Physical therapists' perspectives on practice errors in geriatric, neurologic, or orthopedic clinical settings.

While practice errors have been studied extensively in medicine and pharmacy, little research exists in physical therapy. The purpose of this study was to explore the phenomenon of physical therapy practice errors in geriatric, adult neurologic, and orthopedic clinical settings. Thirty physical therapists with three or more years of practice experience participated in the study, representing four geographically distinct regions of the United States. Four focus groups were conducted via guided discussion questions in four different states. Collected data were transcribed and analyzed by using constant comparative method. Data analysis yielded five major themes including: 1) taxonomy of error, 2) aversive outcomes, 3) individual and systematic causes, 4) post hoc actions, and 5) prevention of future errors. Because human errors are inevitable in physical therapy practice, understanding of causes and prevention strategies is necessary to minimize harm to patients. In addition, physical therapists must recognize their role and responsibility in creating a culture of error analysis and error prevention.

Preventing practice errors and improving patient safety: an examination of case studies reflecting common errors in occupational therapy practice.

Like other health care professionals, occupational therapists make errors in clinical practice. Only recently have we systematically studied errors in occupational therapy practice. In this report, key findings from two grant projects in occupational therapy practice errors are further examined. Specifically, this report includes an in-depth analysis of five examples of occupational therapy practice errors in physical rehabilitation and geriatric settings. These examples from the five most commonly reported causes of errors found in a national survey study on occupational therapy errors are misjudgment, lack of preparation, lack of experience, lack of knowledge, and insufficient communication. For each of the five examples, hypothesized causes of errors and their implications for professional education training and current occupational therapy practice are explored. It is hoped that this report helps to better inform practice and educational approaches to contribute to the prevention and reduction of occupational therapy and other health care practice errors.

Error and patient safety: ethical analysis of cases in occupational and physical therapy practice.

Compared to other health care professions such as medicine, nursing and pharmacy, few studies have been conducted to examine the nature of practice errors in occupational and physical therapy. In an ongoing study to determine root causes, typographies and impact of occupational and physical therapy error on patients, focus group interviews have been conducted across the United States. A substantial number of harmful practice errors and/or other patient safety events (deviations or accidents) have been identified. Often these events have had moral dimensions that troubled the therapist involved. In this article, six of these transcribed cases are analyzed, using predominant bioethical theories, ethical principles and professional codes of ethics. The cases and their analyses are intended to be exemplary, improving the readers' ability to discern and critically address similar such events. Several patient safety strategies are suggested that might have prevented the events described in these cases.

Occupational therapy practice errors in physical rehabilitation and geriatrics settings: a national survey study.

OBJECTIVES: The purpose of this survey study was to investigate occupational therapy practice errors in physical rehabilitation and geriatric practice settings. METHOD: Two hundred and forty-five (245) out of 994 surveyed occupational therapists who have practiced or currently practice in physical rehabilitation or geriatrics settings responded to a self-developed questionnaire. Descriptive statistical analysis was used to describe practice errors as to the types, causes, impact on, and responses of occupational therapists and work sites. Inferential statistical analysis was used to explore the relationships among different variables of interest including: the effect of the number of years of practice experience on the perceived impact of making errors on practice; the relationship between disclosure or nondisclosure of errors; and the types of coping strategies used by occupational therapists and work site administrators' responses to errors. RESULTS: The vast majority of practice errors occurred during the intervention phase of the occupational therapy process. Misjudgment, lack of preparation, and lack of experience were reported as the top three causes of practice errors. Various coping strategies-such as compensating for the errors by voluntarily devoting additional time for care of the patient, making and following a corrective plan, concentrating on the next step, or not letting errors interfere with daily work-were used by the occupational therapists when errors occurred. The types of coping strategies and work site responses appeared to be associated with the disclosure or nondisclosure of errors. CONCLUSION: Errors occur in occupational therapy practice. Making errors has considerable impact on occupational therapists as well as their future practice. However, disclosure of errors can often lead to positive outcomes.

Occupational therapists' responses to practice errors in physical rehabilitation settings.

OBJECTIVE: Errors occur in all health care professions. Practice errors, however, have not been systematically examined in occupational therapy. The purpose of this study was to examine occupational therapists' responses to practice errors in physical rehabilitation settings. METHOD: A qualitative focus group research method was used in this study and a total of 35 occupational therapists from four different states who had practice experience in physical rehabilitation settings participated in four focus groups. Focus group discussions were transcribed verbatim and analyzed by two investigators of the study. Qualitative software program, NUD*IST Vivo was used to aid the data analysis process. RESULTS: Five major themes were generated from the data regarding practice errors, which included (1) Concept of practice error: It is against our standards; (2) Perceived causes of practice error: Not just an individual matter; (3) Emotional responses: I felt horrible; (4) Impact on practice: Doing things differently; and (5) Management of practice error: Being honest and taking initiative. Occupational therapists perceived practice error from a broad perspective and identified physical and psychosocial issues as practice error. CONCLUSION: Most practice errors described by participants appeared to be preventable. Despite the tremendous emotional distress in reaction to making an error, participants valued the learning in the experience and made constructive practice changes. Findings of the study have implications for current educational training programs and practice such as the development of clinical reasoning related to patient safety and assertiveness training for hierarchical situations.