Just in Time Disclosure Tips for Front-Line Physicians, Nurses, and other Clinical Staff
This short document produced for front-line staff is a crash course in what to say and do in the immediate aftermath of an adverse event, including an event potentially caused by a medical error. Not enough doctors and nurses were given this critical information during school or continuing education programs. Consider using these steps when something goes wrong:
If the patient is still alive post-event, make sure he/she is stable and safe.
If you have time, collect your thoughts before speaking to the family or patient. Consider briefly role playing with yourself in the mirror. Also, if time permits, consider role playing with a colleague. If you have religious beliefs, consider saying a prayer. However, don’t delay and procrastinate!
If possible, find a quiet, confidential location to speak with the patient/family. Make sure the room is clean with tissue boxes, water, adequate number of chairs, not too hot or cold, etc.
Plan to bring a colleague to the meeting with the patient/family to serve as a witness, provide moral support, and rescue the conversation if necessary.
Walk into the room, look people in the eye, shake hands, and sit down. Look and act like a leader.
Consider your body language…sit down, put your hands in your lap, and lean forward. Maintain eye contact at all times. Show sincerity. If your chair goes up and down, put it down to become inferior to the patient/family. Never slouch or cross your arms (no matter how tired you are).
Say you are “sorry this happened and we need to do a review to understand what happened.” This is empathy….no different than the empathy offered at a funeral home.
Do not apologize or admit fault, yet. In the immediate aftermath of an event it’s too easy to blame yourself, a colleague, or the team for an event that might not have been caused by medical error. Simply empathize. Do not speculate, joust, or guess. If pushed by the patient or family for answers, discuss the review and next steps.
When discussing the event, say only what you know and speak slowly in plain, understandable language. Talk like you are communicating with a 5th grader. Don’t be a motor mouth rattling off technical jargon or Latin terminology to a bewildered patient or family.
Ask the patient/family if they have questions, or need information repeated. Also, ask them to share their feelings and concerns. If they yell, scream, or make accusations, listen but don’t get defensive. Instead, say something like, “I can hear that you are upset, and you have every right to be upset.”
Promise a review and during this initial meeting be sure to schedule a follow up meeting with the family to discuss your progress in the review…and don’t miss that meeting! Stay in touch with the patient/family throughout the review process.
Take care of the immediate needs of the patient/family, including food and drinks, phone calls, transportation and lodging, minister or social worker, etc. Help them!
Provide your contact information to patient/family, including business card (if you have one). Encourage the patient/family to call or e-mail any time with questions, comments, or concerns. Also, re-confirm time and place of next meeting (or conversation) with patient/family.
Document the conversation with the patient/family, including next steps, in the medical record. However, stick to the facts…no speculation or derogatory remarks about the care, yourself, colleagues, or patient/family.
Call c-suite, risk, legal, or insurer.
Practice scenario! Using the bullet points above, how would handle the following scenario?
Mrs. Woods is a 53-year old woman who goes to the hospital for a CT-guided biopsy of the liver. Mrs. Woods believes the test shouldn’t be a big deal, so she tells her husband to go the mall across the street and do some shopping. The technician assures Mr. Woods she will call him when the test is complete.
Mr. Woods is standing in the mall when his cell phone rings. He answers to hear a nurse frantically screaming, “Come quickly!”
When Mr. Woods gets to the hospital he learns his wife is dead….
Please share this information with colleagues and friends. To schedule a Sorry Works! presentation for your Grand Rounds seminar, call Sorry Works! at 618-559-8168 or e-mail doug@sorryworks.net.