Definitions of the terms harm, adverse event and disclosure, a framework for understanding harm, an explanation of the different stages of disclosure and a brief synopsis about no-harm events.
Communication in these materials is meant to include communicating with a patient, or with a capable patient's permission, with family members or others, or if the patient is not capable, with a Substitute Decision Maker (SDM). An SDM is a person who is legally authorized to make decisions on behalf of the patient. This authority may be granted through a legal document such as an advance directive, by legislation, or by the courts.
Health care providers seek the best possible clinical outcomes for their patients. However, even with the best of medical care, a patient's outcome may not be what was originally desired or anticipated, and in some cases may be entirely unanticipated. Some unexpected outcomes are unfortunately related to health care delivery itself, despite the dedication, training and professionalism of the health care providers.
Patients expect to be informed about harm they have experienced, whatever the reason for it, and this information needs to be delivered in a caring manner. Effective communication with patients and the health care team can improve patient outcomes and satisfaction. Conversely, failures in communication may lead to patient harm, misunderstandings, complaints and lawsuits.
This resource provides advice on communicating with your patient if an unanticipated poor clinical outcome has occurred during care, particularly in the difficult circumstances in which health care delivery is suspected or known to have contributed to that poor outcome.
The advice in this material is based on expert opinion, knowledge of the existing medical literature and the experience of the CMPA.
What is an adverse event?
Terminology is important and should be used consistently. The CMPA encourages the following definitions from the Canadian Disclosure GuidelinesDisclosure Working Group. Canadian Disclosure Guidelines. Edmonton, AB: Canadian Patient Safety Institute; 2008 be adopted in Canada:
Adverse event: An event which results in unintended harm to the patient, and is related to the care and/or services provided to the patient, rather than to the patient's underlying medical condition.
Harm: An outcome that negatively affects a patient's health and/or quality of life.
What is disclosure?
Disclosure is the process by which an adverse event is communicated to the patient.
Health care providers have an ethical, professional and legal obligation to disclose adverse events.
Those knowledgeable about disclosure suggest that following an adverse event, patients want:
- An acknowledgement that something has happened;
- The facts known about what happened;
- An understanding of the recommended next steps in clinical care – what is going to happen and how the clinical situation can be improved, if this is possible;
- A genuine expression of care, concern and regret; and
- Assurance that appropriate steps, if these are possible, are being taken to prevent a similar occurrence from happening to others.
In summary, patients have clinical needs, information needs, and emotional needs after an adverse event.
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