How Should Nurse Practitioners Apologize for a Medical Error?

Making mistakes is part of being human. None of us are perform perfectly at all times. Unfortunately, a career as a nurse practitioner doesn't lend itself to the errant tendency of human nature. In caring for patients we must be on top of our actions at all times. A misstep can carry serious consequences for you, the NP, and your patients. Last month, I discussed steps to take after you make a medical error. Step 1? Admit the mistake. Here's how.

Apologizing for a medical error can seem like stepping on a land mine. If you admit your mistake, will your patient respond with a malpractice lawsuit? How will your employer react to your error? Will a misstep land itself on your permanent record in the National Provider Databank? Given the potential repercussions of disclosing an error in patient care, many nurse practitioners understandably conclude that keeping mum is their best bet. Research regarding medical errors and their consequences, however, recommends otherwise.

Liability is naturally a primary concern of healthcare providers when a medical error is made. A disclosure program based out of the University of Michigan shows their concerns may be misplaced. The program found that apologizing for medical errors reduced patient malpractice claims. Comparing periods before and after implementation of the disclosure program, the university saw claims drop by 36%.

Offering an apology to the patient when a medical error occurs is essential for continued, appropriate care of the patient and to reducing liability risk on part of the nurse practitioner (not to mention, it's the right thing to do). The U.S. National Quality Forum has studied the best methods for offering an apology. Their recommended method is as follows:

  1. Begin by informing the patient that an error has occurred. Let the patient know what happened and how or why. Describe the course of events using language the patient can easily understand rather than technical, medical terminology. 
  2. Inform the patient as to the potential consequences of the mistake and the actions that have been or will need to be taken to correct the error. 
  3. Express regret and apologize. An apology must be sincere, empathetic and personal. Statements like "I'm sorry this happened to you" don't count. 
  4. Allow the patient to ask questions and express concern. Answer any questions the patient might have and address concerns.
  5. Lay out the next steps for the patient. What is the plan? When will you have contact with the patient next? Make sure the plan is clearly understood and in writing. 

Admitting fault personally or professionally isn't an easy task. Fear and ego interfere with our intention to apologize. But, as a nurse practitioner, ignoring a medical error is the worst thing you can do - it may result in harm to the patient, damage your professional credibility, and ultimately lead to legal action taken against you. If you make a mistake in your practice, to any degree, own up and adhere to your organization's guidelines for disclosing medical errors. 

 

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