Absolute Medical Errors to Avoid: Guidelines for Audiologists

(1)

Absolute Medical Errors to Avoid:

Guidelines for Audiologists

James W. Hall III, Ph.D.

Clinical Professor

Department of Speech, Language and Hearing Sciences

College of Public Health & Health Professions

University of Florida

Gainesville, Florida

and

Extraordinary Professor

Department of Communication Pathology

University of Pretoria

South Africa

(2)

Medical Records:

Reasons for Demise on Actual Death Certificates



_“

_{Went to bed feeling well}

_…

_{woke up dead.}

_”



_“

_Don

_’

_{t know}

_…

_{never fatally ill before.}

_”



_“

_{Nothing seriously wrong.}

_”



_“

_{Blow to head. (Contributory cause was another}

man

’

_’

s wife.)

_{s wife.)}

”

_”



_“

_Don

_’

_{t know}

_…

_{died without the aid of a doctor.}

_”

St. Louis Genealogical Society

(3)



_{Rationale for}

_{a medical}

_{errors course}

_“

_{of, for, and by audiologists}

_”



_{Definitions of important terms}



_{Standard of care}



_{General steps for preventing errors and minimizing liability}



_{Professional responsibility, professional liability, and risk}

management in

audiology

_audiology



_{Patient scenarios}

_…

_{Errors and steps to prevent them (You make}

the call!)



_{Real examples of medico-legal cases in the state of Florida}



_{Questions and answers}

Absolute Medical Errors to Avoid:

Guidelines for Audiologists

(4)

 Most common medical errors committed by physicians and medical personnel



 DrugsDrugs



 Giving the wrong drugGiving the wrong drug



 Giving right drug to Giving right drug to wrong patientwrong patient



 Giving right drug to the right patient, but with the Giving right drug to the right patient, but with the wrong dosewrong dose



 Giving the right drug to the right patient with the right dose at the Giving the right drug to the right patient with the right dose at the wrongwrong

time

time 

 Giving the right drug to the right patient with the right dose at the Giving the right drug to the right patient with the right dose at the rightright

time via the wrong route (e.g., IV versus oral)

time via the wrong route (e.g., IV versus oral) 

 Giving two or more drugs that interact unfavorably or cause poisonousGiving two or more drugs that interact unfavorably or cause poisonous

metabolic byproducts

Absolute Medical Errors to Avoid:

(5)

 Most common medical errors committed by physicians and medical personnel

(continued)



 Wrong-site surgery, e.g.,Wrong-site surgery, e.g.,



 Amputating the wrong limbAmputating the wrong limb



 Operating on the wrong earOperating on the wrong ear



 Gossypiboma Gossypiboma or or textiloma textiloma ((WikipediaWikipedia))



 Definition: Definition: Gossypiboma Gossypiboma or or textiloma textiloma is the technical term for a surgicalis the technical term for a surgical

complications resulting from foreign materials, such as a surgical sponge,

accidentally left inside a patient's body.

accidentally left inside a patient's body. 

 The term The term "gossypiboma" "gossypiboma" is derived from the Latin is derived from the Latin gossypium gossypium (cotton) and(cotton) and

the Swahili

the Swahili boma _boma(place of concealment)_{(place of concealment)} 

 "Textiloma" "Textiloma" is derived from textile (surgical sponges have historicallyis derived from textile (surgical sponges have historically

been made of cloth) and the suffix

been made of cloth) and the suffix "-oma"_"-oma", meaning a tumor or growth._{, meaning a tumor or growth.} 

 Patients' implementation of drugs and treatmentsPatients' implementation of drugs and treatments

Absolute Medical Errors to Avoid:

(6)



List topics to cover in a

cerumen

management course



List reasons to obtain medical clearance before being

fit with

hearing aids



List things to examine during a biologic check of an audiometer



List tests to use when non-organic hearing loss is suspected



List clinical applications for

otoacoustic

emission



Explain the difference in information obtained in

otoacoustic

emissions and hearing testing



Identify information obtained through a tinnitus assessment

Absolute Medical Errors to Avoid:

(7)



_{Rationale for}

_{a medical}

_{errors course}

_“

_{of, for, and by audiologists}

_”



_{Definitions of important terms}



_{Standard of care}



_{Factors contributing to}

_“

_medical

_”

_errors

_in

_audiology



_Audiology

_{errors just}

_{waiting to happen}



_{Professional responsibility, professional liability, and risk}

management in

audiology

_audiology



_{Patient scenarios}

_…

_{Errors and steps to prevent them (You make}

the call!)



_{Questions and answers}

Absolute Medical Errors to Avoid:

Guidelines for Audiologists

(8)

Absolute Medical Errors to Avoid:

Defining Professional Liability

“An individual who causes injury to another either intentionally or

unintentionally can be held liable for the action. By virtue of

advanced knowledge, training, and skill, a professional has a

responsibility to conform to certain standards of conduct to

protect the public from unreasonable risks.

… The responsibility of licensed and/or certified professionals to

conform to those standards may be referred to collectively as

professional liability.”

ASHA Technical Report (1994). Professional Liability and Risk Management for the Audiology and Speech-Language Pathology Professions

(9)



 _{Civil professional liability (see ASHA, 1994)}_{Civil professional liability (see ASHA, 1994)} 

 _Tort_Tort_{from Latin for twisted or distorted}_{from Latin for twisted or distorted}_{): Any wrongful act, damage, or injury done}_{): Any wrongful act, damage, or injury done}

willfully or negligently



 _{Action in tort is a private legal action in which}_{Action in tort is a private legal action in which} 

 _{A plaintiff seeks a remedy (generally monetary) for damages to health,}_{A plaintiff seeks a remedy (generally monetary) for damages to health,}

property, peace of mind, or reputation



 _{The defendant is the health care provider to provided services to the plaintiff}_{The defendant is the health care provider to provided services to the plaintiff} 

 _{Plaintiff must prove defendant fault before payments are required from}_{Plaintiff must prove defendant fault before payments are required from}

defendant



 _{Intentional tort}_{Intentional tort} 

 _{Illegal actions were intentional}_{Illegal actions were intentional} 

 _{A reasonable person would conclude that the alleged result}_{A reasonable person would conclude that the alleged result}_{was substantially}_{was substantially}

certain to follow the action, e.g.,



 _{Assault (attempt to do violence)}_{Assault (attempt to do violence)} 

 _{Battery (unauthorized}_{Battery (unauthorized} _{physical contact), e.g. failure to obtain consent to}_{physical contact), e.g. failure to obtain consent to}

treat



 _{Defamation of character}_{Defamation of character} 

 _{Violation of confidentiality, e.g., unauthorized release of PHI}_{Violation of confidentiality, e.g., unauthorized release of PHI}

Absolute Medical Errors to Avoid:

Definitions of Important Terms

(10)



 _{Unintentional tort}_{Unintentional tort} 

 _{Most common form of negligence in civil litigation involving audiologists}_{Most common form of negligence in civil litigation involving audiologists} 

 _{Defendant (practitioner) failed to exercise standard degree of care, e.g.,}_{Defendant (practitioner) failed to exercise standard degree of care, e.g.,} 

 _Negligence_Negligence 

 _Misdiagnosis_Misdiagnosis 

 _{Incorrect or inadequate treatment}_{Incorrect or inadequate treatment} 

 _{Injuries from equipment or premises}_{Injuries from equipment or premises} 

 _{Harmful effects of human subject research}_{Harmful effects of human subject research} 

 _{Four elements of unintentional tort}_{Four elements of unintentional tort} 

 _{A legal duty}_{A legal duty} _{(practitioner/patient relationship) exists between audiologist and}_{(practitioner/patient relationship) exists between audiologist and}

plaintiff



 _{Breach of legal duty}_{Breach of legal duty} _{exists (e.g,. Improper diagnosis, physical injury)}_{exists (e.g,. Improper diagnosis, physical injury)} 

 _{Cause and effect established (proximate cause) between breach of}_{Cause and effect established (proximate cause) between breach of} _{duty and}_{duty and}

injury



 _{Injury results in actual loss or damage}_{Injury results in actual loss or damage}

Absolute Medical Errors to Avoid:

Definitions of Important Terms (2)

(11)



 _{Ethical practice complaints (not discussed today)}_{Ethical practice complaints (not discussed today)}



 _{Action in contract (see ASHA, 1994)}_{Action in contract (see ASHA, 1994)}



 _{A form of civil litigation}_{A form of civil litigation}



 _{Failure to fulfill promises and other obligations, e.g.,}_{Failure to fulfill promises and other obligations, e.g.,}



 _{Audiologists must never imply a guarantee of results of treatment}_{Audiologists must never imply a guarantee of results of treatment}



 _{Criminal liability}_{Criminal liability}



 _{Commission of misdemeanors or felonies during conduct of professional}_{Commission of misdemeanors or felonies during conduct of professional}

activities, e.g., activities, e.g.,   _Battery_Battery   _Fraud_Fraud 

 _{Grand larceny}_{Grand larceny}



 _{HIPAA violations}_{HIPAA violations}



 _{Often criminal liability reflects ignorance of regulations, e.g.,}_{Often criminal liability reflects ignorance of regulations, e.g.,}



 _{Medicare and Medicaid law}_{Medicare and Medicaid law}



 _{State insurance codes}_{State insurance codes}



 _{Audiologist is subject to fines and incarceration}_{Audiologist is subject to fines and incarceration}

Absolute Medical Errors to Avoid:

Definitions of Important Terms (3)

(12)



 _{Employer liability}_{Employer liability}



 _{Employer has}_{Employer has}_“_“_vicarious_vicarious_”_”_{responsibility (}_{responsibility (}_respondeat_respondeat_{superior) for those}_{superior) for those}

who work for them



 _{Unlicensed person inadequately supervised by licensed audiologist}_{Unlicensed person inadequately supervised by licensed audiologist}



 _{Support staff under supervision of an audiologist}_{Support staff under supervision of an audiologist}



 _{Product liability}_{Product liability}



 _{Audiologist drawn into third party liability litigation following dispensing of}_{Audiologist drawn into third party liability litigation following dispensing of}

a product or device, e.g.,



 _{Ingestion of hearing aid battery by a child}_{Ingestion of hearing aid battery by a child}



 _{Allergic reaction to electrode paste or an ear mold}_{Allergic reaction to electrode paste or an ear mold}



 _{Tinnitus worsened by sound generator that produces high frequency}_{Tinnitus worsened by sound generator that produces high frequency}

squeal



 _{Malfunctioning FM system contributing to academic failure}_{Malfunctioning FM system contributing to academic failure}



 _{Defective cochlear implant}_{Defective cochlear implant}

Absolute Medical Errors to Avoid:

Definitions of Important Terms (4)

(13)



_{Rationale for}

_{a medical}

_{errors course}

_“

_{of, for, and by audiologists}

_”



_{Definitions of important terms}



_{Standard of care}



_{General steps for preventing errors and minimizing liability}



_{Professional responsibility, professional liability, and risk}

management in

audiology

_audiology



_{Patient scenarios}

_…

_{Errors and steps to prevent them (You make}

the call!)



_{Real examples of medico-legal cases in the state of Florida}



_{Questions and answers}

Absolute Medical Errors to Avoid:

Guidelines for Audiologists

(14)

Absolute Medical Errors to Avoid:

Guidelines for Audiologists

"Those who fall in love with practice without science are

like a sailor who steers a ship without a rudder or

compass, and who can never be certain whither he is

going.”

(15)



_{Consistent with local, regional or national clinical practice}



_{Follows guidelines or recommendations on clinical practice}

approved by national multi-disciplinary professional committees or

panels, e.g., Joint Committee on Infant Hearing



_{Follows guidelines or recommendations on clinical practice}

approved by national professional organizations, e.g., AAA or ASHA



_{Is consistent with statements of}



_{Scope of Practice}



_{Code of Ethics}



_{Is in compliance with Federal guidelines for clinical practice and}

services, e.g., Joint Committee on Accreditation of Healthcare

Organizations (JCAHO)

Absolute Medical Errors to Avoid:

Standard of Care

(16)



 _{In tort law, the standard of care is the degree of prudence and caution required}_{In tort law, the standard of care is the degree of prudence and caution required}

of an individual who is under a duty of care.

(en.

wikipedia

_wikipedia

.

_.

org/wiki/Standard of_care

_{org/wiki/Standard of_care}

)

₎



 _{In tort law, the degree of caution that a reasonable person should exercise in a}_{In tort law, the degree of caution that a reasonable person should exercise in a}

given situation so as to avoid causing injury

(en.

wiktionary

_wiktionary

.

_.

org/wiki/standard_of_care

_{org/wiki/standard_of_care}

)

₎



 _{The degree or level of service, attention, care and protection that a person}_{The degree or level of service, attention, care and protection that a person}

owes another person according to the law (see also Duty of care).

(www.

ibc

_ibc

.

_.

ca/en/need_more_info/glossary/S

_{ca/en/need_more_info/glossary/S}

.asp)

_.asp)



 _{The level of care which all persons with a particular illness should receive; the}_{The level of care which all persons with a particular illness should receive; the}

level below which care would be considered substandard. standard therapy

(aids.

hallym

_hallym

.ac.

_.ac.

kr/dict/s

_kr/dict/s

.html)

_.html)

Absolute Medical Errors to Avoid:

(17)



 _{Treatment regimen or medical management based on commonly accepted}_{Treatment regimen or medical management based on commonly accepted}

practices.

(www.

(www.nortonhealthcare_{nortonhealthcare}.com/body._.com/body.cfm_cfm)₎



 _{It's the level of care, which an average practitioner would practice. Or in other}_{It's the level of care, which an average practitioner would practice. Or in other}

words how a similar qualified practitioner would manage their patient's care under

similar circumstances. Medical Malpractice claims must establish the standard of

care and show that the standard has been breached.

(

(www.gmlaw.com/medical-malpractice-resources-terms.cfm_{www.gmlaw.com/medical-malpractice-resources-terms.cfm})₎



 _{In medicine, treatment that experts agree is appropriate, accepted, and widely used.}_{In medicine, treatment that experts agree is appropriate, accepted, and widely used.}

Health care providers are obligated to provide patients with the standard of care.

Also called best practice and standard therapy.

(National Cancer Institute)



 _{This is the degree of cautionary action which must be performed at all times when}_{This is the degree of cautionary action which must be performed at all times when}

treating and/or performing surgery on a patient. If a breach of contract occurs, the

care provider can be held liable for negligence.

(

(www.cosmeticsurgerymalpractice.com/resources.cfm/malpractice-glossary.html_{www.cosmeticsurgerymalpractice.com/resources.cfm/malpractice-glossary.html})₎

Absolute Medical Errors to Avoid:

(18)



 _{Guidelines for different clinical practices, e.g.,}_{Guidelines for different clinical practices, e.g.,}



 _Diagnostic_Diagnostic_audiometry_audiometry_{in adults}_{in adults}



 _{Pediatric diagnostic}_{Pediatric diagnostic}_audiology_audiology



 _{Hearing aids and amplification}_{Hearing aids and amplification}



 _{Auditory processing disorders (APD) assessment and management}_{Auditory processing disorders (APD) assessment and management}



 _{Tinnitus assessment and management}_{Tinnitus assessment and management}



 _{Selected sources of guidelines}_{Selected sources of guidelines}



 _{V.A. guidelines by Joint Commission (}_{V.A. guidelines by Joint Commission (}

_Audiology

_Today)



 _{Tinnitus guidelines}_{Tinnitus guidelines}

₍

_{www.audiology.org}

₎



 _Audiologic_Audiologic_{assessment of children birth to 5 years.}_{assessment of children birth to 5 years.}

_{ASHA 2004}

_._.



 _{Joint Committee on Infant Hearing (JCIH) 2007 Statement}_{Joint Committee on Infant Hearing (JCIH) 2007 Statement}



 _{Guidelines for auditory processing disorders.}_{Guidelines for auditory processing disorders.}

_{AAA (2010)}



 _{Guidelines for}_{Guidelines for}_otoacoustic_otoacoustic_{emissions (}_{emissions (}_OAEs_OAEs_)._).

_{AAA (in progress)}

Best Practices in Audiology Today:

Specific Sources for Practice Guidelines

(Standard of Care)

(19)

Categories for Strength of Evidence used in

Developing Clinical Guidelines



_{Grade I:}

_{Evidence is strong and usually obtained from}

randomized controlled trials or well-designed clinical

studies.



_{Grade II:}

_{Evidence is from clinical studies that were}

based on retrospective data analysis, clinical trials that

were not randomized and/or carefully-controlled, or from

panel consensus based on existing guidelines and

practice patterns.



_{Grade III:}

_{Evidence is secondary in that it is based on}

current or long-standing practice without substantial

supporting basic or clinical data.

(20)



 _{Child and family history}_{Child and family history}



 _{Evaluation of risk factors for congenital hearing loss}_{Evaluation of risk factors for congenital hearing loss}



 _{Parental report of infant}_{Parental report of infant}_’_’_{s responses to sound}_{s responses to sound}



 _Audiological_Audiological_assessment_assessment



 _{Auditory brainstem response (ABR)}_{Auditory brainstem response (ABR)}



 _{Click-evoked ABR with rarefaction and condensation}_{Click-evoked ABR with rarefaction and condensation} _{single-polarity}_{single-polarity}

stimulation if there are risk factors for auditory neuropathy



 _{Frequency-specific ABR with air-conduction tone bursts}_{Frequency-specific ABR with air-conduction tone bursts}



 _{Bone-conduction stimulation (as indicated)}_{Bone-conduction stimulation (as indicated)}



 _{Auditory steady state response (ASSR) is optional}_{Auditory steady state response (ASSR) is optional}



 _Otoacoustic_Otoacoustic_{emissions (distortion product or transient}_{emissions (distortion product or transient}_OAEs_OAEs₎₎



 _Tympanometry_Tympanometry_{with 1000 Hz probe tone}_{with 1000 Hz probe tone}



 _“_“_{Clinical observation of infant}_{Clinical observation of infant}_’_’_{s auditory behavior.}_{s auditory behavior.}

_{Behavioral observation}

alone is not adequate for determining whether hearing loss is present in this

age group, and is not adequate for the fitting of amplification devices.

”

_”

Year 2007 JCIH Position Statement:

Protocol for Evaluation for Hearing Loss

(21)



 _{Caregiver concern regarding hearing, speech, language, or developmental delay.}_{Caregiver concern regarding hearing, speech, language, or developmental delay.}



 _{Family history of permanent childhood hearing loss}_{Family history of permanent childhood hearing loss}



 _{NICU stay of > 5 days or}_{NICU stay of > 5 days or}



 _ECMO_ECMO



 _{Assisted ventilation}_{Assisted ventilation}



 _{Exposure to}_{Exposure to}_ototoxic_ototoxic_medicines_medicines



 _{Hyperbilirubinemia}_{Hyperbilirubinemia}_{requiring exchange}_{requiring exchange} _transfusion_transfusion



 _In_In_utero_utero_{infections, e.g.,}_{infections, e.g.,}

  _CMV_CMV   _Herpes_Herpes   _Rubella_Rubella   _Syphillis_Syphillis   _{Toxoplasmosis}_{Toxoplasmosis} 

 _{Craniofacial anomalies,}_{Craniofacial anomalies,} _{including involvement of}_{including involvement of} _the_the



 _Pinna_Pinna



 _{Ear canals}_{Ear canals}



 _{Ear tags and pits}_{Ear tags and pits}



 _{Temporal bone anomalies}_{Temporal bone anomalies}

Year 2007 JCIH Position Statement:

Risk Indicators Associated with Permanent Congenital,

(22)



 _{Physical findings associated with a syndrome, e.g., white forelock}_{Physical findings associated with a syndrome, e.g., white forelock} 

 _{Syndromes associated with hearing loss, e.g.,}_{Syndromes associated with hearing loss, e.g.,} 

 _{Neurofibromatosis}_{Neurofibromatosis} 

 _{Osteopetrosis}_{Osteopetrosis} 

 _{Usher syndrome}_{Usher syndrome}   _Waardenburg_Waardenburg   _Alport_Alport   _Pendred_Pendred   _Jervell_Jervell   _{Lange-Nielson}_{Lange-Nielson} 

 _{Neuro-degenerative}_{Neuro-degenerative}_{disorders, e.g.,}_{disorders, e.g.,} 

 _{Hunter syndrome}_{Hunter syndrome} 

 _{Sensory motor neuropathies}_{Sensory motor neuropathies} 

 _Friedreich_Friedreich_ataxia_ataxia 

 _{Charcot-Marie-Tooth}_{Charcot-Marie-Tooth}_syndrome_syndrome 

 _{Culture positive post-natal infections associated with}_{Culture positive post-natal infections associated with}_{sensorineural}_{sensorineural}_{hearing loss, e.g.,}_{hearing loss, e.g.,}

Confirmed bacterial

Confirmed bacterial and viral meningitis_{and viral meningitis}



 _{Head trauma requiring hospitalization}_{Head trauma requiring hospitalization} 

 _Chemotherapy_Chemotherapy

Year 2007 JCIH Position Statement:

Risk Indicators Associated with Permanent Congenital,

(23)



 _{Prior (2000 JCIH) recommendations for follow up at 6-month intervals of all NICU}_{Prior (2000 JCIH) recommendations for follow up at 6-month intervals of all NICU}

graduates (approximately 400,000 babies annually) placed an excessive burden on

audiologists



 _{2007 JCIH shifts responsibility for surveillance of all infants to the primary care}_{2007 JCIH shifts responsibility for surveillance of all infants to the primary care}

provider who will refer to audiologists as needed, e.g.,:



 _{Concerns or findings consistent with hearing loss}_{Concerns or findings consistent with hearing loss}



 _{Risk factors for delayed/late onset or progressive hearing loss}_{Risk factors for delayed/late onset or progressive hearing loss}



 _{2007 JCIH recommends at least one}_{2007 JCIH recommends at least one}_audiologic_audiologic_{referral for low risk infants by age 24}_{referral for low risk infants by age 24}

to 30 months



 _{Early and more frequent referral (every 6 months) to audiologists for risk factors}_{Early and more frequent referral (every 6 months) to audiologists for risk factors}

associated with delayed onset and progressive hearing loss, e.g.,:



 _{Family history}_{Family history}



 _CMV_CMV



 _{ECMO therapy}_{ECMO therapy}



 _Potentially_Potentially_ototoxic_ototoxic_{chemotherapy (e.g.,}_{chemotherapy (e.g.,}_cisplatin_cisplatin₎₎



 _{Neurodegenerative disorders}_{Neurodegenerative disorders}

Year 2007 JCIH Position Statement Recommendations for Timing

and Frequency of Audiologic Follow up for Infants with Risk

Indicators Associated with Permanent Congenital, Delayed-Onset,

or Progressive Hearing Loss

(24)



_{Rationale for}

_{a medical}

_{errors course}

_“

_{of, for, and by audiologists}

_”



_{Definitions of important terms}



_{Standard of care}



_{General steps for preventing errors and minimizing liability}



_{Professional responsibility, professional liability, and risk}

management in

audiology

_audiology



_{Patient scenarios}

_…

_{Errors and steps to prevent them (You make}

the call!)



_{Real examples of medico-legal cases in the state of Florida}



_{Questions and answers}

Absolute Medical Errors to Avoid:

Guidelines for Audiologists

(25)



 _{Awareness and education of the audiologist}_{Awareness and education of the audiologist}



 _{Identify potential risks}_{Identify potential risks}



 _{Reduce risks by providing accepted standard of care}_{Reduce risks by providing accepted standard of care}



 _{Practice within the scope of}_{Practice within the scope of}_audiology_audiology



 _{Remain up to date with professional developments (formal and informal}_{Remain up to date with professional developments (formal and informal}

continuing education)



 _Know_Know



 _{State licensing laws}_{State licensing laws}



 _{Code of ethics}_{Code of ethics}



 _{Patient Bill of Rights}_{Patient Bill of Rights}



 _{Policies and procedures of hospital or other organization you would}_{Policies and procedures of hospital or other organization you would}

within or with



 _{Refer when you do not have knowledge, expertise, or credentials to}_{Refer when you do not have knowledge, expertise, or credentials to}

provide

provide a service the patient needs _{a service the patient needs}…_… “_“When in doubt, always refer out!_{When in doubt, always refer out!}”_”



 _{Verify licensure, certification, and other qualifications of professionals you}_{Verify licensure, certification, and other qualifications of professionals you}

refer patients to

Absolute Medical Errors to Avoid:

(26)



 _{Maintain professional credentials in}_{Maintain professional credentials in}_audiology_audiology_{, e.g.}_{, e.g.} 

 _{State license with required continuing education}_{State license with required continuing education} 

 _{Board certification with required continuation education}_{Board certification with required continuation education} 

 _{Specialty certification}_{Specialty certification} 

 _{Effective communication with patient and family, e.g.,}_{Effective communication with patient and family, e.g.,} 

 _{Establish positive relationship with patient and family}_{Establish positive relationship with patient and family} 

 _{Explain all test findings, treatment options, and treatment goals}_{Explain all test findings, treatment options, and treatment goals} 

 _{Fully disclose fees, billing schedules, etc}_{Fully disclose fees, billing schedules, etc} 

 _{Provide written warranties}_{Provide written warranties} _{and warnings}_{and warnings} 

 _{Secure patient signature on informed consent, release of information, and other}_{Secure patient signature on informed consent, release of information, and other}

documents documents



 _{Adequate verbal and written communication with patient and family}_{Adequate verbal and written communication with patient and family} 

 _{Documentation, record keeping, and reporting}_{Documentation, record keeping, and reporting} 

 _{Written documentation in official medical or clinic records}_{Written documentation in official medical or clinic records} 

 _{Documentation is legible and thorough}_{Documentation is legible and thorough} 

 _{Make corrections appropriately}_{Make corrections appropriately} 

 _{Document all contacts with patient and family (face to face, telephone, email)}_{Document all contacts with patient and family (face to face, telephone, email)} 

 _{Document all contacts with professionals}_{Document all contacts with professionals} _{regarding the patient}_{regarding the patient} 

 _{Retain all correspondence between}_{Retain all correspondence between} _audiologist_audiologist _{with or about the patient}_{with or about the patient}

Absolute Medical Errors to Avoid:

(27)



 _{Compliance with state and federal privacy and security regulations, e.g.,}_{Compliance with state and federal privacy and security regulations, e.g.,}



 _{Health Insurance Portability and Accountability Act (HIPAA) of 1996}_{Health Insurance Portability and Accountability Act (HIPAA) of 1996}



 _{Follow accepted policies for infection control, e.g.,}_{Follow accepted policies for infection control, e.g.,}



 _{Compliance with Joint Commission}_{Compliance with Joint Commission}



 _{Institutional policies}_{Institutional policies}



 _{Equipment calibration}_{Equipment calibration}



 _{Periodic physical calibration with documentation}_{Periodic physical calibration with documentation}



 _{Daily biological checks}_{Daily biological checks}



 _{Meet or exceed national standards of care for}_{Meet or exceed national standards of care for}_audiology_audiology

Absolute Medical Errors to Avoid:

(28)



_{Rationale for}

_{a medical}

_{errors course}

_“

_{of, for, and by audiologists}

_”



_{Definitions of important terms}



_{Standard of care}



_{Factors contributing to}

_“

_medical

_”

_errors

_in

_audiology



_{Professional responsibility, professional liability, and risk}

management in

audiology

_audiology



_{Patient scenarios}

_…

_{Errors and steps to prevent them (You make}

the call!)



_{Questions and answers}

Absolute Medical Errors to Avoid:

Guidelines for Audiologists

(29)

Absolute Medical Errors to Avoid:

Guidelines for Audiologists

“To err is human, to forgive is divine.”

“A little knowledge is a dangerous thing.”

Alexander Pope (1688-1744)

(30)



_{Audiologists are vulnerable to liability claims}



_{Important factors in reducing exposure to liability are}



_Awareness



_Education



_“

_{Risk exposure may be increased if services are provided for:}



_{Invasive procedures}



_{Specific disorders}



_{In certain physical settings}



_{For special populations}



_{Can you}

_{name some examples of the above?}

Absolute Medical Errors to Avoid:

Risk Exposure

(31)



_Improper

_procedure

_{treatment (25 claims)}



_{Most frequent category of}

_“

_malpractice

_”

_claim



_{Details not available}



_{Hearing aids (23 claims)}



_{11 claims}

_{related to ear mold material left in ear canal}



_{5 claims for dispensing}

_“

_wrong

_”

_{hearing aid}



_{1 claim for child swallowing a hearing aid battery}



_{Employment conflict (15 claims)}



_{Breach of confidence (remember}

_…

_{time period is pre-HIPAA!)}



_Slander



_Workmen

_’

_{s compensation}



_{Discrimination}



_{Physical injury to the ear/hearing}



_{Physical injury to other parts of the}

_body

Absolute Medical Errors to Avoid:

Claims Summary from Liability Insurance Broker (1)

(32)



 _{Physical injury to the ear/hearing (11 claims)}_{Physical injury to the ear/hearing (11 claims)}



 _{Damage to ear canal}_{Damage to ear canal}



 _{Hearing loss caused by assessment or treatment}_{Hearing loss caused by assessment or treatment}



 _{Tinnitus worsened by assessment or treatment}_{Tinnitus worsened by assessment or treatment}



 _{Physical injury to other parts of the body (11 claims)}_{Physical injury to other parts of the body (11 claims)}



 _{Burns to face from solvents or electrodes most common in category}_{Burns to face from solvents or electrodes most common in category}



 _{Eye damage}_{Eye damage}



 _{1 claim for shortness of breath during an examination (maybe SLP)}_{1 claim for shortness of breath during an examination (maybe SLP)}



 _{Improper diagnosis (10 claims)}_{Improper diagnosis (10 claims)}



 _{Improper or misdiagnosis (e.g., failure to diagnose hearing loss in young child)}_{Improper or misdiagnosis (e.g., failure to diagnose hearing loss in young child)}



 _{Injuries due to falls (9 claims)}_{Injuries due to falls (9 claims)}



 _{Patients who fell from examining tables or wheelchairs}_{Patients who fell from examining tables or wheelchairs}



 _{Falls are a major problem in health care facilities}_{Falls are a major problem in health care facilities}



 _{In 2000, the total direct cost of all fall injuries for people 65 and older exceeded}_{In 2000, the total direct cost of all fall injuries for people 65 and older exceeded}

$19 billion



 _{Fall prevention policies and regular education now mandatory in hospitals}_{Fall prevention policies and regular education now mandatory in hospitals}

Absolute Medical Errors to Avoid:

Claims Summary from Liability Insurance Broker (2)

(33)



_{Patient death (8 claims)}



_{Patient with heart attack}

_{in preparation for examination}



_{Fatal accident associated with}

_{travel to repair of defective hearing aid}



_{Distraught individual who killed her}

_{father after having}

_{a speech,}

language, and hearing

evaluation

_evaluation



_Sexual

_{harassment (3 claims)}



_{Property damage (3 claims)}



_{Failure to provide sufficient information (2 claims)}



_{Warning of medical risks was not provided}



_{Ex-employer who tested positive for}

_HIV

Absolute Medical Errors to Avoid:

Claims Summary from Liability Insurance Broker (3)

(34)



 _{Intra-operative monitoring (1 claim but largest}_{Intra-operative monitoring (1 claim but largest}_…_…_{> $1,000,000)}_{> $1,000,000)}



 _Examiner_Examiner_“_“_{failure to advise the surgeon}_{failure to advise the surgeon}_”_”_during_during_{somatosensory}_{somatosensory}_monitoring_monitoring



 _{False guarantee of results (1 claim)}_{False guarantee of results (1 claim)}



 _A_A_stutterer_stutterer_{was told he}_{was told he}_’_’_{d be cured in 2 days}_{d be cured in 2 days}



 _{Other (4 claims)}_{Other (4 claims)}



 _{Mistaken identity}_{Mistaken identity}



 _{Announcing death of wrong person}_{Announcing death of wrong person}



 _{Unspecified criminal/fraudulent act}_{Unspecified criminal/fraudulent act}



 _{Fatality and subpoena of the insured to serve as expert witness}_{Fatality and subpoena of the insured to serve as expert witness}

*

* Note: Majority (58%) of claims related to _{Note: Majority (58%) of claims related to}audiology_audiology. Data are not necessarily representative of_{. Data are not necessarily representative of}

audiology

audiology: 1)_{: 1)} include data for _{include data for}SLPs_SLPs, 2) only derived from one insurance company, 3) Only 1/3 of_{, 2) only derived from one insurance company, 3) Only 1/3 of} ASHA audiologists were covered by the carrier, 4) in medical settings audiologists are often

ASHA audiologists were covered by the carrier, 4) in medical settings audiologists are often covered by institutional

covered by institutional professional liability, not_{professional liability, not} the ASHA carrier_{the ASHA carrier}

Absolute Medical Errors to Avoid:

Claims Summary from Liability Insurance Broker (4)

(35)



_{Rationale for}

_{a medical}

_{errors course}

_“

_{of, for, and by audiologists}

_”



_{Definitions of important terms}



_{Standard of care}



_{General steps for preventing errors and minimizing liability}



_{Professional responsibility, professional liability, and risk}

management in

audiology

_audiology



_{Patient scenarios}

_…

_{Errors and steps to prevent them (You make}

the call!)



_{Real examples of medico-legal cases in the state of Florida}



_{Questions and answers}

Absolute Medical Errors to Avoid:

Guidelines for Audiologists

(36)

Absolute Medical Errors to Avoid:

Guidelines for Audiologists

“I will use treatment to help the sick according to my ability

and judgment, but never with a view to injury and

wrongdoing.”

Hippocratic Oath (c. 460-400 B.C.)

(37)



 _{Inadvertent over-stimulation of patient due to audiometer settings}_{Inadvertent over-stimulation of patient due to audiometer settings}



 _{Middle ear complications following ear mold impressions}_{Middle ear complications following ear mold impressions}



 _{Acoustic reflex measurement in}_{Acoustic reflex measurement in}_hyperacusis_hyperacusis



 _{Inadvertent over-stimulation of patient due to audiometer settings}_{Inadvertent over-stimulation of patient due to audiometer settings}



 _{Patient with severe tinnitus commits suicide}_{Patient with severe tinnitus commits suicide}



 _{Patient with APD and TBI loses job}_{Patient with APD and TBI loses job}



 _{Failure to diagnose infant with hearing loss}_{Failure to diagnose infant with hearing loss}



 _{Failure to diagnose a child with APD and resultant academic failure, reading}_{Failure to diagnose a child with APD and resultant academic failure, reading}

disorder, psycho-social problems



 _{Failure to diagnose BPPV}_{Failure to diagnose BPPV}



 _{Recommendation for cochlear implant in post-synaptic ANSD}_{Recommendation for cochlear implant in post-synaptic ANSD}



 _{Over-amplification of patient with mild hearing loss}_{Over-amplification of patient with mild hearing loss}



 _{Loss of hearing and facial nerve function during intra-operative monitoring}_{Loss of hearing and facial nerve function during intra-operative monitoring}



 _{Inadequate management with hearing aids}_{Inadequate management with hearing aids}



 _{Noise induced hearing loss following}_{Noise induced hearing loss following}_audiologic_audiologic_{assessment (e.g., failure to}_{assessment (e.g., failure to}

provide adequate education (or to document) about hearing protection leading

to noise induced hearing loss

Absolute Medical Errors to Avoid: