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#74687 - 06/23/07 10:23 AM
Critical Errors & MT's Role in Risk Management
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ebadrake
Moderator
Registered: 10/08/03
Posts: 2104
Loc: Tavares, FL; Peachtree City, G...
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This is no criticism of the types of posts we usually have on the Grammar forum. We're MTs--attention to detail is our middle name, and no detail is too small to merit our attention. However, so much of what we take the time to discuss (sometimes ad infinitum or ad nauseam) has little consequence in terms of patient care or the quality of documentation.
I used to tout critical thinking and problem-solving as the key characteristics that set us MTs apart and ensure a place for us in the ever-changing and challenging future of healthcare. The tag line for my signature was "MTs are critical thinkers and problem solvers. Every word transcribed is a decision made, a problem solved." I stopped using the tag line because, frankly, I don't see a lot of evidence to support that declaration.
This post is an attempt to collect evidence to support the notion that MTs are, indeed, critical thinkers and that one of our biggest contributions to healthcare is the ability to identify and correct, edit, or flag medical errors, discrepancies, omissions, and any other detail that might affect a patient's care.
Please post examples of the above, being as complete and thorough as possible without violating HIPAA rules and regulations or ethical standards of your company. Please do NOT post grammar issues like subject-verb agreement or punctuation issues. What I HOPE to collect are examples of true critical medical CONTENT issues that could have affected patient care had you not caught the problem and done something to correct it.
If anyone has old issues of Perspectives, I wrote an article called “Managing Risks with the MT Team.” Winter 1994-95, 20-22. That's the kind of evidence I'm looking for.
Thanks,
Ellen
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#74693 - 06/23/07 10:42 AM
Re: Critical Errors & MT's Role in Risk Management
[Re: ebadrake]
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SusanT
Member
Registered: 07/10/04
Posts: 259
Loc: Southern California
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Just a couple days ago I had an ER physician dictate "the patient is a Jehovah's Witness..." Later in the report she said the patient was a Christian Scientist. I flagged the discrepancy. It could potentially be an issue if the patient needed a blood transfusion.
Susan
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#74696 - 06/23/07 11:05 AM
Re: Critical Errors & MT's Role in Risk Management
[Re: SusanT]
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straws
Member
Registered: 12/15/00
Posts: 2809
Loc: in limbo
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It is simply a case of ENGAGE THY BRAIN!
I think many MTs are typing more of what they hear and not more of what they SHOULD BE hearing. I have little patience for "Marisa infections" (MRSA), only to be told "but I found it....on Google." At what point Google became a valid medical reference is beyond me.
MTs have GOT TO get past THAT mentality and move onto transcribing for context. So many are either poorly trained to begin with, have had poor QA support over the years, or are SO distracted by whatever that they simply do not meet those minimums; how do we expect them to go above and beyond to the extent of transcribing without context and flagging discrepancies. Sorry, if they don't realize there is no "Marisa infection", how are they going to catch the errors doctors are making?
And, yes, I DO expect them to go above and beyond. I do it, I expect others to as well.
With the "I type what I heard" or "I found it on Google" mentality, we, as a group, are lowering our own standards and INVITING replacement by computers and chimps.
Sorry for not giving a positive example; I have not been seeing a lot of it coming across my desk recently.
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#74697 - 06/23/07 11:21 AM
Re: Critical Errors & MT's Role in Risk Management
[Re: straws]
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Gisele Dubson
Member
Registered: 05/28/99
Posts: 5608
Loc: Boulder, CO, USA
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I think very few MTs have sufficient education to be called part of the risk management team. There is NO educational requirement whatsoever to do this work, and until there is, I wouldn't nominate MTs to be members of that team. There are times when I simply cannot tell if what a doctor is dictating is actually correct. I transcribe what I hear, flag anything I'm in doubt over, but it's the dictator's responsibility to look at my product and verify that it's correct.
_________________________
Gisele F. Dubson, RHIA, Mercury Medical Communications
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#74699 - 06/23/07 11:28 AM
Re: Critical Errors & MT's Role in Risk Management
[Re: ebadrake]
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mptang
Member
Registered: 10/24/99
Posts: 3145
Loc: Freedonia
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the one I see most often is a drug in a current med list that patient was supposedly allergic to in the aforementioned allergy section.
WTF?
gotta stay awake to catch these.
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#74706 - 06/23/07 11:52 AM
Re: Critical Errors & MT's Role in Risk Management
[Re: ebadrake]
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Shadowed_by_3
Member
Registered: 03/08/05
Posts: 299
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Radiographic Findings: The MRI shows a large disc protrusion at lumbosacral.
Plan: The patient will be scheduled for lumbar microdiskectomy at L4-L5.
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#74710 - 06/23/07 12:00 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: mptang]
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haggis
Member
Registered: 04/29/04
Posts: 2565
Loc: Left Coast, FL
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I agree. Drug errors are the thing I have to flag most often--wrong meds given (often a soundalike or one stated as an allergy elsewhere), weird dosages (which we can't be expected to always catch, but sometimes they're obvious, i.e. Synthroid 125 "mg"), and sometimes pronunciations mangled so badly it's not possible to figure out what they really meant. I have one annoying woman who tries to go so fast that she routinely messes up at least one--and sometimes several--meds. My most recent catch was a patient in for angioplasty and stenting, and the dictator made a big point of stating he was sent home on his previous home medications plus "Prevacid" 75 mg daily. Gisele, we may not be educated enough to make these kinds of corrections FOR a doctor, but I have to believe we're performing something approaching quality control by flagging them so he/she can. When I've flagged something deadly like methotrexate 15 mg per DAY, I imagine that doctor sucks wind in a big way when they see that questioned.
Of course, into my fifth year I've just seen the first evidence a dictator actually paid attention to my flags and went through to correct them. . . It's a pretty sad commentary that the majority must be found by subsequent doctors reading through old chart notes.
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#74711 - 06/23/07 12:10 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: ebadrake]
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SandWitch
Member
Registered: 04/24/04
Posts: 622
Loc: Sarasota, Florida
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Not sure if this is what you are after or not. Not 20 minutes ago I transcribed a discharge summary where, in the discharge medication paragraph, the physician dictated both atenolol 100 mg 1 tablet daily and, after several more medications, Tenormin 100 mg 1 tablet daily. I blanked the Tenormin with a note that he had already dictated atenolol.
He had also dictated Risperdal/dose/dosage twice (exactly the same) in the paragraph, but I did not leave a blank as that was blatantly a duplication. I simply did not transcribe it twice.
Edited to add: This was one in a series of multiple backlogged discharge summaries by this dictator. This is an acute care account. This is his habit. He does not dictate his discharge summaries in a timely fashion and waits until the MRD hands him a pile of charts to dictate. It is 2 months after the patients were discharged and he is now perusing these charts.
Edited by SandWitch (06/23/07 12:16 PM)
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#74712 - 06/23/07 12:12 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: haggis]
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Gisele Dubson
Member
Registered: 05/28/99
Posts: 5608
Loc: Boulder, CO, USA
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Well, one MT will know that Synthroid is dosed in mcg, not mg, but another will not. Someone might be working so fast to meet TAT, they simply miss it. There is also no guarantee that an MT will not introduce an error into a report, typing mg when the dictator clearly said mcg. What then?
_________________________
Gisele F. Dubson, RHIA, Mercury Medical Communications
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#74713 - 06/23/07 12:28 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: Gisele Dubson]
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inkyfingers2
Member
Registered: 03/25/03
Posts: 596
Loc: southern California
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You may think this grasping at straws, but...
I have one female doc who consistently states, on letters where the plan is for the patient to undergo surgery, "I described the procedure, including indications, risks and benefits, with the patient's parents, and they wish to proceed."
Obvious to me because of my years as an RN and training in fully informed legal consent is that you don't just describe with the parents (also a grammar problem), and that she could actually be letting herself in for legal trouble if there is not actually discussion of the procedure, et cetera, to indicate that there was feedback and that questions were asked and answered, and my critical thinking skills justify my changing her words to state discussion instead of description taking place.
I might add that I have another doc who has actually had several lawsuits in the last 3 years regarding fully informed consent, issues of allegedly just being told things instead of a discussion having occurred.
_________________________
inkyfingers
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#74715 - 06/23/07 12:40 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: inkyfingers2]
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Gisele Dubson
Member
Registered: 05/28/99
Posts: 5608
Loc: Boulder, CO, USA
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I would absolutely not change the word description into discussion. You weren't there, and you don't know that discussion took place. I think this is an excellent example of what MTs should not be doing.
_________________________
Gisele F. Dubson, RHIA, Mercury Medical Communications
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#74717 - 06/23/07 01:02 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: Gisele Dubson]
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haggis
Member
Registered: 04/29/04
Posts: 2565
Loc: Left Coast, FL
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Well, one MT will know that Synthroid is dosed in mcg, not mg, but another will not.
That might not seem so alarming if you'd use a different example--isn't thyroid supplement common enough that any of us should recognize 125 mg as an error?
As for changing intent, inky? You're on your own there. I'm afraid you couldn't justify changing a word for something greater than, say, fixing a verb tense. Our job is never to change the meaning. In making legal decisions (I didn't know RNs or MTs were trained as legal counsel!), you've clearly stepped out of bounds. This is the kind of thing that gives legs to that moronic idea that MTs need to have E&O insurance and have real responsibility for the content of medical records.
IMHO, the value of a good MT is that we're as accurate as possible and MAY flag obvious problems to the dictator. To try to sell us as something that WILL catch errors or even "fix" them on our own is outside our purview.
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#74718 - 06/23/07 01:12 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: Gisele Dubson]
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straws
Member
Registered: 12/15/00
Posts: 2809
Loc: in limbo
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I would absolutely not change the word description into discussion. You weren't there, and you don't know that discussion took place. I think this is an excellent example of what MTs should not be doing.
I agree with Gisele on this one. I've had numerous times when doctors come in, state what they ARE going to do, and do not allow for any discussion at all. Of course, that doesn't fly with me, but you get the point. Many docs do simply describe and not discuss; if they want to lessen their liability, then THEY should be the ones to change it. I wouldn't change that, nor would I think to change that.
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#74719 - 06/23/07 01:15 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: haggis]
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AnnR
Member
Registered: 12/31/69
Posts: 18431
Loc: Ocean Park WA
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but "thyroid supplement" may also mean something other than Synthroid, i.e. for example Armour thyroid (in other words desiccated porcine thyroid gland), and 120 mg (2 grains) is a common dose of that
_________________________
so many docs dictate stuff that makes sense only to them. . .
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#74720 - 06/23/07 01:16 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: haggis]
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Gisele Dubson
Member
Registered: 05/28/99
Posts: 5608
Loc: Boulder, CO, USA
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Well, one MT will know that Synthroid is dosed in mcg, not mg, but another will not. That might not seem so alarming if you'd use a different example--isn't thyroid supplement common enough that any of us should recognize 125 mg as an error?
Well, I've going into my 17th year of MTing (including proofing the work of other MTs), and I've simply stopped being surprised at the things that some MTs do not know. If you could make some kind of requirement that MTs know these simple things before they are allowed near a medical record, that would be great, but I see no sign of that happening.
_________________________
Gisele F. Dubson, RHIA, Mercury Medical Communications
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#74723 - 06/23/07 02:11 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: Gisele Dubson]
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ebadrake
Moderator
Registered: 10/08/03
Posts: 2104
Loc: Tavares, FL; Peachtree City, G...
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I'm afraid to post a follow-up because I don't want to stop the thread. Thanks, everyone, who has contributed examples of errors in dictation. Please keep the examples coming. I've made this a sticky post so it will stay near the top for awhile.
In leaving blanks and/or flagging medical content you are uncertain of, Gisele, aren't you, in essence, helping in risk management? I'm not and never would suggest that MTs be the sole arbiters of risk, but I think we perform a valuable service in pointing out discrepancies. I don't think pointing out discrepancies (flagging) means that the MT is taking on the responsibility for the content of the document, either.
Also, I would NOT recommend that MTs change medical content except for very minor cases like changing mg to mcg when Synthroid was dictated. Even then, I would ALWAYS flag ANY change except for grammar and punctuation. Some may argue, however, that changing any medical content is assuming responsibility, and therefore, risk.
The AAMT Model Curriculum does include a competency (P3) that states "The student will recognize, evaluate, and call attention to inconsistencies, discrepancies, and inaccuracies in healthcare dictation while transcribing, without altering the meaning of the dictation or changing the author's style."
True, there is no requirement that anyone even go to school to become an MT and no requirement for a credential. However, any organization hiring MTs (whether it be a hospital, an MTSO, a physician or a clinic) should consider the potential for the untrained, uncredentialed, and unthinking MT to cause the patient harm as well as adding to the dictator's and/or the facility's legal liability.
I've had my article, which was written in 1994 scanned, but since they scanned the 2nd page twice, I have to go back and have them scan the third page. When I get it rescanned, I'll make it available to anyone who wants to read it.
Ellen
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#74724 - 06/23/07 02:16 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: ebadrake]
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thisismyusername
Member
Registered: 06/04/04
Posts: 653
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The patient's diagnosis was anemia, pending transfusion. Under lab values, the doctor dictated, "Hemoglobin 8, hematocrit 91."
I placed a flag for the hematocrit value.
Edited by thisismyusername (06/23/07 02:19 PM)
_________________________
I think that 1 of the poisons America faces is from a generation of well-educated triangulators.
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#74725 - 06/23/07 02:19 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: ebadrake]
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MicheleA
Member
Registered: 02/18/05
Posts: 1009
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My example doesn't affect patient care but it is certainly a legal issue, although it may not have much of an impact there, either. Anyway, it is a discrepancy I pick up on so I act on it.
When I type a letter for a certain doc and he wants a copy to go to the patient but the patient is a minor, I always add "The parents of ___________" instead of just the patient's name. If he does not dictate an age but I have a suspicion that the patient might be a minor or if no age is given but he says that the patient presented with his or her mother or father, I can call my contact person in the office and she will check the computer and/or chart. If I can't reach her, I flag it and ask if the patient is a minor.
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#74726 - 06/23/07 02:28 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: ebadrake]
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Gisele Dubson
Member
Registered: 05/28/99
Posts: 5608
Loc: Boulder, CO, USA
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In leaving blanks and/or flagging medical content you are uncertain of, Gisele, aren't you, in essence, helping in risk management? I'm not and never would suggest that MTs be the sole arbiters of risk, but I think we perform a valuable service in pointing out discrepancies. I don't think pointing out discrepancies (flagging) means that the MT is taking on the responsibility for the content of the document, either.
Honestly, I don't think of it that way, and I don't know anyone in HIM who does. For me, it's a case of either, "I can't hear this word, please fill in the blank," or, "Is this what you meant to say?" Since I cannot affirm that I would always know when a dictator makes an error, I would not claim to be performing risk management. I'm just not up for that amount of liability.
_________________________
Gisele F. Dubson, RHIA, Mercury Medical Communications
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#74727 - 06/23/07 02:54 PM
Re: Critical Errors & MT's Role in Risk Management
[Re: Gisele Dubson]
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straws
Member
Registered: 12/15/00
Posts: 2809
Loc: in limbo
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"...but I think we perform a valuable service in pointing out discrepancies. "
Yes, we do, IF we know what they are. If you put an MT who has been stuck in neurology forever on an OB/GYN account, I guarantee they are not going to pick up on dictator errors.
The other problem is, we are only privy to the record at hand. If there is an obvious error in the record at hand (patient had a hysterectomy but then has full female anatomy including measurements in the physical exam), I can flag that for the clinic. However, if the doc doesn't mention a hysterectomy in this record, because it was mentioned on the previous one, and they go on to dictate full female anatomy, it is not only a dictator error, but one I would never catch.
Here is yet ANOTHER problem...doctors don't get it. If they dictate a complex patient name with a first name of Jim, and all they spell is "Jim", they often assume we should know how to spell the last name. They are the ones holding the chart, but WE are supposed to know what is contained in it. It doesn't matter to me if I transcribed on "Jim" yesterday; we not only do not always have the ability to recall that record, nor is it part of our job, but they may have made changes in the office that we, again, are not privy to.
This is obviously not a medical error I'm referring to, but it is a sloppy HIPAA area.
I don't extract from old records. I don't presume to know that patient's history. I can transcribe according to the context of the current record and will gladly let them know when they dictated an allergy to penicillin as well as a prescription for penicillin to the same patient, or maybe right/left confusion, but I'm not going much beyond that.
The more we clean up for the docs, the more we are 1) enabling them to slop through records and 2) setting ourselves up as scapegoats.
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Moderator: ebadrake
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