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February 2, 2009 NEWSLETTER
Doug Wojcieszak, Founder & Spokesperson
Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net
THIS WEEK'S EDITION:
SORRY WORKS! EDITORIAL: NURSES AND DISCLOSURE - MORE WORK NEEDED
UPDATE FROM ENGLAND
SORRY WORKS! SPEAKING OPPORTUNITIES - PIGGYBACK OPPS?
SORRY WORKS! EDITORIAL: NURSES AND DISCLOSURE - MORE WORK NEEDED
Below is a short excerpt from McKnight's referencing a report that was recently released by the Joint Commission on the role of nurses in disclosure. In short, the report says that nurses are reluctant to disclose for many reasons, including they feel its not their place, but they want to see disclosure happen and want to be a part of those discussions. Important point: The excerpt states that "nurses who are uninformed about a serious medical error may seem evasive or appear to stall when asked a question by a patient or family member." The same could be said for nurses are very well- informed about an error because they don't feel comfortable "ratting out" a doctor, other nurses, and/or themselves.
Nurses are the lifeblood of any hospital or healthcare organization. Often, they have the most contact with the patient/family, and, often, they are the friendliest, most caring people in any institution. So, when a nurse grows "cold" after an adverse event the patient/family is left to wonder if there has been a mistake. If a nurse's personality changes from sunny and chatty to a frown, eyes cast down, and in and out of the room in a shot, the entire healthcare team/organization is put at risk for a lawsuit. But who can blame a nurse? Maybe they made a mistake, or more likely a physician made a mistake they know about, but they don't want to be asked questions by the patient/family and either divulge information and get fired or be caught trying to be evasive. Better to just turn a cold shoulder to the patient/family and hope the whole situation goes away, right? Wrong!
We say this a million times in this forum - but we'll say it again because the nursing issue really drives it home: You need a disclosure program! Without a program, disclosure is just a nice thought that still leaves people down the chain of command - a nurse, for example - out in the cold, not knowing what to say, sending off all sorts of bad vibes to the patient/family, and increasing the chances of litigation for themselves, the doctor(s), the institution, and the insurers. Nurses are the front-line employees, but not developing a disclosure program to train and support them is literally like sending a soldier off to war without a gun.
Developing a program will not only help train nurses (and other front-line staff) on empathetic conversations in the immediate aftermath of an adverse event ("I'm sorry this happened...we feel bad for you...is there anything we can do for you?") and also the importance of increased customer service after something goes wrong, but also resolve conflicts that naturally arise when, for example, you have a hospital-employed nurse and an independent contractor physician involved in an error. The time to decide how such situations should be handled is not when the mistake happens, but well before it! This is what a disclosure program is all about! And, yes, good disclosure programs involve nurses in the actual disclosure and apology to the family.
To learn more about developing a disclosure program, be sure to get a copy of the Sorry Works! Book: http://www.sorryworks.net/booksoon.phtml.
Nurses often left out of error disclosure process, report finds
January 20, 2009
Nurses frequently do not play a role in telling patients about serious medical errors, according to a recently released Joint Commission report.
Hospital nurses surveyed for the report indicated that, while they are reluctant to independently disclose serious medical errors to patients, they would like a larger role in the disclosure process. Due to a nurse's important role in the overall care of a patient, study authors suggest the nurse's absence from the error disclosure process could lessen the quality of the disclosure experience for the patient. According to the report, nurses who are uninformed about a serious medical error may seem evasive or appear to stall when asked a question by a patient or family member.
Study authors indicate that not being involved in this aspect of care could lead to increased job dissatisfaction, job turnover rates and moral distress. Additional training in the area of error disclosure could help improve quality of care and nurse job satisfaction, the authors suggest.
For more information, visit www.jointcommission.org.
UPDATE FROM ENGLAND
Home News Health News
NHS could avoid hefty legal bills if frank apologies given, claims lawyer Ken Thomas
Dec 29 2008 by Ken Thomas, Western Mail
WHISTLE-BLOWING in the NHS has landed several senior medics in hot water over the years.
A case recently came to light in Oxford in which a senior anaesthetist sent a letter to all personnel at the hospital where he worked alleging that untrained staff were looking after children, and that patients were being left in post-surgery recovery with staff who had not received any anaesthetic training.
He was later sacked from his job on other grounds and is now claiming unfair dismissal.
Closer to home, a West Wales consultant was suspended from her post after apparently blowing the whistle about medical colleagues allegedly using NHS facilities for private operations.
Of course, perhaps the most high profile incident of whistle-blowing occurred just across the Severn Bridge where another anaesthetist revealed the scale of the Bristol babies’ heart scandal.
He subsequently went to work abroad, but the investigations that ensued after he spoke out sent shock waves through the medical profession.
The extent of any duty or obligation on medical practitioners to make patients aware where there has been an error in their treatment is not widely understood.
Within the General Medical Council's good medical practice guidelines, there is a professional duty on doctors to advise patients when such errors have occurred.
The guidelines say an apology should be offered and a full and prompt explanation given about what has happened.
Unfortunately, this does not always occur in practice.
In my day-to-day job I frequently find clients telling me they feel there has been a "cover-up" or that doctors always "protect each other's backs".
While there may be a long way to go in addressing these concerns, there have been steps in the right direction.
As long ago as 1999 the Government launched an initiative to ensure medical staff who spoke up about, for example, incompetent colleagues were not subsequently victimised themselves.
Where a medical negligence claim is launched, independent medical experts' input is routinely secured to assess whether or not there has been a negligent mistake.
In reporting their findings, these experts operate under a court- imposed duty to provide unbiased and impartial opinions.
If they feel there has been a negligent mistake made, they must say so, and vice versa if they feel no mistake has been made.
Recently, the head of the NHS litigation authority, which operates in England, urged NHS hospitals to adopt a new culture of honesty and openness towards patients.
It may not always be the doctor who made the mistake who brings the matter to the attention of the patient – it can sometimes be other healthcare workers or doctors who treat the patient subsequently.
One concern of course among the medical profession, and perhaps in government too, is that the wide-ranging disclosure of medical errors will increase litigation.
A recent paper in one leading journal disputes this.
It has suggested that routine disclosure of medical errors which is made promptly and frankly could, in fact, reduce the level of legal action against the NHS.
The suggestion is that, in many cases, patients only feel they need recourse to the law because those treating them have not been honest and up front in acknowledging where things went wrong.
An early explanation and apology might prevent the matter developing into a court claim. This is arguably borne out by a recent Healthcare Commission report which established that only one in five complainants surveyed actually wanted to take action against medical staff.
Ken Thomas is a partner and medical negligence specialist at Harding Evans solicitors
UPCOMING SORRY WORKS! PRESENTATIONS - PIGGYBACK OPPORTUNITIES?
The Sorry Works! speaking schedule is filling up quickly for spring and early summer - however, there are still holes in the schedule. Furthermore, when we are out on the road we like to double up with presentations in nearby locations to save on travel costs and make the most use of time on the road. Below is the list of upcoming presentations and dates - if you are nearby one of these sites and would like your own presentation for your hospital, insurer, or association, please let us know by contacting doug@sorryworks.net, calling 618-559-8168, or clicking on this link: http://www.sorryworks.net/presentation.phtml . Furthermore, if you are not by one of these sites but still want your own presentation and see a hole in the calendar, call or e-mail today and help us fill it!
Sorry Works! presentations are perfect for Grand Rounds, ethics seminars, and for training on disclosure and apology. Of course, presentations always qualify for CME & CEU credits.
Feb 2, 3 - Northern Iowa
Feb 6th - Oregon
Feb 10th - Memphis, TN
Feb 11th - San Diego
Feb 18/19th - Northern Indiana
Feb 26/27th - Oklahoma
March 5th - Arkansas
March 10th/11th - Northern Indiana
March 12th (tenative) - New Jersey
March 13th - Connecticutt
March 26th/27th - Oklahoma
March 30th - San Diego
April 10th - Cleveland, OH
April 17th - San Diego
April 22nd - Las Vegas
May 24th - San Diego
May 26th - Seattle
June 19th - Peoria,IL
Call 618-559-8168 or e-mail doug@sorryworks.net to schedule a Sorry Works! Presentation today!
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