Disclosure of Adverse Jane McKay Events
Adverse Events • Adverse events will happen through out your medical career . You must be able to discuss this with your patients . Lets outline a strategy to do this
Disclosure of Adverse Events • My story – Mr DB
Disclosure of Adverse Events • Medical error –preventable adverse events: – Pts are harmed as a consequence of what is done to them error of commission – Pt are harmed by what is not done to them error of omission
Disclosure of Adverse Events • What is disclosure ? – Communication to patient or family about an adverse event – Patient and providers experience distress making discussion difficult requiring advanced communication skills
Disclosure of Adverse Events • Research confirms patients want : – An acknowledgement that something went wrong – The facts that are known about what happened – An understanding of the recommended next steps in clinical care – A genuine expression of concern –an apology – Assurance that appropriate steps if possible are being taken to prevent similar occurrence from further events happening to others
Disclosure of Adverse Events • The CMPA outlines a Disclosure map – It is a 3 step map to use as a frame work in disclosing an adverse event to a patient and family .
Disclosure of Adverse Events • 1. First things first – attend to clinical care – Address clinical needs and deal with emergencies – Consider next steps in clinical care consider offering another provider your skill level( eg transfer to ICU ) , your own emotional state the patient wants another doctor
Disclosure of Adverse Events • Provide emotional support – Pt, family may have wide array of emotions – Anger , frustration , mistrust – You need to try to meet their emotional needs • You need to be there for them , your aim is to support healing and restore trust
Disclosure of Adverse Events • Document Adverse Event – Document the facts in the progress notes • The current clinical condition • Consent discussion , options and decisions made by your patient or the family regarding any future investigation ,treatments, and consultations – rationale for them • Any emergent care given
Disclosure of Adverse Events • 2. Plan the initial disclosure – What are the facts • Before meeting with the patient the attending physician determines the facts as known at this stage , decides who will be present at the disclosure meeting and decided when and where
Disclosure of Adverse Events • Plan the disclosure –( continued ) – Who will be involved • An adverse event discussion involves the attending physician and the medical residents and medical students involved in the case primarily for learning
Disclosure of Adverse Events • 2. Plan the Initial Disclosure – When and where will the meeting occur need a quiet room with no distractions consider who else needs to be at the meeting eg other health care providers , family etc
Disclosure of Adverse Events • 3. The initial Disclosure meeting – Provide the facts – Be sensitive and take time – DO NOT blame or speculate
Disclosure of Adverse Events • Apology – Saying you are sorry at all points in the disclosure process is so important. Genuine regret and concern by a caring physician and health care team is appreciated by patients and families
Disclosure of Adverse Events What documentation do you need for the initial disclosure ? time , location date name and roles of those present facts of the discussion participants reactions and responses agreed upon next steps any plan for providing follow up when further information available
Disclosure of Adverse Events • Post Analysis disclosure – The purpose of this is to take time and review the factors involved in the initial adverse event eg was it a systems error – It is important to let the family know that there will be a ‘further look ‘ into the area with communication – Essentaily what you are doing is looking at the error and trying to convey what went wrong and what remediation will happen to prevent a further error
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