Q&A: Medical errors in veterinary settings

Medical errors are an uncomfortable but unavoidable reality in any clinical setting, and veterinary medicine is no exception. Despite the profession's commitment to patient care, mistakes happen, and how a practice responds to them can mean the difference between a culture of safety and one of fear. From misfilled prescriptions to wrong-site surgeries, errors rarely stem from a single catastrophic lapse, argues Theresa Cosper-Roberts, RVT, CVPM, ACVE(DE), CVBL, a distinguished expert of the Academy of Veterinary Educators. More often, they result from a quiet chain of small missteps that go unchecked. Understanding how and why errors occur, and fostering an environment where they can be openly acknowledged, is one of the most important steps the veterinary profession can take toward better outcomes for patients and staff alike, explains Cosper-Roberts in this Q&A from an earlier interview with dvm360.

Editor’s note: This dvm360 Q&A has been edited and consolidated from a verbal interview to better fit a written format while retaining the substance of the original conversation.

dvm360: How do medical errors occur in clinical settings?

Cosper-Roberts: There are so many different reasons why medical errors can occur. They can occur because we're rushing. They can occur because we're not properly documenting things. There's a model called the Swiss Cheese Model of accident causation, and it shows that for every accident or medical error, it's usually not just one big thing—it's a series of…little things that have to happen for the major error to occur. So if we look at it like that, it's usually never one big thing. It's a bunch of itty-bitty things that had to line up to make an error occur.

dvm360: What are some of the most common medical errors made in veterinary practice?

Cosper-Roberts: The most common error that we see in practice is sending home the wrong prescription. Maybe a dog was supposed to get 25 mg of a drug, but someone accidentally grabbed 50 mg, potentially giving the wrong drug to the wrong patient—all the way up to performing surgery on an incorrect limb or on an incorrect animal.

dvm360: How do veterinary professionals typically react when they realize an error has been made?

Cosper-Roberts: Panic. Everybody panics whenever there's an error. They run around screaming like Chicken Little. "The sky is falling! The sky is falling! Oh my gosh, what are we going to do?" We're freaking out, we're blaming everyone, we're trying to figure out whose fault it was. And instead of assigning fault, we need to deal with things calmly and rationally address the issue. Make sure that the patient is OK, make sure that the person who committed the mistake is OK, and then go from there.

dvm360: What do you think is the most important thing the profession needs to do to address medical errors more effectively?

Cosper-Roberts: The big thing that we need to do as a profession is destigmatize errors. Things happen all the time. Everybody makes mistakes. No one is infallible, and we need to take away the stigma associated with making a mistake. We need to have a just culture where everyone has psychological safety, because when people are terrified of making mistakes—terrified of being punished or humiliated or embarrassed—they don't admit those mistakes, and that's when patients suffer. When it's OK to make mistakes, it's OK to admit that we don't know how to do things, or to question orders that we may think are slightly incorrect. That's how we can really prevent mistakes.