1. Acknowledgement:

•What happened i.e. the adverse event

• Impact on the individual/family/support person

• Use an example and sample language

2.Truthfulness, timeliness and clarity of communication:

Truthfulness: Stick to the facts

Remember that you won’t always have and don’t need to know all the answers initially. If you don’t know just tell the patient that you don’t know.

Do not speculate/surmise and no conjecture.

Provide reassurance regarding the review of the event and when further information may be available.

Agree next steps and future communications.

Timeliness:

•Timing is of the essence

•ASAP. On the day if possible.

•Dr Albert Wu’s 24 hr golden window of opportunity.

•Discuss what may influence the timing of the disclosure i.e. condition of the patient,availability of the patient, agreement of the patient, availability of their support person, availability of the most responsible clinician etc.

•Discuss timing when the adverse event becomes known after the patient is discharged using an example e.g. Missed diagnosis on scan or x-ray. How should this patient be contacted and by whom? What measures need to be in place before contacting the patient e.g. Most Responsible Physician (MRP) need to be aware and appointment time allocated to see MRP asap.

Clarity of communication:

  • Avoid medical jargon.
  • Use simple language which the patient can understand.
  • Ensure understanding by asking the patient to feedback to you their understanding of what theyhave been told.
  • Encourage questions.

3: The Apology: (Reference Section 6.4 of National Guidelines 2013)

•Definition

•Discuss the meaning of the word – contexts used

•Is an apology an admission of liability? – discussion

•Avoidance of legal terminology such as “Liability” – “Negligence”.

•Apology v expression of regret

•Discuss the 4 essential components of an apology using an example:

- Acknowledge: what it is you are apologising for

- Explanation: as to why or how it happened – should be factual

- Delivery: timing -language- tone of voice – confidentiality, respectful – dignified – sincere – empathetic - where it should happen – who should deliver the apology?

- Reparation: making things right – increased contact, reassurance re ongoing care – VIP treatment – cover expenses.

Consider the different contexts of the word “Apology”

Admission of guilt

•request for forgiveness

•admission of guilt

•regret

•confession

•act of contrition

Defence

•defence

•excuse

•explanation

•Assurance

Poor substitute

•poor substitute

•pathetic excuse

•poor example

•pretence of a

•epitome

  1. Recognising patient and carer expectations

Ask the audience to consider what their expectations would be if they or a loved

one was involved in an adverse event?

•Acknowledgement – reassurance regarding current and ongoing care - explanation, anxpression of regret or apology – answers to questions – involvement and inclusion in

the review process – reassurance regarding how a recurrence of the event ma be avoided and measures being taken by the organisation.

5. Professional Support

•Discuss the impact of adverse events on staff and the importance of staff support

•Albert Wu – Concept of the second victim

•When an adverse event occurs the care of the patient and family is critical but parallel to this we must identify the second victims i.e. the staff involved and ensure that they are being supported on an ongoing basis. Impact on the wider organisation should also be considered.

6. Risk management and systems improvement

Discuss how open disclosure is an essential component in the incident

management and quality improvement process.

Incident identification, management, reporting, disclosure, review, learning and

taking measures to try to prevent a recurrence of the event are all

essential cogs in the risk management and quality improvement wheel.

Involving patients and their families in that process.

Consider the Role of risk management department.

7. Multidisciplinary responsibility

Discuss, using examples how open disclosure relates to all staff and not just

clinicians e.g. catering staff spill hot tea on patient, simple medication error by a

nurse or midwife, member of portering staff has an incident on way to x-ray

where patient was not secured in the chair and fell out.

Discuss the importance of team support and a multidisciplinary approach to incidents and OD.

8. Clinical Governance:

The open disclosure process is one of the key elements of the HSE clinical

governance system. Health and social care services are required to have appropriate

accountability structures in place which ensure that open disclosure occurs and that

it is integrated with other clinical governance systems and processes including

clinicalincident reporting and management procedures, systems analysis reviews,

complaintsmanagement and privacy and confidentiality procedures.

Consider the processes/structures in place at organisation level to manage situations

when there is a conflict of opinion in relation to OD.

9. Confidentiality

Stress the importance of confidentiality in relation to open disclosure discussions.

Discuss disclosure to the next of kin/support person.

Discuss the role and rights of the next of kin in relation to disclosure and also

disclosure to persons/family members withpower of attorney and enduring power

of attorney.

10. Continuity of care:

Discuss the importance of reassuring the patient in relation to their ongoing

care – that they are involved in and understand their care plan going forward.

VIP treatment. Instil confidence.

Increased contact.

If they complain or pursue a legal case that they are not treated any differently.

Discuss the management of a breakdown in the patient/clinician relationship –

referralto another clinician if the breakdown is irreparable.

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