Medical errors - a hospital in Nepal searches for answers

Medical errors are recognized as a significant issue in medical practice. Ethical and professional guide-lines emphasize the responsibility of physicians to disclose errors to patients. However, in practice, even in the developed world this often does not happen. This study which involved 12 focus groups formed from 127 members of staff within Patan Hospital in the Kathmandu Valley sought to understand Nepali staff attitudes to medical errors and suggest how they could be handled. Most agreed, for good reasons of honesty and patient autonomy, that admission of errors is important, but the doctors struggled to decide how it should be done. For most of the staff the educational level was a key decider as to what would be disclosed. Most agreed that the socio-legal climate in Nepal, and the possible financial implications, made it difficult to be completely honest. Other strong fears included patient harm, violence from the patient, damage to the hospital's reputation and to the reputation of the doctors and possible loss of jobs for nurses. We recommend that the hospital initiate a clear hospital policy on dealing with errors and that they should: implement the development of incident reporting forms; set up an error investigation team; provide specific training in communicating about errors for the appropriate staff.