This policy sets out the requirements for Open disclosure process, this ensures that patients, carers nursing staff and Nephrologist are:
- Communicating effectively and honestly about a patient incident
- Provided with an opportunity to recount their experiences, concerns and feelings and are listened to
- Treated respectfully and provided with ongoing care and support for as long as is required
The open disclosure approach includes an expression of regret for what has occurred, keeps the patient and carer informed and provides feedback on investigations including the steps taken to prevent a similar event from recurring.
Principles of Open Disclosure
Open and timely communication
The patient and their support person should be provided with information about what happened, in an open and honest manner at all times.
Adverse events should be acknowledged to the patient and their support person as soon as practicable.
Apology or expression of regret
As early as possible, the patient and their support person should receive an expression of regret for any harm that resulted from an adverse event.
Recognition of reasonable expectations of patients and their support person
The patient and their support person may reasonably expect to be fully informed of the facts surrounding an adverse event and its consequence, treated with empathy, respect and consideration and provided with support in a manner appropriate to their needs. The discussion will include:
- a factual explanation of what happened
- an opportunity for the patient to relate their experience of the adverse event
- a discussion of the potential consequences of the adverse event, and
- an explanation of the steps being taken to manage the adverse event and prevent recurrence.
We supports a “no blame” culture where staff are able and encouraged to recognise and report adverse events and are supported through the open disclosure process. Opportunities for a debrief following a sentinel or serious incident will be given.
Integrated Risk Management and Systems Improvement
Our Risk Management Framework, Incident Reporting Procedure and Quality Plan form the framework for integrated risk management and system improvement.
Outcomes of investigations are to focus on improving systems of care and will be reviewed for their effectiveness.
Our clinical risk management and quality improvement processes through the governance frameworks ensures adverse events are investigated and analysed to find out what can be done to prevent their recurrence.
Root Cause Analysis
The open disclosure process commences with the recognition that the patient has suffered unintended harm during their episode of care. A Root Cause Analysis may be required (refer to 501.04 BAV Procedure Sentinel Events and Root Cause Analysis)
As soon as a Sentinel Event or Serious Incident is identified, the first priority will be prompt and appropriate clinical care and prevention of further harm. The Renal Care Centre (RCC) Manager or designee should gather any evidence that will assist in investigating the incident and report to Health department with the time frames outline in Procedure Sentinel Events and Root Cause Analysis for your state.
All incidents shall be assessed initially by the first member of the clinical team to detect the incident. The employee will perform an initial assessment of the incident and notify the RCC Manager or Team Leader to confirm their evaluation (refer to Incident Reporting 501.03 BAV Procedure).
Responsibility for Disclosure
The responsibility for the management of disclosure will rest with the Manager with the support of the Executive Governance Committee.
The management of the open disclosure process will give due regard to and be consistent with our legal obligations and insurance requirements.
Low level response:
It is likely that in most cases where a low-level response is indicated, the disclosure process will be completed with the initial disclosure discussion with the patient. Unless there are specific indications or the patient requests it, the disclosure process and the investigation and implementation of changes will occur at local service delivery level, with participation of those directly involved in the event.
Reporting to management will occur through standard incident reporting and will be analysed to detect high frequency events. Review will occur through standard investigation processes.
Management of high-level response
For all Sentinel Events or Serious Incidents, the EGC shall be notified immediately and be available to provide support and advice during the open disclosure process if required.
The EGC and other staff involved in the adverse event management, should communicate as soon as possible after the event to:
- Establish the basic clinical and other facts (including timelines)
- Assess the event to determine the level of response
- Identify who will take responsibility for discussion with the patient and their support person
- Identify immediate support needs for the staff involved
- Ensure that all team members maintain a consistent approach in any discussions with the patient and their support person; and
- Consider legal and insurance issues, both for B. Braun Avitum and health care professionals.
The initial discussion with the patient and their support person should occur as soon as possible after the event. Factors to consider with the timing of the disclosure discussion include:
- Clinical condition of the patient
- Particular patient needs, eg language, age, disability
- Availability of appropriate managers and employees
- Availability of the patients support person
- Availability of support for staff
- Patient preference, and
- Emotional and psychological state of the patient.
The open disclosure process shall be accurately recorded as per 503.01 Customer Complaints and Feedback policy.
Admission of liability - An “admission” of liability is a statement by a person that proves, or tends to prove a person’s or organisation’s liability in negligence for harm or damage caused by another. There is a clear distinction between an admission of fact on the one hand ("we lacerated your liver during the course of the operation"), versus an admission of liability for negligence (" the liver laceration constitutes a breach of my duty of care to you and that breach has caused you injury").
Adverse event – An incident in which unintended harm resulted to a person receiving health care.
Expression of regret – An expression of sorrow for the harm experienced by the Patient.
Low level incident - A low level incident is where there is no permanent injury or increased level of care required and refers to incidents resulting in negligible or minor consequences.
High level incident - A high level incident is any incident resulting in a Sentinel Event or Serious Incident in accordance with the definitions described in Procedure 501.4 Sentinel Events Reporting. A high-level incident can also be an event that results in major or catastrophic consequences for the patient. Open disclosure – The process of open discussion of adverse events that result in unintended harm to a patient while receiving health care and the associated investigation and recommendations for improvement.