Exercise

Role playing patient discussions about medication

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Part 1: Understanding the elements of patient-focused disclosure

This part of Exercise #1 can be provided to participants as a handout or presented via didactic lecture

1. Preparation
   1. Stabilize the situation
   2. Contact appropriate clinical and administrative parties
   3. Determine the need to disclose—consult hospital policy
   4. Decide who will speak to the patient/family and whether or not others need to be present
   5. Determine what will be explained
   6. Plan the patient/family meeting
      1. convenient time for patient/family
      2. comfortable and private place
      3. enough time
      4. supportive atmosphere
2. Conducting the Disclosure Talk
   1. Explain the patient’s status
   2. Listen, then answer questions without speculation
   3. Ask the patient (or family) what they want to know
   4. Listen, then answer questions without speculation
   5. Explain what happened
      1. tell what you know
      2. tell what you’re trying to find out
      3. don’t speculate
      4. don’t fingerpoint
   6. Listen, then answer questions without speculation
   7. Empathize/apologize
      1. Apologies double edge sword
      2. Laws vary by state
      3. May prevent a lawsuit
      4. May have an impact on the jury
      5. Healing process for the relationship
      6. Be sincere
      7. Avoid placing or accepting blame
      8. Appropriate apology
         1. I’m sorry this happened to you
         2. We’re trying to find out what happened and why
      9. Inappropriate apologies
         1. “I am sorry I did this to you..”
         2. “This is the third time that this has happened”
   8. Listen, then answer questions without speculation
3. Following up the disclosure talk
   1. Document the disclosure meeting in the patient’s chart
      1. Facts
      2. Individuals present
      3. Follow-up steps
   2. Plan and discuss subsequent care
   3. Plan and discuss subsequent contact with patient/family
      1. Give patient/family time to assimilate info
      2. Give patient/family time to grieve
      3. Offer to convey additional facts as they emerge
      4. Answer questions without speculation
      5. Group make up: who will speak with the patient
   4. Listen, then answer questions without speculation

Part 2: Practicing the Disclosure Process

This part of Exercise #1 involves applying the didactic learning to disclosure preparation, discussion, and follow-up.

Note: Unless you have sufficient experience in facilitating a role-play training (or access to an experienced trainer) the role play should be avoided, or conducted without comment about the players' skills. Contact Program Director, Loss Prevention & Patient Safety Operations, Ann Louise Puopolo, BSN, RN for recommendations regarding experienced role-play trainers.

1. Select an actual case that would (at least potentially) lead to the need for an error disclosure to the patient or family. (The First, Do No Harm video, is one suggestion.)
2. Prior to reading or viewing the case, ask the participants to select a role (i.e., attending, resident, nurse, risk manager, patient) and to approach the case from that perspective.
3. Read or view the case without comment.
4. Ask participants to break into groups, each of which has a diversity of roles, with the goal of conducting the preparation segment of the disclosure process.
5. After an appointed time, conduct a discussion of the preparation plans.
6. Select one group to (briefly) role play the disclosure discussion; include the “patient” in the role play. See Part 3
7. If you choose not to conduct a role-play (see Note above) , the facilitator can describe a sample discussion as the setup for planning the follow-up.
8. Following the role-play (without comment about the players’ skills), ask the groups to (internally) discuss the disclosure follow-up
9. After an appointed time, select a (preferably) different group to explain its follow-up plan.
10. Discuss the strengths and weaknesses of the process.

Part 3: Role Playing to Practice Giving a Patient Bad News

Note: Unless you have sufficient experience in facilitating a role-play training (or access to an experienced trainer) the role play should be avoided, or conducted without comment about the players' skills. Contact Program Director, Loss Prevention & Patient Safety Operations, Ann Louise Puopolo, BSN, RN for recommendations regarding experienced role-play trainers.

1. Include a “patient” in the role play who (if possible) has not been privy to the Preparation discussions
2. Praise the group’s courage for presenting.
3. Set ground rules e.g., “we are working together to develop a process for dealing with a very difficult situation.”
4. Ask everyone to consider if their own group’s preparation addresses the patient’s concerns.
5. At the conclusion spend a few minutes debriefing. Consider what went well and how you might adjust other parts.
6. In the debrief, the instructor should move right into asking the group to create a “what was done well” list, then ask for suggested adjustments. Push the group to refer to exact examples and to use exact wording when suggesting alternatives.