Nurses may have to admit drug errors to patients

1 June 2010 | By Clare Lomas

Nurses could soon be legally bound to inform a patient after they have made a drug or other treatment error, under plans being considered by the Department of Health.

Nursing Times has learnt that discussions are about to begin on a proposal to introduce a “corporate duty of candour” on treatment errors, which was included in the government’s coalition agreement document published last month.

The move, which also formed part of the Liberal Democrats original health manifesto, “will require hospitals to be open about mistakes and always tell patients if something has gone wrong”.

The charity Action against Medical Accidents has told Nursing Times it is meeting with the Department of Health and other interested parties next week to discuss the proposal.

The charity’s chief executive Peter Walsh said trusts failing to demonstrate compliance with it should have their registration reviewed by the Care Quality Commission..

He said a “duty of candour” should not be specific to clinical staff but should apply to trust chief executives and all board members involved in healthcare provision.

A Department of Health spokeswoman said it was “essential” to be honest with patients when things went wrong and that a decision on how to take the proposal forward “will be reached in due course”.

A survey on drug errors, carried out by Nursing Times, suggests that such a move would be supported by a majority of nurses.

Of the 1,900 nurses who responded to the online survey on medication administration, 45 per cent said it should become mandatory for patients to be made aware of drug errors, whether or not the error resulted in harm to the patient. Only 7 per cent of respondents were completely against the move, while 34 per cent said patients should only be informed if they were harmed or their condition changed as a result of the error.

Foundation of Nursing Studies chief executive Theresa Shaw said: “Although it may be hard to admit to a patient that a drug error has been made, if patients feel [nurses] are being honest with them it could increase trust in the longer term. Trying to hide it will inevitably backfire.”

Readers' comments (22)

Sandra Joyce Powell | 2-Jun-2010 9:04 am
i am not too sure about this one , surely telling the patient that you have made a drug error will cause them stress, are doctors going to have to admit errors in surgery also.

i really do not know where this is going.
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Anonymous | 2-Jun-2010 9:59 am
i would want honesty if i was the patient, but i can see stress it may cause to someone who is not educated in medicine... i'm sure my bank wouldn't own up if they made a bad investment with my money... business and ethics huh!
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Anonymous | 2-Jun-2010 10:25 am
They can forget that! Not unless every patient signs a waver on entry saying they will not sue us personally or destroy our careers!
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Anonymous | 2-Jun-2010 12:16 pm
I've been a nurse for 9 years, and I honestly thought we already had to tell patients if we made a drug error to them. Surely it is what is right and ethical! I DID make a drug error, and I DID tell the patient. It was the hardest bit of the process, but I did not go in to nursing to cause others harm, intentional or otherwise. I treat others as I wish to be treated! Yes of course it could cause stress, and the information should be delivered in an appropriate way, outlining the possible side effects and what monitoring will be required. My patient was also aware of the consequences to my actions, I was disciplined, and systems were changed as a result. He was happy with the outcome, and also felt I was a little harshly delt with! Surely we are supposed to be creating a culture of trust!
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Anonymous | 2-Jun-2010 5:38 pm
Unless Trust's and the Government are seriously going to addresss the factors that can contribute to drug errors, then we may as well put a set of stocks outside the ward and we can be pilloried there. drug errors are not always down to the nurse.
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Anonymous | 2-Jun-2010 5:39 pm
I don't think this is a good idea...

If the patient takes this out on the nurse it could very easily be career ending.

As a patient, unless it was going to kill me, I'd prefer to remain blissfully unaware of the error.
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Anonymous | 2-Jun-2010 5:43 pm
To Anonymous @ 2-Jun-2010 12:16 pm:

You say 'we are supposed to be creating a culture of trust' but would you honestly trust a nurse who you'd just been told had made a drug error? I cannot believe for a second you would not have the thought "they're going to kill me" in the back of your mind.

I'm an HCA, soon to be student nurse and so I understand entirely what nurses go through and the awesome things they do daily. I know for a fact though that if I was told about an error they'd made, at my most vulnerable time, I would not trust them again.
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Anonymous | 2-Jun-2010 7:58 pm
Sounds like an ideal world - again! You are never going to change people's levels of honesty - even nurses. Regrettably, I cannot see it working.
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Anonymous | 2-Jun-2010 9:53 pm
i think that being open and transparent would be the best way forward in the nhs, yes it may cause distress but if approached accordingly to each individual case and not notified in a manner that causes even more stress, i would like to be told if an error had been made and not to be fobbed off or found out later an error had been made that would give me stress.
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Anonymous | 2-Jun-2010 10:57 pm
"Anonymous | 2-Jun-2010 7:58 pm

Sounds like an ideal world - again! You are never going to change people's levels of honesty - even nurses. Regrettably, I cannot see it working."

I take it your impression is that nurses tend to be dishonest? Or is this a neutral statement saying that people cannot become more or less honest?

Anyway, I found it interesting to hear at the RCN Congress this year about a trust which had changed its approach to incident reporting - looking at the wider picture instead of going after the individual. Maybe this should be more widely adopted before asking staff to land themselves in it even more, if we realistically want a chance of this potential new rule (which some already follow anyway) working?
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Anonymous | 3-Jun-2010 7:11 am
Anonomously 12:16, we have been doing this at my trust for years already. I agree, it is not easy, but it is the best way to go. If you screw up, 'fess up, we are dealing with lives here and many things can be reversed if caught quickly enough. Our code of conduct states non malevolence, by not owning up to a mistake that hopefully can be remedied, we put a life at risk. Harsh,... maybe, but fair,... certainly.
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Anonymous | 3-Jun-2010 7:52 am
I thought we had to anyway, as long as it is within the patients interests. It cannot be as black and white as 'the government says we must so we will'

In the case where the person is too ill to deal with this information (physically or mentally) as long as we take action to ensure they come to no harm, I can't see the benefit in telling them, for the sake of telling them.
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Anonymous | 3-Jun-2010 8:12 am
Anonymous | 2-Jun-2010 5:38 pm

Unless Trust's and the Government are seriously going to addresss the factors that can contribute to drug errors, then we may as well put a set of stocks outside the ward and we can be pilloried there. drug errors are not always down to the nurse.

I agree with this... when undergoing my training and on placement in a charity based nursing home two residents were sent their monthly med of course along with all the other residents. During clerking these in it was apparent an error had been made in the labelling of two patients medicines. It turned out the chemist used by the organisation wrongly labelled two patients drugs. Should the senior nurses not noticed the mistake these two patients could have been wrongly medicated and dead! It would be the nurse at fault. During investigation of this matter it had turned out that the GP had actually wrote up the scripts putting the wrong patient details on the scripts. thankfully no one was harmed but the GP didn't get any formal punishment!
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sandra fleming | 3-Jun-2010 9:15 am
I have always advocated to my staff that if an error has been made it is far better practice to be up front admit it and apologise. I have not found that this caused the patients stress - more the opposite they were glad of our honesty, I usually find the nurse involved is actually more stressed. If you can admit to what happened, apologise and state what is happening to prevent it happening again (although often it is pure human error) it is much better than the patient or their relatives finding out by accident that is what causes the public to distrust us as they then think we are just covering our backs
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maurizio mizzoni | 3-Jun-2010 11:46 am
Tere will be only the honest and most responsable nurses that will going to be disciplined, while nurses that don't admit drug errors and doctors as well will keep on doing so
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Anonymous | 3-Jun-2010 12:33 pm
honesty is the only option regarding drug errors, lying is never ok, and saying but it happens may be an acknowledgement of what does happen but it is not an appropriate or professional defence of it.
A lack of honesty is directly related to a lack of respect, dignity and humanity. It denies both parties, and the management, from engaging in a real relationship and the opportunity to resolve a mistake, which if possible is not only the best PR but an opportunity for learning, changing circumstances in which it happened and permission for everyone to be human. If that honesty doesn't happen immediately and voluntarily, people in my experience come away feeling denied their right to respond, positively or otherwise, which leads to anger, feeling 'done unto' or abused and then suspicious of everything (and rightly so!).
Willingness to take the opportunity to engage relies on feeling able to handle the potential responses either individually and/or in partnership and supported. It also demands a reality check that we will get it wrong, we won't be perfect all the time and that we are not responsible for absolutely everything on everybody else's behalf.
I think we also have to look at the culture we have created between us that doesn't enable people to feel able to be honest or supported that ends up resulting in a lack of respect for people in our care and eventually a lack of respect for ourselves, and the job we do .
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Anonymous | 5-Jun-2010 12:36 pm
Re. 2nd June 7.58pm and 10.57pm of course I'm not saying nurses are dishonest but you cannot change how people are and how they behave.
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Nicholas Rowsell | 6-Jun-2010 2:33 am
To legislate is fine and with the current trend of tranparency and political correctness etc this is to be expected. However, as with all nursing interventions, I think that we need to put the patient first and deal with each situation on a case by case basis - if the nurse can honestly say that the disclosure would harm the patient (e.g. by raising anxiety levels and in so doing make their situation worse) it might be best not to tell them. All the same, we have a duty to be honest with our patients. After all what would WE expect if we were the patient? So my conclusion is that we have to act in the best interests of the patient at all times, but always report the error using the correct procedure. Remember that you are more likely to get sacked for lying about an error than making it.
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tim stokes CAMHS | 10-Jun-2010 10:24 pm
sadly i feel that as we do not feel our careers are safe with some trusts if we admit a drug error...........
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Heather Speirs | 14-Jun-2010 12:26 pm
Having read the comments above I too am surprised that some nurses are not admitting to drug errors.

I made a drug error on my chosen speciality of ITU a short time after moving onto the unit to work. I had chosen to specialise in ITU and this was to be my career path, and I was devastated at making the error. It was entirely my fault, lack of concentration on a night shift and I had no excuse at all - having slept well during the day and feeling fine throughout the shift until I made the error.

I was horrified and very quickly attended to the patient, taking obs, replacing ECG electrodes (which he had pulled off repeatedly) to assess his condition. My heart was pounding and I ensured he was physically ok before I enlisted the help of a colleague nearby in case of any difficulties and waited to tell the charge nurse what I had done, (he was busy with other colleagues admitting a new patient to the unit and too tied up at that point to speak to me). I briefly caught his attention and told him I needed to speak to him as soon as he was free, and I returned to my patient to keep an eye on him.

I confessed to the charge nurse, who advised me that he would need to inform the doctor on for the unit who would need to check the patient and ensure he was ok. I had no problem with this and told him to inform whoever he needed to.

I later had to explain to the unit manager and the directorate manager what had happened, which I did, and I received a written warning which stayed on my record for twelve months and was then removed and never mentioned again. The error was documented in the medical notes and the patient was informed of it later on when on the ward (and conscious).

Throughout the process my colleagues were very supportive, as were management, especially the unit manager, who told me not to think my 'career' in ITU was finished, as she knew she could trust me to own up if I made a mistake and not try to cover it over, as some had done. This helped me to gain confidence, which I lacked for a long time afterwards, and to get over the error.

But it was never an option to cover up and brush it under the carpet. The patient was informed, and his relatives, and it was documented in his notes. And fortunately he did not come to any harm as a result of my actions. But I do not know many nurses that have not made a drug error at some time in some place. We are human, as are doctors, not machines.
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