Teaching Future Doctors the Basics of Medication Errors

Medical students should have basic knowledge of common medication errors before they begin seeing patients at the hospital, and researchers from the Johns Hopkins Children’s Center report that allowing them to play detective by watching, spotting and analyzing medical errors as they occur can go a long way toward helping prevent potentially fatal mistakes in their future practices.

The observational course, now taught as part of the Johns Hopkins School of Medicine curriculum, was piloted in the 2008-2009 academic year, and an analysis of its impact is to be published online on Jan. 12 in the journal BMJ Quality and Safety in Healthcare.

The course was part of a nine-week pediatric rotation at Hopkins Children’s during which 108 second, third and fourth-year medical students shadowed and observed doctors and nurses perform daily work on inpatient and outpatient units. The instruction combined personal observation of actual medical errors in the making or near-misses and required students to deconstruct the errors, the investigators say.

Students began the course by watching a video of a child receiving the wrong medication. They were then asked to reconstruct the events leading up to the error, answering questions such as “What happened and why?” and “What can be done to prevent future errors?” The students then applied the same watch-spot-analyze approach to their daily rotation in the hospital. Each day’s rotation ended with students discussing any near-misses or errors they witnessed and ways to prevent them from happening. Students were also encouraged to speak up about errors and report them to attending physicians and senior doctors before they reached the patient, as well as log the errors in the hospital’s electronic system that keeps track of such events. On several occasions, the drills led to the reporting of patient-safety concerns by students and were dealt with promptly. In one instance, a student reviewing a chart noted that the patient’s weight had been entered incorrectly, which would have led to the wrong medication dose.

“Beyond providing first-hand, observation a course like this one may give teaching hospitals an untapped and invaluable resource for spotting and preventing medication and other errors — medical students,” says lead investigator Robert Dudas, M.D., a pediatrician at Hopkins Children’s.

Allowing medical students to spot mistakes while observing physicians, nurses and hospital staff “in the trenches” teaches them how and why medication errors occur and what can be done to prevent them, the Hopkins researchers say. It also fosters an open culture by encouraging them to speak up about and point out mistakes made by others.

“The foundation of patient safety lies in a solid understanding of how and why medication errors happen, combined with a sobering reality check that mistakes do happen,” says co-investigator Marlene Miller, M.D., M.Sc., a pediatric patient safety expert at Hopkins Children’s.