MEAO

MEAO ("meow") is the acronym for the Medical Error Adverse Outcome committee. A more extensive blurb about what MEAO is will be put here later. toc This page is intended to:
 * 1) Provide a brief guideline when a possible medical error and/or adverse outcome has been recognized and plans are being made for disclosure of this information to patients and families.
 * 2) Identify a person from the MEAO Committee who is on call for advice during this process. (See call schedule below)

See also a [|Family Meeting Guideline] for critically ill patients (prepared by Drs. Applegate, Barrow, Freedman and Kuruvilla, in May, 2010)

=Guidelines/Goals:=
 * 1) //Honesty and transparency// with the patient and family are paramount. Present what is factually known as well as what is uncertain and to be reviewed.
 * 2) //Avoid premature conclusions// prior to a thorough review. Distinguish fact from conjecture. Immediate conclusions about cause and effect are often erroneous; assigning guilt to oneself or others is often inaccurate. Medical care is complex, and avoidable adverse events are more commonly multifactorial than they are due to a single “error” or factor.
 * 3) //Document the known facts// in the medical record. Avoid conjecture, blame or premature conclusions.
 * 4) //Take time// to meet with others involved. Residents should review the events with the attending physician. Taking the time for a careful review honors the patient’s right to know accurately what happened and why. Most significant events are more complex than it appears initially and it often takes a few days to discover and interpret the “cause(s)”.
 * 5) //Communicate//. Provide timely initial communication with the patient and family. Establish a process for ongoing communication to review new information and answer questions. Assign a primary contact person who can provide continuity and establish a time and place for future conversations.
 * 6) //Expressions of sorrow and empathy// for adverse outcomes are encouraged.
 * 7) //Support each other//. Errors can (and do) happen to everyone.
 * 8) //Open yourself to learning// from the events. Medicine is a lifetime “practice” of learning and growing.

=MEAO Membership and Call Schedule= Roger Barrow – Internal Medicine/Family Medicine – 203 Julie Freedman – Internal Medicine – 091 Kim Haglund – Surgery/Family Medicine – 527 Scott Loeliger – Obstetrics and Gynecology – 922 Jon Stanger – Ethics – 256 Brian Johnson - Internal Medicine - 589

Resident members: Bradley Randles – 318 Julie Pham – 314

MEAO does not maintain a formal call schedule. However, one or more of us are generally available each weekday (see below). You may contact the person listed for the day you are calling. You should also feel free to contact whomever you feel most comfortable with, or to contact the person from the most relevant discipline. Kim Haglund || Scott Loeliger Brian Johnson || Roger Barrow || Kim Haglund || Brian Johnson ||
 * **Monday** || **Tuesday** || **Wednesday** || **Thursday** || **Friday** ||
 * Roger Barrow

=Medical Error Adverse Outcome Dialogue Examples:=

__Initial disclosure__:

“As you know, [you, your mother, your sister, etc.] had a setback last night and has been moved to the Intensive Care Unit. We are working hard to understand why this has happened, and we want you to understand as well. One question we have is whether [an overdose of a medication, a missed medication dose, bleeding from a procedure, etc.] might have made you worse. I don’t want to draw premature conclusions, but I want you to know we are committed to finding out everything that happened and why. If any mistakes were made, I’ll discuss them with you. I am very sorry that you are experiencing [pain, difficulty breathing, needing ICU care, needing surgery, etc.]. We are doing everything we can to help [you/her] get better. Is there anything else we can do to help you right now?

I’ll have more information [tomorrow, in a few days, in a week] and would like us to meet again then. In the meantime, here is how you contact me if questions come up.”

__After thorough review and conclusions__:

“I have reviewed [your care, your mother’s care] thoroughly and met with the people involved in what happened. We found that you were [given the wrong medication, had an error or a complication of a procedure, etc.]. We believe this caused you to experience [bleeding, intubation, need for surgery]. We are very sorry that this happened. When something goes wrong like this, we need to understand it so we can prevent such a thing from happening again. In this case, I believe we can do better by [doing more educations, instituting safety mechanisms, instituting a new protocol], and we are working on this goal. I wish we could have avoided this problem with your loved one.

Again, I want to tell you how sorry we are that this happened to you.

You can reach me in the future if I can answer any questions for you, or if there are others in the family who have questions.”

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