Transcript Open Disclosure - Home - NSW Health Care Complaints Commission

Open Disclosure
Dr. Maree Bellamy
Principal Advisor, Patient Safety
CEC
[email protected]
Open Disclosure is about
“doing the right thing”
… when a patient has been harmed while
receiving health care.
It enables staff to communicate with empathy –
to walk in another’s shoes – and to say sorry for
what has happened.
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Drivers for Change
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Revision of National Standard
Policy out of date
Response to Ombudsman
Accreditation requirements
Further research e.g. Patient Stories
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Current Status – NSW Health
– Revised policy PD2014_028 has been released
– Handbook will be published in 1 week.
– First introductory module – mandated for clinical
staff NSW Health - almost ready to go at HETI online.
– All modules available by end of December 2014 –
Clinician Disclosure and Open Disclosure Advisors
– Roadshow being planned
– Expert training proposed early 2015.
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Key Changes to Policy & Process
• More patient centred whilst still promoting risk
management approach
• Enhanced focus on supporting second victim(s)
• Greater scope for reimbursement discussion
• Distinction made between Clinician and Formal OD
• Introduction of the role of OD Advisors
• Guideline replaced by a CEC Handbook
• Less reliance on SAC - OD applicable in patient safety
incidents regardless of SAC
• Introduction of OD in relation to no harm incidents
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Effective open disclosure includes:
• acknowledging to the patient and/or their support person(s)
when things go wrong
• listening and responding appropriately when the patient
and/or their support person(s) relate their experiences,
concerns and feelings
• the opportunity for the patient and/or their support person(s)
to ask questions and to have those questions answered
• providing support for patients and their support person(s)
and health care staff to cope with the physical and
psychological consequences of what happened.
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Patient Safety Incident
• A patient safety incident is any unplanned or
unintended event or circumstance which could have
resulted or did result in harm to a patient.
• This includes harm from an outcome of an illness or
its treatment that did not meet the patient’s or the
clinician’s expectation for improvement or cure.
• Additionally, open disclosure is recommended when
the patient has been harmed from a risk inherent to
the investigation and treatment of their medical
condition
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An incident may have been caused:
• because something has gone wrong during the
patient’s episode of care –
• because the outcome of the patient’s illness or its
treatment did not meet the patient’s or his/her
doctor’s expectation for improvement or cure
• from a recognised risk inherent to an investigation or
treatment
• because the patient did not receive his/her planned
or expected treatment
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The five essential elements of open disclosure
are:
1. an apology “I’m sorry” or “We are sorry”
2. a factual explanation of what happened
3. an opportunity for the patient to relate his or her
experience
4. a discussion of the potential consequences
5. an explanation of the steps being taken to manage
the event and prevent recurrence.
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Apology
• Defined in the Act as:
– “an expression of sympathy or regret, or of a
general sense of benevolence or compassion, in
connection with any matter, whether or not the
apology admits or implies an admission of fault in
connection with the matter
– An apology doesn’t constitute an admission of
liability, will not be relevant to the determination
of fault or liability in connection with civil liability
proceedings and cannot be adduced into evidence
Civil Liability Act 2002
• Full statutory protection
• First jurisdiction in world to implement legal
protection for a full apology – that is, one that
includes an admission of fault or liability – made by
any member of the community
Clinician Disclosure
• There should always be an early meeting between
patient/family and treating clinician
• This occurs close to the event and is referred to as
Clinician Disclosure
• Any clinician may be responsible - and should
therefore need the skills - for leading this type of
discussion
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Clinician Disclosure
• Informal process where the treating clinician
(and/or senior clinician or line manager)
provides information and apologises
• Process may stop there or be linked to
ongoing communication and/or Formal
Disclosure.
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Formal Open Disclosure
• Structured process that may follow on from clinician
disclosure
• Requires planning and preparation
• Involves the appointment of a co-ordinator, an Advisor
and an Open Disclosure team
• May occur over multiple meetings
• Will usually include the sharing of investigation outcomes
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Open Disclosure Advisors
OD Advisors are senior health professionals who have
received intensive training in empathic communication
skills and are available to support the process within their
facility – an impartial third party who facilitates the formal
OD meeting with family and/or patient
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Open Disclosure Advisors
Have a key communication and reporting role
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Member of OD Team
Lead the OD Team planning with clinician
Participate in the Disclosure
Debrief with clinician
Hand over commitments, made during disclosure, to the
facility executive
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Skills Development
• Expert Advisors – 2 day workshop proposed.
Focus on simulation with actors. Covers skills
for coaching colleagues
• Ongoing revision of skills – 1 day / year
• Debrief programme seen as key element of
success
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Practical Support
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Clinical Governance
Persons responsible for insurable risk
CEC
Professional Indemnity Insurers
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The CEC Open Disclosure Handbook
1 INTRODUCTION
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WHAT IS A PATIENT SAFETY INCIDENT?
WHAT IS OPEN DISCLOSURE?
CLINICIAN DISCLOSURE
FORMAL OPEN DISCLOSURE
APOLOGISING AND SAYING SORRY
PRACTICALITIES OF OPEN DISCLOSURE
SUPPORT FOR STAFF
OPEN DISCLOSURE IN SPECIFIC CIRCUMSTANCES
FREQUENTLY ASKED LEGAL AND INSURANCE QUESTIONS
KEY DEFINITIONS AND REFERENCES
RESOURCES
Available from the Open Disclosure page on the CEC website
http://www.cec.health.nsw.gov.au/programs/open-disclosure
Limited hard copies will be available.
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Reimbursement of Expenses
• PD2014_028 supports an early offer of, and approval for,
reimbursement for reasonable out-of-pocket expenses
incurred as a direct result of a patient safety incident.
• Practical support such as the above, sends a strong signal of
sincerity, and may be raised at a formal open disclosure
discussion, if not already discussed during clinician disclosure.
• It is generally accepted that the practical support offered
through reimbursement does not imply responsibility or
liability.
• Reasonable out-of-pocket expenses may include, but are not
limited to, accommodation, meals, travel and childcare.
Thank you
Questions
For further information:
Maree Bellamy
t: 9269 5565
e: [email protected]
[email protected]
http://www.cec.health.nsw.gov.au/programs/open-disclosure
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