When things go wrong get better not bitter General Practice Perspective

Transcription

1 When things go wrong get better not bitter General Practice Perspective Chris Moughan Medical Advisor, Treatment Injury Centre MB ChB, FRNZCGP, DipObst, DipOccMed Sreekanth Konda Clinical Analyst, Treatment Injury Centre MBBS, Pgdip in Public Health

2 Agenda You don't know what you don't know maybe we can help? What is a treatment injury? How can ACC help your patient? All about data: Sharing information to enhance patient safety Adverse event notifications Case studies

3 Defining Treatment Injury Section 32 Accident Compensation Act 2001: Personal injury suffered by a person Caused by treatment received from, or at the direction of, a registered health professional Physical Injury bodily damage not just symptoms / signs

4 Defining Treatment Injury Personal (physical) injury caused by treatment AND Not a necessary part, or ordinary consequence, of the treatment Not simply a case of treatment failing to achieve the desired result.

5 Ordinary Consequence 7 year old boy receives penicillin injection standing in upper/outer quadrant buttock Returns following day with bruising around the injection site Not a treatment injury.

6 Not Ordinary Same boy, returns with pain down leg and foot drop Injection caused sciatic nerve injury ACC accepts claim Report event to DGOH See case study 47 Wrong site of ventrogluteal injection 2012

7 Why lodge claims?

8 Treatment Injury national profile Claims decided by region Common accepted Treatment Injuries 15% Auckland 20% Related to infections commonly SSI s 9% 9% 12% Related to adverse drug reaction claims to antibiotic and other drugs 10% Canterbury Wellington 8% of the claims were related to Haematoma bruising after IV cannulation * Data was collated from the claims decided by ACC between July 2005 and May 2015

9 Bird s eye view of General Practice 3% 5% 3% 5% Ethnicity 1% European Maori Asian 9% 74% Pacific Peoples Residual Categories Other Ethnicity 28% Middle Eastern/Latin American/African * Data was collated from the claims decided by ACC between July 2005 and May 2015

10 Common Themes in General Practice 50% Related to adverse drug reaction claims to routine antibiotic usage 29% Related to infection claims were related removal of skin lesions and cryotherapy treatment 4 % of the claims were related to Haematoma bruising Adverse Drug reactions Infection Haematoma- Bruising Vaccination Removal skin lesions Vascular access failure Prescription Cryotherapy Injection * Data was collated from the claims decided by ACC between July 2005 and May 2015

11 Reporting Belief of Risk of Harm ACC Statutory Responsibility Section 284: Reasonable belief of risk of harm Use only cover decision information Review accepted and declined claims Notify Director General of Health (monthly) Facility identifiers only Registration authorities (extraordinary) Must have peer advice Peer advice must be critical of standards Sentinel and serious events may be notified Shouldn t be unknown to facility

12 Common Themes in Adverse Events related to General Practice Medication Adverse Drug Reaction Allergic reaction Anaphylactic reaction Treatment omission Delay / failure to diagnose Delay / failure to provide treatment Medication Omission Medication prescribing Medication Administration

13 Case studies

14 Failure to treat? 43 year old male consults with GP for a chest infection. Antibiotics prescribed At end of short consultation patient advises his father had been diagnosed with bowel cancer at age 55 and died at age 59 GP recommended a screening colonoscopy at age 45 and provided a lab form for cholesterol test.

15 Failure to treat? Patient turned 45 but did not return to GP to arrange colonoscopy GP did not contact patient to remind Patient finally had cholesterol test performed. Normal Patient did not return to GP clinic again until just before diagnosis of bowel cancer at age 47 Patient subsequently died of metastatic bowel cancer.

16 Failure to treat? Claim was lodged with ACC for treatment injury Basis of claim that GP should have recalled the patient at age 45 for colonoscopy ACC sought advice from an independent expert peer GP Expert referred to NZ Guidelines Group s Surveillance for people at increased risk of colorectal cancer, January 2012.

17 Failure to treat? Independent expert GP concluded (in part): The GP took a cautious approach and offered colonoscopy at age 45. Should the GP have recalled the patient? In my opinion, unless the GP quite clearly told the patient that he would recall him at age 45, he discharged his duty and acted properly according to currently understood practice. ACC declined claim.

18 Failure to treat? Decision upheld at Review and in the District Court. Another expert GP opinion obtained: The doctor fulfilled his obligation to his patient by recommending a colonoscopy at 45 and did not thereby take on any obligation for ensuring that this happened. This advice is supported by that of a number of colleagues whose opinion I have sought.

19 Metallosis 57 year old female with acetabular dyplasia and OA Elective metal on metal hip replacement 2 years later pain and unable to walk Serum cobalt 314 nmol/l, chromium 380 nmol/l USS abnormal soft tissue thickening See case study 45 Failure of Hip Replacement published June 2012

20 Nitrofurantoin lung disease 62 year old female diabetic/hypertensive/hyperthyroid 2 year Hx of UTIs treated with Nitrofurantoin C/o SOB, cough and recurrent infections X-ray showed extensive disease and CT interstitial fibrosis See case study 48 Prolonged Nitrofurantoin Usage published September 2012

21 Temporal arteritis 74 year old female, history of RA and PMR C/o bitemporal headache sinusitis 2/52 later facial pain on chewing,?transient visual disturbance. Dx still sinusitis Admitted to hospital 1/52 later with sudden visual loss temporal arteritis GP ECA: not an easy diagnosis, but classical presentation and should not have been missed See case study 53 Delay in Diagnosis published March 2012

22 Warfarin haemorrhage 82 year old female developed AF PMHx HT, mild RF, aortic valve homograft CHAD score/cardiologist recommend Warfarin Patient not keen in blood tests 9 months later collapsed and died CT intracerebral haemorrhage See case study 22 Warfarin and Aspirin published May 2010

23 And finally. Providers Targeted & appropriate lodgement Consent ACC Sharing information Case Studies > for providers > clinical best practice > treatment injury case studies Feedback Welcome

24 Bio s Dr Chris Moughan is Medical Advisor to the Treatment Injury Centre, ACC Wellington. Chris graduated from Otago University in FRNZCGP GP and GP Obstetrician, in Hastings from Chris has also worked in Occupational Medicine from 2000, and has been Medical Advisor to the Treatment Injury Centre since Sreekanth is a medical graduate from India with a post graduate diploma in public health from New Zealand. Due to his interest in public health and policy, he worked previously as a Research analyst for a public health organisation and as a health advisor for a Maori health organisation in Hawkes Bay NZ. Sreekanth has worked as a Clinical Analyst for the Treatment Injury Centre since 2011 and is involved in the Centre s activities to support quality of healthcare by sharing information, sector engagement and case study publications.