o setor público e o setor privado assim como há julgados em vista de problemas processuais e erros formais no processo civil. Conclusão - É possível aferir a partir do discurso analisado tanto a negligência, como imperícia e imprudência no trato dos pacientes o que evidencia falhas no sistema de saúde. Constata-se a necessidade de efetivação de ações de saúde e propostas de formação dos profissionais de saúde e do direito mais humanizadas

Objective - It is necessary to knowledge the importance and the factors associated to medical errors to promote measures in order to avoid professional malpractice. In order to understand the arguments used in sentences regarding medical error that were pronounced in the TJDFT. Methods - this research made a qualitative analysis through an idiosyncratic reading of the sentences conducted with the purpose of understanding assumptions classified as: legal, procedural and material. Results - We observed differentiated uses of legislation for the lawsuits regarding medical error in a different way for the public sector and the private sector; we also observed the outcome of the complaints due to procedure and formal errors in civil proceedings. Conclusion - It is possible to estimate from the complaints problems such as negligence, malpractice and presumption in the treatment of the patients, which demonstrates failures in the health system. There is a need for health actions and proposals of health professionals and law practitioners training with a more humanized manner

Objetivo - Conocer los argumentos utilizados en las decisiones judiciales procedentes sobre error médico que fueron juzgadas en el TJDFT. Metodología - Se optó por una metodología cualitativa con análisis idiosincrático del discurso con la finalidad de conocer presupuestos clasificados como: legal, procesal y material. Resultados - Hay uso diferenciado de la legislación para el juicio de casos de error médico de forma distinta para el sector público y el sector privado, así como hay juzgados en vista de problemas procesales y errores formales en el proceso civil. Conclusión - Es posible aferir a partir del discurso analizado tanto la negligencia, como impericia e imprudencia en el trato de los pacientes lo que evidencia fallas en el sistema de salud. Se constata la necesidad de efectividad de acciones de salud y propuestas de formación de los profesionales de salud y del derecho más humanizadas.

Detección de eventos adversos en pacientes pediátricos hospitalizados mediante la herramienta de disparadores globales Global Trigger Tool / Measuring adverse events in pediatric inpatients with the Global Trigger Tool

Introducción: La seguridad del paciente hospitalizado es prioritaria para el sistema de salud. La herramienta de disparadores globales parecería ser adecuada para estimar la incidencia de eventos adversos (EA) en niños hospitalizados. Objetivos: Describir la incidencia y la categorización de EA en niños hospitalizados utilizando la herramienta de disparadores globales e identificar los factores de riesgo asociados a su aparición. Población y métodos: Estudio retrospectivo. Se incluyeron 200 historias clínicas de pacientes internados en el Hospital Elizalde en el año 2013. Variables de resultado: número de EA/100 ingresos y distribución del dano. Se utilizó la prueba de chi cuadrado, la prueba de t y la correlación de Pearson. Nivel de significación de p < 0,05. Resultados: Se detectaron 289 disparadores (1,4/paciente); 52 EA (26 EA cada 100 pacientes, IC 95%: 20,4-32,5). Presentaron, al menos, un EA 36 pacientes; 7 pacientes sufrieron más de uno; 45 EA fueron categoría E y F (dano temporario). Los disparadores de cuidados médicos se asociaron con EA (OR 8,1; IC 95%: 3,7-17,3; p < 0,001). Se encontró una correlación positiva entre el número de disparadores y el número de EA por paciente (R= 0,46; p < 0,001). Los pacientes internados en unidad cerrada (OR 2,8; IC 95%: 1,2-6,5; p= 0,03) y el mayor promedio de días de internación se asociaron a EA (p < 0,001). Conclusión: Se identificó una frecuencia de 26% de EA; la mayoría fue dano temporario. La internación en una unidad cerrada, la mayor cantidad de días de internación, el mayor número de disparadores y los disparadores de cuidados generales se asociaron con la presencia de EA.

Introduction: The safety of inpatients is a priority in the health care system. The Global Trigger Tool seems to be suitable to estimate the incidence of adverse events (AE) in pediatric inpatients. Objectives: To describe the incidence and categories of AE in pediatric inpatients using the Global Trigger Tool and to identify risk factors associated to their development. Population and methods: Retrospective study. Medical records of 200 patients hospitalized at Hospital Elizalde during 2013 were included. Outcome measures: number of AE/100 admissions and distribution of harm. A chi² test, Student's t test and Pearson's correlation test were carried out. Significance level = p < 0.05. Results: The study detected 289 triggers (1.4/patient); 52 AEs (26 AEs/100 patients, 95% CI: 20.4-32.5). There was at least one AE every 36 patients; 7 patients had more than one AE; 45 AEs were in the E and F categories (temporary harm). Medical care triggers were associated to AEs (OR 8.1; 95% CI: 3.7-17.3, p < 0.001). A positive correlation was found between the number of triggers and the number of AEs per patient (R= 0.46; p < 0.001). Being hospitalized in a closed unit (OR 2.8; 95% CI: 1.2-6.5; p= 0.03) and a longer hospital stay were associated to AEs (p < 0.001). Conclusion: An AE frequency of 26% was identified, and most AEs resulted in temporary harm. The presence of AEs was associated to hospitalization in a closed unit, longer hospital stay, higher number of triggers and general care triggers.

O Erro médico sob o olhar do Judiciário: uma investigação no Tribunal de Justiça do Distrito Federal e Territórios / The medical error under the eyes of the Judiciary: an investigation at the Court of Justice of Federal District and Territories / La mala praxis bajo la mirada del poder judicial: una investigación ante el Tribunal de Justicia del Distrito Federal y Territorios

Objetivo: A atividade do profissional da área médica pode suscitar em morte do paciente ou o comprometimento de sua integridade física ou de sua saúde, por conduta culposa (negligência, imperícia ou imprudência). Esses atos geram ações de responsabilidade civil levando-o a ressarcir os danos produzidos ao paciente ou ações de responsabilidade penal trazendo consequências criminais agente. Método acórdãos em segunda instância disponível no site do TJDFT no período de 2013 a 2015, utilizando os termos "erro médico" no campo disponibilizado para pesquisa resultando um total de 204 processos. Resultados: Desta analise 97% dos processos foram julgados pela justiça comum e 3% por juizados especiais; 1% tratavam de dano material, 46% sobre danos morais e 53% relacionados a danos morais e materiais; as especialidades de menor participação nos pleitos de erro médico foram endocrinologia, dermatologia, fisioterapia, pneumologia, proctologia e erros provenientes da farmácia enquanto as com maior número de processos foram gineco-obstetrícia, cirurgia geral e plástica; encontramos ações cujo o réu foi o setor privado em 51%, o setor público 44% e individual em 5% dos processos analisados; as sentenças foram improcedentes em 57%, procedentes em 22% parcialmente procedentes em 19% e extintos em 2% dos processos analisados. Conclusão: A influência jurídica dentro da prática médica vem a moldar as atitudes e as práticas de saúde nos serviços motivado pelas repercussões legais e também pelas consequências econômicas para a gestão sendo um reflexo de uma sociedade em que a afirmação de direitos e a ideia de ter sofrido uma lesão compensável é entendida como a responsabilidade de um bom profissional ou de um bom serviço de saúde. O médico não deve ser considerado o único responsável e causador do dano pois é necessário que todas as partes envolvidas estejam engajadas nas mudanças sugeridas pela Organização Mundial de Saúde e que merecem ser implementadas. Palavras-chave: Judicialização. Erro médico. Direito à Saúde. Saúde Pública.

Objective: Actions related to health professionals can end in death of the patient or impairment of his or her physical integrity and health, through misconduct (negligence, malpractice or recklessness). These actions can lead to civil liability towards compensating damages towards the patient or criminal liability actions towards criminal charges. Methods: This article performed a jurisprudential research with data collected from second instance judgments available on the TJDFT website throughout 2013 to 2015, using the terms "medical error" in the research field involving 204 cases. Results: From this analysis 97% of the cases were judged by the common justice and 3% by special courts; 1% dealt with material damage, 46% about moral damages and 53% on moral and material damages. Specialties with fewer participation in medical error lawsuits were endocrinology, dermatology, physiotherapy, pneumology, proctology and errors from the pharmacy, whereas lawsuits with most cases were gynecological-obstetrics, general and plastic surgery. We found actions whose defendant was the private sector in 51%, the public sector in 44% and individual in 5% of the analyzed cases. The sentences were dismissed in 57%, ruled in favor of the plaintiff 22% partially in favor 19% and extinguished in 2% of the lawsuits analyzed. Conclusion: The legal influence within medical practice shapes health attitudes and practices in medical services motivated by the legal repercussions and also by the economic management consequences as a reflection of a society in which rights affirmation and the idea of undergoing an indemnable injury is understood as the responsibility of a good professional or a good health service. Physicians should not be considered the sole responsible of the harmful event and all parties related should be involved in the changes that deserve to be performed and were once suggested by the world health organization.

Objective: El campo de la medicina de la actividad profesional puede aumentar las tasas de muerte del paciente o el compromiso de su integridad física o su salud, por conducta culposa. Estas acciones generan acciones de responsabilidad que lo llevó a compensar el daño causado a las demandas de los pacientes o de responsabilidad penal que traen consecuencias criminales. Métodos: En este artículo se llevó a una investigación judicial de la recolección de datos de los juicios en apelación disponibles en el sitio TJDFT 2013-2015, utilizando los términos "error médico" en el campo correspondiente para la investigación que resulta en un total de 204 casos. Resultados: Este análisis el 97% de los casos fueron juzgados por los tribunales ordinarios y 3% por los tribunales especiales; 1% tratada daños materiales, el 46% de daño moral y el 53% en relación con los daños morales y materiales; las especialidades de menor participación en demandas por negligencia médica eran endocrinología, dermatología, fisioterapia, neumología, proctología y los errores de la farmacia, mientras que el mayor número de casos fueron ginecológica y obstetricia, cirugía general y plástica; encontrar acciones que el acusado era el sector privado en un 51%, el sector público 44% e individual 5% de los casos analizados; las frases fueron rechazadas por el 57%, llegando en el 22% parcialmente procedentes en un 19% y se disolvieron en 2% de los casos analizados. Conclusión: La influencia jurídica en el ejercicio de la medicina viene a dar forma a las actitudes y las prácticas de salud en los servicios motivados por las repercusiones legales y también las consecuencias económicas para la gestión como un reflejo de una sociedad en que las afirmaciones de los derechos y de la idea de haber sido objeto de una lesión compensable se entiende como la responsabilidad de un buen profesional y un buen servicio de salud. El médico no debe ser considerado el único responsable de causar el daño y es necesario que todas las partes están involucradas en los cambios que merecen ser hecho y que en sugeridos por la Organización Mundial de la Salud.

Views of faculty members in a medical school with regards to error disclosure and reporting to parents and/or higher authorities

Background: Little is known about the views of faculty members who train medical students concerning open disclosure. Objectives: The objectives of this study were to determine the views of faculty in a medical school on: 1 what constitutes a medical error and the severity of such an error in relation to medication use or diagnosis; 2 information giving following such an adverse event, based on severity; and 3 acknowledgement of responsibility, remedial action, compensation, disciplinary action, legal action, and reporting to a higher body in relation to such adverse event. Methods: We adapted and contextualized a questionnaire developed from a previous study. The questionnaire had 4 case vignettes that described 1 clear medication error with lifelong disability; 2 possible diagnostic error with lifelong disability; 3 possible diagnostic error without harm; and 4 clear medication error without harm. We invited all faculty members attached to the medical school at the International Medical University to participate in the study. Results: Seventy faculty members took part. Faculty members viewed a medical error as having taken place depending on how clearly an error had occurred (94% and 73% versus 53% and 27%). They viewed cases as more severe based on the severity of complications (85% and 46% versus 5% and 10%). With increasing severity, they tended to attribute responsibility for the event and the duty to disclose towards more senior clinicians. They were also more agreeable with remedial action, compensation, disciplinary action, and reporting to a higher agency. There was no strong evidence of association between these areas and the demographics of faculty members. Conclusions: Faculty members are more likely to perceive an error had occurred depending on the clarity of the circumstances. They viewed severity based on the presence of complications. Severity determined how they attributed responsibility, duty to disclose, and other areas related to open disclosure.

Parental preferences with regards to disclosure following adverse events occurring in relation to medication use or diagnosis in the care of their children – perspectives from Malaysia

Introduction: Open disclosure is poorly understood in Malaysia but is an ethical and professional responsibility. The objectives of this study were to determine: (1) the perception of parents regarding the severity of medical error in relation to medication use or diagnosis; (2) the preference of parents for information following the medical error and its relation to severity; and (3) the preference of parents with regards to disciplinary action, reporting, and legal action. Methods: We translated and contextualised a questionnaire developed from a previous study. The questionnaire consisted of four case vignettes that described the following: medication error with a lifelong complication; diagnostic error with a lifelong complication; diagnostic error without lifelong effect; and medication error without lifelong effect. Each case vignette was followed by a series of questions examining the subject’s perception on the above areas. We also determined the content validity of the questionnaire. We invited parents of Malaysian children admitted to the paediatric wards of Tuanku Jaafar Hospital to participate in the study. Results: One hundred and twenty-three parents participated in the study. The majority of parents wanted to be told regarding the event. As the severity of the case vignettes increased, the desire for information, remedial action, acknowledgement of responsibility, compensation, punishment, legal action, and reporting to a higher agency also increased. The findings did not have strong evidence of a relationship with subject’s demographics. Conclusion: This study gives insights into previously unexplored perspectives and preferences of parents in Malaysia regarding open disclosure. It also highlights the opportunity for more research in this area with potentially broad applications.

O erro médico na imprensa portuguesa: quando os pacientes fazem parte da notícia / Medical error in the Portuguese press: when patients are part of the news

Esta investigação aborda a qualidade da produção noticiosa sobre o erro médico, como um fator essencial na construção do conhecimento público sobre o tema, com o objetivo de compreender que características definem tal produção e até que ponto poderão ser explicadas pela periodicidade e orientação editorial dos jornais; que conceito de erro médico é veiculado pela produção noticiosa sobre o tema; e quais são os protagonistas no discurso jornalístico sobre o erro médico. Foram analisadas as edições de três jornais portugueses, de 2008 a 2011, resultando num corpus de 266 (4,2%) artigos, que foram classificados de acordo com as seguintes variáveis: as fontes de informação citadas (o seu estatuto e especialidade, no caso dos médicos); os temas que são tratados; as características de enquadramento da informação publicada (tom, gênero jornalístico; e a presença e número de fontes de informação). Pela análise de conteúdo quantitativa, apurou-se que esse tema está em crescimento, essencialmente com notícias de tom negativo e fontes de informação habitualmente identificadas. Não há evidência para afirmar que a periodicidade e a orientação editorial expliquem as variações dessas características, a não ser relativamente ao número de fontes citadas. Vigoram as notícias centradas nos resultados dos erros (mortes ou lesões), provocados por "erros de omissão" e por "erros de comissão", envolvendo uma diversidade de protagonistas: são, tal como acontece na informação sobre saúde em geral, fontes oficiais e especializadas do campo da saúde. Destacam-se os médicos e os juristas e é dado relevo aos pacientes.

Abstract This research addresses the quality of news production on medical error, as an essential factor in building public knowledge on the subject, in order to understand which characteristics define the news production of medical error and to what extent can they be explained by the periodicity and editorial orientation of the newspaper; which concept of medical error is transmitted by the news production on the subject; and who are the main actors in the journalistic discourse about medical error. The editions of three Portuguese newspapers were analyzed, from 2008 to 2011, resulting in a corpus of 266 (4.2%) articles, which were classified according to the following variables: the sources of information quoted (their status and specialty, in the case of doctors); the issues covered; and characteristic framework of the published information (tone, journalistic style, and the presence and number of information sources). Through quantitative content analysis, it was found that this topic is growing, essentially with negative news and information sources usually being identified. There is no evidence to support that periodicity and editorial orientation explain the variations in these characteristics, except for the number of cited sources. News focused on the results of errors (death or injury), caused by "errors of omission" and "commission errors", prevail, involving a variety of actors: they are, such as it happens in health information, in general, official sources and experts in health. Doctors and lawyers stand out, and special attention is given to patients.

Mala praxis médica en el quirófano / Medical malpractice in the operating room

La mala praxis médica constituye actualmente un problema global de salud, incluso en los mejores centros hospitalarios del mundo. Se consultaron 26 referencias bibliográficas nacionales e internacionales acerca del tema con el objetivo de determinar el estado actual de los errores médicos en el quirófano. El ejercicio de la medicina tiene riesgos inherentes y la naturaleza humana hace imposible que el hombre sea infalible. Los tipos de errores más frecuentes en la práctica médica son: administración equívoca de medicamentos, diagnósticos inciertos, fallas técnicas (procedimientos insuficientes, incompletos y/o incorrectos) y demora en el salón de operaciones. Las causas más frecuentes engloban el cansancio, la prisa, falta de conocimientos, entre otras. La prevención es posible y son numerosas las estrategias aplicadas por los diferentes sistemas de salud: estimular el trabajo en equipo, fortalecer la capacitación del médico y personal paramédico, evitar confiar en la memoria usando listas de chequeo, estandarizar procedimientos y protocolos, crear la cultura del reporte voluntario de errores. El error debe ser utilizado como una oportunidad para aprender, para mejorar la calidad en la atención y por ende, la seguridad de los enfermos(AU)

The medical malpractice represents a global health problem, even in the best hospitals of the world. Twenty six bibliographic references, both national and international, were consulted about the topic, with the objective of determining the current situation of the medical errors in the operating room. Medical practice has its inherent risks since the human nature makes it impossible to be totally error-free. The most common errors in medical practice are wrong administration of drugs, uncertain diagnoses, technical failures (inadequate, incomplete and/or incorrect procedures) and delays in the operating room. The most frequent causes comprise tiredness, hurry, lack of knowledge and others. Prevention is possible and a number of strategies have been applied by the various health systems: encouraging the teamwork, strengthening the physician and the paramedic staff training, avoiding just trust on one´s memory by using checking lists, standardizing procedures and protocols and creating the culture of voluntary reporting errors. The error should be used as a possibility of learning in order to improve the quality of care and thus the patient´s safety(AU)