Medical mistakes in the dental practice: a view from the inside

The purpose of the study was revealing the subjective opinion of doctors of various dental medical specialties about the experience of making medical mistakes. Methods: a single semi-structured interview method, qualitative deductive content analysis of the content of recorded interviews for encoding and categorizing text units using the OpenCode 4.02 program. Results: it was found that all respondents associated the concept of "medical mistake" with incorrect actions or inaction of the doctor, which led to negative consequences in the treatment of the patient. Thirty percent of respondents admitted to making manipulative and diagnostic mistakes in their dental practice. Analysis and ranking of factors indicated by dentists to commit a medical mistake showed that these are 1) objective factors of a subjective nature related to the personal characteristics of the doctor: insufficient knowledge and lack of experience, fatigue, arrogance; 2) objective factors related to the shortcomings of the organization of dental care in a medical institution; 3) objective factors of a subjective nature related to individual characteristics of patients. Conclusions: Continuous improvement of the training system for future dentists, residents, and doctors based on modern achievements in the field of dentistry, as well as the widespread use of simulation technologies for practicing manipulative skills, and the introduction of the "standardized patient" method for developing communication skills in order to effectively interact with patients are preventive measures aimed at preventing medical mistakes in dental practice. Awareness of the factors of medical mistakes and their analysis at the personal level will minimize their number and, consequently, improve the quality of dental care provided to the population.

Analysis of methods for quantitive evaluation of facial skeleton injuries applicable in forensic dental practice

Continuous improvement of the medical care in Ukraine substantiates the need for development appropriate approaches for evaluating the quality of the iatrogenic interventions and rehabilitation measures. The success of treatment mostly depends on the adequacy of the primary diagnosis of the patient or the victim and the corresponding registration of present functional and structural violations at the time of admission. This stage of complex rehabilitation, in addition, plays an important role during forensic examinations that aimed at identifying the fact of a medical mistake, establishing conformity of medical care provision taking into account the initial clinical conditions and quantifying the effectiveness of treatment and prevention measures at the stage of long-term post-therapy monitoring. During provided retrospective analysis of publications, the following systems (algorithms) of the quantification of maxillofacial injuries were identified: Cooter-David Score, ISS, AIS, TRISS, MFISS, FFSS, ZS, AO/ASIF, FLOSID. The conducted analysis of the systems for quantitative assessment of the injuries parameters at the maxillofacial region indicates about the variability of the above described approaches in terms of topographical distribution of region of interest, criteria for assessing the severity of functional and structural violations, as well as in the terms of corresponding filling registration cards or computerized forms in relation to the specifics of methodological algorithm.

Examination of Nurses’ State Anxiety and Their Tendency to Medical Error at Different Working Hours

Objective: This prospective, descriptive and cross-sectional study was implemented with the aim of comparing the state anxiety of nurses and their tendency for nursing medical error during day working and night shifts. Methods: The study was conducted between 30 November 2012 and 30 May 2013 with 317 nurses in four different state hospitals. Data were collected using an Individual Identification Form, the Trait Anxiety Inventory and the Nursing Medical Mistake Scale. Results: The Trait Anxiety Inventory and the Nursing Medical Mistake Scale were applied to the same nurses during their day and night shifts. It was determined that nurses experienced state anxiety during both day and night shifts. Work units, antidepressant use and caring for children affected the state anxiety experienced by nurses during day and night shifts. It was determined that the error tendency of most of the nurses was related to the administration of medication and transfusion, nosocomial infections and patient monitoring and equipment safety more during the night shift than during the day shift. It was found that the tendency of approximately half of the nurses to make mistakes in communication was twice as much on the night shift as on the day shift. Conclusion: There was a difference in medical error tendencies and state anxiety between the day and night shifts. State anxiety and error tendencies were higher during the day shift.

Development of the Objective, Structured Communication Assessment of Residents (OSCAR) Tool for Measuring Communication Skills With Patients

Background Although interpersonal and communication skills are essential to physician practice, there is a dearth of effective tools to meaningfully teach and assess communication skills. Objective The purpose of our study was to create a standardized tool for evaluation of communication skills for residents across specialties. Methods We designed an Objective, Structured Communication Assessment of Residents (OSCAR) tool, consisting of 4 clinical stations, to assess intern communication skills with relationship development, their establishment of case goals, and their organization and time management skills. Interns from 11 training programs completed the stations, with senior residents trained to function as standardized patients. The 4 stations' scenarios were a disruptive patient, handling a phone call for a narcotics refill, disclosing a medical mistake, and delivering bad news. Results Eighty-three interns completed OSCAR during orientation. The assessment took interns about 40 minutes to complete, and participants were given immediate feedback by the standardized patients. The total possible score for each station was 50. Resident performance was highest for disclosing a medical error (94%, 47 of 50), followed by handling a disruptive patient (90%, 45 of 50), disclosing bad news (86%, 43 of 50), and handling the phone call for the narcotics refill (62%, 31 of 50). Multivariate analysis of variance results indicated differences between residents from US and international medical schools, but there were no significant differences across specialties. Interrater reliability was excellent for each station (> 0.80). Conclusions OSCAR is a practical tool for assessing interns' communication skills to provide timely results to program directors.