Discussing Veterinary Medical Errors & How to Fix Them

In the Literature 

Low R, Wu AW. Veterinary healthcare needs to talk more about error: for the wellbeing of our patients and medical teams. J Vet Intern Med. 2022;36(6):2199-2202. doi:10.1111/jvim.16554 

The Research … 

Medical errors are prevalent in human health care, but data are limited on the scale of medical errors in veterinary medicine. One study reported veterinary medical errors in 5.3 out of 1,000 patient visits, 8% of which resulted in permanent harm or death.¹ Drug errors were most prevalent. In addition to harming patients, errors can result in clinician distress and burnout. Errors typically reflect systemic issues within the team, hospital, or industry rather than lack of care or effort.  

A culture of psychological safety in the clinic is necessary to allow open discussion of medical errors. All team members should feel comfortable providing input and voicing concerns without fear of judgement or reprisal. Staff should also know how and be encouraged to report medical errors. A key element of a culture of psychological safety is an approachable leader who is open, friendly, honest, and calm. 

This article describes a serious medication error and how the situation was addressed to illustrate key components of a culture of safety and a system-based approach to improvement. The authors discuss how complex work duties and long hours can contribute to medical errors. 

In the case, a hospitalized dog was administered an overdose of insulin that resulted in profound hypoglycemia and clinical deterioration. The clinician quickly took corrective actions and discussed the situation with the medical director, who was empathetic and able to provide coaching for communication with the patient’s owners. Following patient discharge, a multidisciplinary team of hospital leadership, clinicians, and nursing staff determined fatigue and high caseload may have contributed to the error. To help prevent future errors, a system was implemented in which all drugs with a narrow therapeutic index (eg, insulin) are checked by a second team member prior to administration.  

… The Takeaways 

Key pearls to put into practice: 

• A culture of psychological safety and adequate staffing can help limit and better address medical errors. 

• Clinics should have a system (eg, web form) for reporting errors, including narrowly missed mistakes and unsafe conditions. Staff will likely be more willing to report errors if they observe changes based on feedback given. 

• Clinic processes that may be prone to serious errors (eg, administration of drugs with a narrow therapeutic index) should be identified. Patient transfers may be at high risk for medical errors if salient information (eg, comorbidities, previous medications) is not conveyed to or received by incoming team members. Formal tools (eg, I-PASS handoff system) can help address and prevent such errors.² 

• Misdiagnoses and poor outcomes are not always a result of medical error. Hindsight and outcome biases can cause inappropriate second-guessing of reasonable diagnoses or actions.³