Most practice errors described by participants appeared to be preventable. Despite the tremendous emotional distress in reaction to making an error, participants valued the learning in the experience and made constructive practice changes. Findings of the study have implications for current educational training programs and practice such as the development of clinical reasoning related to patient safety and assertiveness training for hierarchical situations.
Errors occur in occupational therapy practice. Making errors has considerable impact on occupational therapists as well as their future practice. However, disclosure of errors can often lead to positive outcomes.
at the time of the study. OBJECTIVE. This qualitative focus group study investigated the strategies to prevent or reduce practice errors used by occupational therapists who practice in physical rehabilitation and geriatrics. METHOD. A total of 34 occupational therapists from four geographic regions across the United States participated in four focus groups. Participants worked in the areas of physical rehabilitation or geriatrics and had a minimum of 1 year of practice. Participants responded to open-ended, guiding questions. Data collected from the focus groups were analyzed qualitatively for themes. RESULTS. Analysis of the collected data yielded four themes related to specific strategies occupational therapists use to prevent or reduce practice errors: (1) strengthen orientation and mentoring for new therapists, (2) ensure competency through performance competency checks, (3) enhance existing or establish new safety policies and procedures, and (4) advocate for the profession and for systemic change. CONCLUSION. Findings of the study suggest that occupational therapists implement various discrete strategies to prevent or reduce practice errors and improve client safety. Occupational therapy practice and professional training must emphasize the inevitability of practice errors; the importance of orientation and training, including assertiveness training; and the inclusion of performance-based competency checks.
In December 1990, an empirical study assessing hospital ethics committee (HEC) success was completed. Success was measured in terms of the number of interventions undertaken by the committees in four functional areas: education, guidelines development, prospective and retrospective case review. Some commonly quoted success determinants, such as multidisciplinarity, physician chairpersons, and a high institutional status of the chairperson were found not to foster success; the latter two, actually decreased committee success.
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