Disclosure

Suggestions

Suggestions for Presentation

  1. Examine the events in First, Do No Harm and ask physicians “Who should disclose what to whom?”
  2. Discuss the points found in “Responding to an Adverse Event”
  3. Disclosure of unanticipated outcomes can be presented in two sessions.
    • The first is an introduction to the principles, reasons for disclosure, and the challenge that it poses for the clinician from the personal and the legal perspective. This session can be presented using two methods: case based facilitated discussion, or a didactic session.
    • The second session should be one in which the participants have the opportunity to role play and disclose unanticipated outcomes in the presence of a trainer (contact Program Director, Loss Prevention & Patient Safety Operations, Ann Louise Puopolo, BSN, RN for recommendations regarding experienced role-play trainers).

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Suggestions for Customization

Additional Learning Points

  1. Disclosure of unanticipated outcomes is often linked to the consent processes the patient underwent prior to the event. Exploring the connection between these two patient engagements can be useful in strengthening the consent process.

Additional Presentation Materials

  1. Honesty Is the Best Policy
  2. Guidelines for Responding to an Adverse Event
  3. Framework for Handling Adverse Events
  4. Responding to an Adverse Event: Checklist [PDF]

Additional References

  1. Baker SK. Chapter 15: Adverse Patient Outcomes: In: Managing Patient Expectations. San Francisco: Jossey-Bass Publishers, 1998, pp.213-222.
  2. Berman S. Reporting outcomes and other issues in patient safety: an interview with Albert Wu. The Joint Commission Journal on Quality Improvement. 2002;28(4):197-204.
  3. Build the public’s trust by dealing openly with errors. AHA News. 1999;35(30):6.
  4. Chapter Six: Ethical Considerations. In: What Every Hospital Should Know About Sentinel Events. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations, 2000, pp.89-106.
  5. Darr K. Uncircling the wagons: informing patients about unanticipated outcomes. Hospital Topics. 2001;79(3):33-35.
  6. Disclosure requires some hard choices. Healthcare Risk Management. 2001;(12):137-40.
  7. Gallagher TH, et al. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. Journal of the American Medical Association. 2003; 289(8):1001-07.
  8. Gilbert S. Wrongful Death, A Medical Tragedy. New York: WW Norton and Co., 1995.
  9. Johnson C and Horton S. Owning up to errors: put an end to the blame game. Nursing. 2001;31(6):54-55.
  10. Medical mistakes: tell patients, families say risk managers in national survey. QRC Advisor. 2000;16(11):12.
  11. Quill TE and Townsend P. Bad news: delivery, dialogue, and dilemmas. Archives of Internal Medicine. 1991;151(3):463-68.
  12. Rosner F, et al. Disclosure and prevention of medical errors. Archives of Internal Medicine. 2000;160(14):2089-92.
  13. Walton M. Open Disclosure To Patients or Families After an Adverse Event; A Literature Review. Sydney, Australia: Australian Council for Safety and Quality in Health Care, Open Disclosure Project, November 2001.
  14. Wu AW. Handling hospital errors: is disclosure the best defense? Annals of Internal Medicine. 1999;(12):970-72.

Additional Subject Matter Experts

  1. none identified

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Suggestions for Measurement of Competency in the Objectives

  1. Responding to an adverse event from RMF. This document is a take home that they will receive at the end of the session.
  2. Direct observation of disclosure
  3. Chart review for appropriate documentation

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