An 82-year-old man with a history of advanced Alzheimer dementia is brought to the hospital by his daughter, who is his power of attorney and caregiver. She says that her father is increasingly confused and verbally aggressive. He is admitted to the hospital and found to have a urinary tract infection. Intravenous antibiotics are initiated and he appears less disoriented and agitated but remains unable to recall nursing instructions throughout the day and is fairly nonverbal. Three days into his treatment, the antibiotic order expires and is missed by the physician, nurses, and pharmacy staff. The patient receives no medication for 2 days before the error is noted and corrected. There are no consequences to this error other than extension of his hospital stay by 2 days. Which of the following is the most appropriate course of action?

Question

An 82-year-old man with a history of advanced Alzheimer dementia is brought to the hospital by his daughter, who is his power of attorney and caregiver.  She says that her father is increasingly confused and verbally aggressive.  He is admitted to the hospital and found to have a urinary tract infection.  Intravenous antibiotics are initiated and he appears less disoriented and agitated but remains unable to recall nursing instructions throughout the day and is fairly nonverbal.  Three days into his treatment, the antibiotic order expires and is missed by the physician, nurses, and pharmacy staff.  The patient receives no medication for 2 days before the error is noted and corrected.  There are no consequences to this error other than extension of his hospital stay by 2 days.  Which of the following is the most appropriate course of action?

Quizplus · Accepted Answer

Medication errors play a major role in patient morbidity and mortality, particularly in the hospital setting. These errors may be caused by health care professionals (eg, errors in entering medication, failure to renew medication), factors related to the medication (eg, similar names, narrow therapeutic window), and factors related to the patient (eg, poor renal function, polypharmacy). Quality improvement measures such as checklists or medication reconciliation attempt to minimize these preventable errors. It is often challenging for physicians to disclose when medication errors have occurred, particularly when no serious harm has come to the patient. Reasons for this reluctance may include fear of litigation or loss of patient trust and confidence. However, full disclosure of medical errors should occur in a timely manner and has been associated with a neutral-to-positive effect on patient response and the physician-patient relationship. When an error is noted, disclosure should be provided in person, in a timely manner that includes an apology for what occurred. Because this patient's altered mental status and advanced dementia prevent him from being able to understand what occurred, it would be more appropriate for the physician to disclose the error to his daughter (Choice D). (Choice A) Although the patient was not harmed physically, extra days in the hospital certainly expose him to greater financial risk and to hospital-acquired infection. It would not be advisable to withhold this information. (Choice B) Although having the hospital revoke charges for the extra days would be appropriate, this does not substitute for disclosure and apology for the error. (Choice E) Waiting to discuss the incident with pharmacy and nursing staff would be the first step if there is doubt about whether a medication error occurred. However, in this case, it is clear that the medication error did occur, making the best next step disclosure and apology for the event. Educational objective: Physicians should disclose medication errors and provide an apology in a timely fashion regardless of whether harm has occurred. __________ References: Medication errors: an overview for clinicians. (http://www.ncbi.nlm.nih.gov/pubmed/24981217)

An 82-Year-Old Man with a History of Advanced Alzheimer Dementia