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Medical Error Prevention in Comprehensive Integrated Systems of Care 2017
Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP
Executive Director: AllCEUs Counselor Education
Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery

CEUs are available on demand for this video at

~ Identify medical errors common in a comprehensive integrated system of care including pain management
~ Discuss how pain influences the comprehensive treatment process
~ Identify causes of errors
~ Describe effects of medical errors on the patient and family
~ Identify common documentation and communication errors in multidisciplinary teams
~ Define “medical error”
~ Identify the factors in a credible root cause analysis
~ Identify major signs and symptoms of a medical emergency
~ Describe other interventions designed to prevent harm and to protect patient safety commonly utilized by therapists

Definition of “medical error” (NIM)
~ Diagnostic errors
~ Error or delay in diagnosis
~ Failure to use indicated tests
~ Use of outdated therapy
~ Failure to act on results of monitoring or testing



~ Treatment
~ Error in the performance of procedure, test
~ Avoidable delay in treatment or in responding to an abnormal test
~ Inappropriate (not indicated) care
~ Type
~ Intensity
~ Breadth/Diversity
~ Duration

Medical Errors in Counseling
~ Counselors often work with teams of specialists and support personnel
~ Psychiatrists & Psychologists, Mental health professionals
~ Physicians, Physician’s assistants & Nurse practitioners
~ Nutritionists
~ Physical and occupational therapists
~ Pain management specialists
~ Certified addiction professionals
~ Pastor/ religion/faith leaders
~ Relatives

More Medical Errors
~ Prevention
~ Failure to consider multiple causes of symptoms
~ Failure to provide preventative treatment
~ Inadequate monitoring or follow-up of treatment
~ Other
~ Failure of communication
~ Equipment failure
~ Other system failure

Documentation & Communication Errors
~ Short hand
~ Poor communication between teams
~ Documentation quality
~ Content
~ Lack of a single point of contact
~ HIPAA Violations
~ Making assumptions without clarification or confirmation
~ Reasons for medications the patient is taking
~ Causes of pain or distress


Error Causes
~ Multiple professional involvement. (Too many cooks without a Chef)
~ Misdiagnosis or assignment of a false diagnosis
~ Intimidation
~ Over-treatment
~ Relay false client/patient or their own personal information
~ Inappropriately share or distort information
~ Attempt to treat out of the realm of expertise
~ Do not consult with medical professionals
Error Causes
~ Do not thoroughly collect background histories or complete assessments
~ Provide inadequate safety or security of physical environment
~ Recommend inappropriate or dangerous treatment protocol
Medical Error Effects
~ Loss of trust  drop-out, relapse or symptom worsening
~ Loss of trust that accurate, complete information will be passed
~ Reversal or relapse of mental health and other physical conditions
~ Take incompatible medications due to a lack of communication by the patient’s various providers
~ Abuse medications or take inappropriate medications when multiple causes for emotional or physical pain are not considered
Medical Error Effects
~ Lose important wraparound services due to poor team communication or lack of necessary paperwork
~ Lose family support if psychological and financial assistance is withdrawn or reduced through lack of follow-up with insurance or completed recommendations by any team member(s).

Effects cont…
~ Lose the ability to feel psychologically or physically safe.
~ Experience anxiety about new or particular environmental settings, and/or the introduction of new professionals, as well as treatment protocols when proper protocols are not followed/referrals made
~ Place themselves in unnecessary physical or emotional danger because of their inability to use sound judgment
~ Worsen existing or create new physical or mental health conditions

Effects cont…
~ Experiencing trauma as a result of medical error can cause mental health clients to develop acute stress issues
~ Take unnecessary personal risks
~ Cause harm to self or others


Common Issues/Symptoms: Pain
~ More than 50% of patients with pain have concurrent depression
~ Pain assessment and management techniques
~ Type, duration, frequency, intensity, exacerbating and mitigating factors
~ Medication, physical therapy, stretching, stress management, ergonomic assessment
Common Issues/Symptoms: Pain
~ How pain influences comprehensive treatment (i.e Why a counselor would care…)
~ Treatment compliance and motivation
~ Self Medication
~ Mood disorders: Anxiety, depression, irritability
~ Serotonin Syndrome
~ Sleep disturbance

Symptoms Requiring Urgent Action
~ General
~ Suicidal/homicidal feelings
~ Sudden severe pain
~ Signs of Serotonin Syndrome
~ Head or spine injury
~ Bleeding that will not stop
~ Swallowing a poison
~ Cool, clammy pale skin
~ Sudden change in consciousness or confusion
~ TB
~ Coughing up blood
~ Persistent night sweats
~ Unexplained fever

More Symptoms
~ Heart attack
~ Chest pains
~ Dizziness
~ Weakness
~ Irregular pulse
~ Fatigue for days
~ Shortness of breath

~ Stroke
~ Difficulty seeing out of one or both eyes
~ Difficulty walking
~ Numbness or paralysis with face, arm or leg
~ Difficulty speaking or understanding

Prevention of Errors
~ Single point of contact
~ Procedures for conducting and reviewing assessments/clinical histories
~ Policy for communication with team-members and referral sources (what, how often)
~ Multidisciplinary policy regarding abbreviations in the clinical record
~ Informed consent procedures
~ Comprehensive, nonpunitive risk management and incident reporting policy
~ Mutual respect and open communication within teams

Prevention cont…
~ Annual staff training on:
~ Signs of medical emergencies and emergency procedures
~ Pain assessment, medical errors related to pain management and impact of pain on biopsychosocial treatment
~ Signs of addiction and substance impairment
~ Regular supervision
~ Reasonable caseloads
~ Administrative policies that focus on the wellbeing of the client over profits and billable units

Root Cause Analysis
~ Defines the problem and its significance
~ Identify causative factors
~ Institutional/Regulatory (Medicaid changes)
~ Organizational (emphasis on billable hours or census, frequent changes in policy or procedure)
~ Work Environment (chaotic, lack of role delineation, burnout)
~ Team Environment (lack of respect, poor communication, intimidation)
~ Staffing (levels, education, expectations)
~ Task Related (Lack of safeguards, human error)
~ Patient Characteristics (concurrent conditions, biopsychosocial history, diagnosis…)
Root cont.
~ Identifies the relationship between the causative factors and the problem
~ Clearly identifies evidence of the causative factors
~ Identifies solutions to correct/prevent further occurrence of the causative factors
~ Reviews the potential impacts of the solutions
~ Decides on a course of action
~ Documents the problem, the causes, the solutions and clearly identifies the relationship between the cause and the solutions
~ In an integrated, comprehensive system of care, it is important to ensure appropriate and effective documentation
~ Medical errors can occur in many settings
~ A medical error causes or has the potential to cause physical, psychological, social or financial harm to a client
~ Medications can be both the solution and the cause of problems
~ Professionals must be aware of the signs of medical emergencies
~ A comprehensive risk management plan is essential to the prevention of medical errors
~ An effective root cause analysis examines the identifiable and preventable causes of problems