Weekly glitches!

-BY QUALITY TEAM

Purpose:
 To highlight AVOIDABLE errors and
suggest appropriate measures to
prevent those in future.
 1. Proofreading errors

 The errors, which can be eradicated with a vigilant checking using search engines
(Google & drugs.com) and critical thinking, and reading.
 Why is it important to proofread ?
as it leads to either

CRITICAL errors i.e., inaccuracies Grammatical errors like spelling, &

missing content punctuation, articles, awkward
phrasing, et cetera.
 (a) Examples of critical errors:
Incorrect Version Correct Version
- The patient went to - The patient went to the
EMG. ER.
- The patient reports - The patient reports
weight gain. unintentional weight
gain.
- The patient went for - The patient went for a 7-
a 7-week vacation. week vacation to
Arizona.
Feedback
-"EM G" was misinterpreted for ER as the scribe assumed
it as an another kind of ER, whereas it is a diagnostic
procedure called "Electromyography“. Could be
rectified with google.com.
-Whether it is weight loss or gain, it should be specified.
For instance, if the patient is gaining weight
unintentionally, then doctor must be giving her/him
instructions to maintain a healthy lifestyle with diet and
exercise as it is a concern or could check labs to rule
out any related cause. However, if it is intentional, then
no instruction is needed because it is patient's
preference.
- If a patient discusses his vacation, then he must
have mentioned where he went and if not then
doctor ought to ask because it is important for
immunization purposes, so we could rectified this by
asking a specific query from the provider. Hence, no
missing info.
… to be cnt’d
 …continued
Incorrect Version Correct Version
- She has back pain. - She has low/upper back pain.
- She has leg pain. - She has bilateral/right/left leg
pain.
- She has pain in ears. - She has pain in both ears/left
or right ear.
- The patient complains of right-
- The patient complains of sided/left-sided/lower
abdominal pain. abdominal pain.
Feedback
***Specify the location – if we don’t get
it during the patient-provider discussion,
then it should click in our mind while
proofreading that specificity is missing
which can be asked from the provider
or can be rectified with PE details
(once the provider dictates).
- Such mistakes are not missing errors,
these are proofreading errors as we
know which body parts are not one
in number, so we should specify
accordingly.
- In worst case scenario, if these
details are not discussed during the
visit but we asked from the provider,
then it will show our alertness &
attentiveness.
 (b) Examples of grammatical errors:
Incorrect Version Correct Version Feedback
- She has flu like symptoms. - She has flu-like symptoms. - Spelling error: It will be treated as
one word because these both words
(flu and like) are used for describing
one thing (symptoms). Another e.g. –
patient has cough with greenish-
bluish phlegm.

- The patient followed up with - The patient followed up with Dr. - Awkward phrasing
the paediatrician for a sleep XX, pediatrician for a sleep
consult with Dr. XX. consultation.

- He has a history of diabetes for - He has a history of diabetes for - Tense error but made it
inaccurate.
which he took Trulicity weekly which he takes Trulicity weekly
and Actos daily. and Actos daily.

- The patient is a xx-year-old - The patient is an xx-year-old - M issing articles

male who presents today for male who presents today for a - Why is that person following up?
follow-up. follow-up visit. There must be an area of concern
be it – hypertension, labs, regular
follow up, etc.
 2. Organizational errors
 The errors, which occur due to disassociation of content present in the note. These errors
can also be rectified with an attentive and careful proofreading.

•Place the content/paragraphs on the basis of severity i.e., descending

Order of order.
•Example - the complaint with highest severity will be the 1 st paragraph of
complaints the HPI, after the introduction sentence (The patient is an xx-year-old
female/male presents today for abc).

•Related information should be placed together in one paragraph.

•Example – all the diabetes-related context will go in one para including
Inter-paragraph stability, medications, any side effects, any kidney or eye problems, callus on
foot, lab result particularly HbA1c and blood glucose levels, etc.

•Organization within the paragraph i.e., a complaint or concern should be

followed by its onset, associated symptoms, treatment (if any, along with
benefit/side effect), related context, and denial symptoms.
Intra-paragraph •Example – He has a history of hyperlipidemia for which he is taking
atorvastatin with benefit. His recent lipid panel showed elevated triglycerides
and LDL; otherwise, within normal limits.

Incorrect Version
- He was diagnosed with
arthritis for which he took
anti-inflammatory
medications.
- The patient was advised to
take Questran powder
every day.
3. Miscellaneous
Correct Version Feedback
- He was diagnosed - It is important to mention whether the
with arthritis for which medication was prescribed, taken OTC, or
he was prescribed from any previous meds without any
consultation.
anti-inflammatory
medications.
- There is a difference amongst prescribed,
- The patient was given advised, and recommended.
a prescription of Prescribed: a written direction/order that a
Questran powder to patient must take + such meds are not
be taken daily. available OTC.
Advised: an instruction for prevention of
undesirable, e.g. “I advised the patient to
reduce salt intake”, in case when patient’s BP is
borderline normal
Recommended: an instruction, in general, that
should be followed by a patient be it about an
OTC meds or lifestyle change.
 4. A Few hyphenated phrases

 As-of-now

 Up-to-date

 Back-and-forth

 Back-to-back
Thank you…..
I hope this PPT was helpful.