German critical incident reporting system database of prehospital emergency medicine: Analysis of reported communication and medication errors between 2005-2015

doi:10.5847/wjem.j.1920-8642.2016.02.002

Abstract

Abstract:

BACKGROUND: Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well. We analyzed the database of the critical incident reporting system for prehospital emergency medicine in Germany retrospectively regarding communication errors.
METHODS: Experts of prehospital emergency medicine and risk management screened the database for verbal communication failure, non-verbal communication failure and missing communication at all.
RESULTS: Between 2005 and 2015, 845 reports were analyzed, of which 247 reports were considered to be related to communication failure. An arbitrary classification resulted in six different kinds: 1) no acknowledgement of a suggestion; 2) medication error; 3) miscommunication with dispatcher; 4) utterance heard/understood improperly; 5) missing information transfer between two persons; and 6) other communication failure.
CONCLUSION: Communication deficits can lead to critical incidents in prehospital emergency medicine and are a very important aspect in patient safety.

Key words: Critical incident reporting system, Prehospital emergency medicine, Communication error, Medication error

Christian Hohenstein, Thomas Fleischmann, Peter Rupp, Dorothea Hempel, Sophia Wilk, Johannes Winning. German critical incident reporting system database of prehospital emergency medicine: Analysis of reported communication and medication errors between 2005-2015[J]. World Journal of Emergency Medicine, 2016, 7(2): 90-96.

Figures/Tables 2

Figure 1.

Table 1

Examples of different communication failures related to categories

Variables	Number	Examples
Team member suggestion not acknowledged	n=109	Emergency physician does not consider advice from other team members (mostly paramedics) (n=83) Family doctor does not consider EMS advice (mostly paramedics) (n=7) Non-physicians (mostly paramedics) do not consider advice (n=3) Relative (physician) does not consider advice (n=1)
Medication error	n=66	No double check: wrong dose or drug (n=16) Wrong drug recognized: prevention of administration (n=15) Different drug concentrations in ampules lead to wrong dose application (n=11) Similar sounding drug is ordered (n=7) Drug administration through not labelled syringes (n=5) Drug and/or dose handed over falsely or incomplete (n=4) Wrong drug not recognized although double check is done (n=3) Wrong drug application of EMS of another district, where another medication looks similar to the required (n=2) Ambulance was equipped with wrong medication that lead to confusion (n=2) Several drug dosages prepared, wrong dose administered (n=1)
Communication failure with involvement of dispatcher	n=41	Communication failure with dispatcher and ambulance (n=15) Hospital rejects patient (n=13) EMS unable to locate the address (n=6) Unsuitable ambulance is dispatched (n=4) Wrong dispatch directions to EMS (n=3)
Acoustical problems	n=27	No communication about the patient condition at all (n=9) Misunderstanding of orders other than related to drugs (n=6) Lack of language skills in a non-native speaking emergency physician (n=3) Information orally given is not heard (n=3) Contradictory information about patient condition (n=2) Lack of language skills of patient or relatives (n=2) Confounding of patient data (n=1) Misunderstood information about patient condition (n=1)
Missing information transfer between two persons	n=22	Handover to EMS leads to misinformation (n=10) EMS handover to hospital leads to misinformation (n=7) Drug administration through paramedics without physician approval (n=2) Relatives hold back information (n=2) Handover at change of shift leads to misinformation (n=1)
Other	n=17	Delayed patient treatment (n=7) Drug company label on different drugs, but identification is made by label and not by name-therefore confusing (n=3) No familiar drugs stocked in ambulance (n=1) Family physician is asked to do a house call and rejects (n=1) Emergency physician rejects to escort the patient although indicated (n=1) No communication among EMS team about worsening of patient's condition (n=1) Preparation of (wrong) medication without prior order or communication (n=1) No communication equipment (n=1) No labelling of blood samples (n=1)

Table 1

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