If hospitals want to reduce medication errors, one challenge is to get their physicians and other medication prescribers to react without condescension and intimidation to questions and concerns from the professionals charged with carrying out the orders.
That's the conclusion reached by the Institute for Safe Medication Practices after a survey it conducted showing that such intimidation contributes to medical errors by preventing nurses and pharmacists from voicing concerns about the correctness or safety of medications.
In a survey of 2,099 healthcare practitioners conducted in November 2003 and released last week, 40% of respondents assumed a prescription was correct at least once during the previous year rather than raise the matter with a physician or other prescribing professional with a reputation for reacting with intimidation. When they did speak up, 49% said they felt pressure to give the medication despite their concerns.
Often no harm resulted, but 7% of all respondents said they were involved in a medication error during the past year "in which intimidation clearly played a role," according to the institute. Some 10% of pharmacists reported intimidation-related medical errors.
Hospitals are trying to change their culture to head off medical errors by encouraging caregivers to report errors without fear of sanction and enable everyone to learn from them, said Hedy Cohen, the institute's vice president. Good working relationships among those caregivers are crucial to the effort. "Part of this culture change is working as a team, which will prevent errors," Cohen said.
Often, however, pharmacists and nurses were left to huddle with colleagues or do research on their own to assuage fears about orders. Among pharmacists, 23% said they attempted to clarify the safety of an order themselves at least 10 times during the year rather than interact with a prescriber.
Physicians were more likely to use condescending language or be impatient with requests from nurses rather than pharmacists, but more than 20% of both groups reported such incidents happened at least 10 times in the past year. Nearly half of all respondents said past experiences with intimidation have altered how they handle questions or clarifications.
The experiences sometimes included strong verbal abuse, mentioned by 48%, but subtle expressions of exasperation may be all it takes to throw cold water on communication, Cohen said. "It's like with your spouse," she said. "If every time you ask a question they look at you (derisively) and they put their hands on their hips, you're not going to ask more questions."