Open Disclosure

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Open Disclosure

• 45-minute presentation for frontline clinicians

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What is Open Disclosure?
Open Disclosure is a frank discussion with a
patient and/or their support person(s) about an
incident that resulted in harm or injury to the
patient. NSW Open Disclosure Policy Directive
PD2007_040
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Why is Open Disclosure important?

• Patients value honesty, empathy and transparency.
• Its the right thing to do.
• Staff are supported by NSW Health and the NSW
  Government to always practise Open Disclosure.
• Nurtures an open and just culture that values
  learning from incidents.

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Principles of Open Disclosure
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• Openness and timeliness of communication.
• Acknowledgement of incident.
• Expression of regret.
• Recognition of the patients reasonable
  expectations regarding their care.
• Support for health staff.
• Confidentiality.

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General and High Level Open Disclosure

• An incident is any unplanned event resulting in,
  or with the potential for, injury, damage or
  other loss.
• General level refers to SAC 3 or SAC 4 incidents
  and involves frontline clinicians, such as
  nurses, residents, JMOs, allied health
  professionals.
• High level refers to SAC 1 and SAC 2 incidents
  and involves senior clinicians and management and
  is a more detailed process.

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Steps of Open Disclosure

• Acknowledge the incident and its impact.
• Explain the known clinical facts.
• Apologise for what has occurred.
• Reassure and agree on a plan for ongoing care
• Investigate the incident to learn what has
  happened. Remember that staff and patients have a
  different understanding of whats involved in an
  investigation.
• Feedback to patient and staff.
• Document by notifying in IIMS and the patients
  medical record.

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An easy way to remember the steps is
Explain Apologise Reassure
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Your role and responsibility

• To support and practise Open Disclosure.
• To support your colleagues in practising Open
  Disclosure.
• To focus on the patients needs and expectations
  if an incident occurs.
• To initiate the Open Disclosure process within 24
  hours of the incident or when it was identified.

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Key factors in apologising
When apologising, remember

• Timeliness
• Empathy
• Legal considerations
• Open Disclosure is not about assigning blame.
  Dont blame
• yourself
• another staff member
• an organisation
• the patient

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Examples of what and what not to say

• You could say
• ? Mrs Smith, unfortunately we took an x-ray of
  your left hand rather than than your right hand.
  Im really sorry this happened, but we would like
  to do another x-ray now if thats OK. We will be
  reviewing our procedures to find out why this
  occurred and to ensure it wont happen again.
• ? I am very sorry this has happened.
• What NOT to say
• ? We x-rayed the wrong side. Sorry, but weve
  been really busy today and these things happen.
  Well do you again now. "

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Putting it into practice a case study
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(No Transcript)
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Legal considerations

• Section 68 of the Civil Liability Act 2002 states
  that an apology does not constitute an express
  or implied admission of fault or liability and is
  not admissible in any civil proceedings as
  evidence of fault or liability.
• An apology is not an admission of liability if it
  is given in accordance with the NSW Health Open
  Disclosure Guidelines

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Open Disclosure requires

• supportive environment
• strong commitment
• strong leadership
• strong support from
• Clinical Excellence Commission
• Australian Medical Association (NSW)
• Medical Defence Organisations (MDOs)
• Treasury Managed Fund (TMF)
• Professional Colleges Associations

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Who to go to for support

• The Director of Clinical Governance in each AHS
  has overall responsibility for Open Disclosure.
• Staff can seek support from
• Clinical Governance Unit
• Line managers, senior clinicians and clinical
  teams
• Employee Assistance Program
• Medical Defence Organisations
• Patient Safety Officers
• Open Disclosure mentors and support network
• Patients can seek support from
• Patient Liaison Officers

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Resources
Open Disclosure websitehttp//www.health.nsw.gov.
au/quality/opendisc/index.html Open Disclosure
Guidelineshttp//www.health.nsw.gov.au/policies/g
l/2007/GL2007_007.html Open Disclosure Policy
Directivehttp//www.health.nsw.gov.au/policies/pd
/2007/PD2007_040.html
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Questions?