Nearly one in two healthcare professionals will be involved in a serious incident (severe adverse event) during their career. While prevention and recovery strategies exist and are generally known, mitigation strategies remain important and should also be understood.
Hot debriefing as a team and disclosing care-related harm to patients and their parents are fundamental aspects of the damage mitigation strategy.
Whether from a moral, ethical or legal standpoint, disclosing damage associated with care is one of the duties of a healthcare professional. According to the French Public Health Code*, " everyone has the right to be informed about their state of health ".
In principle, this duty to inform is owed only to the patient, but in certain cases the information may be provided to the legal beneficiaries or representatives (death of the patient, minor patient or under guardianship, etc.).
The reporting of a healthcare-associated harm is generally accompanied by a strong emotional burden. Announcing to a patient that they have been the victim of an accident or error during care can be a complicated moment for healthcare professionals.
To meet patient expectations, but also to integrate professional practices into a continuous improvement approach, it is essential to remove certain barriers such as lack of training, the difficulty caregivers have in managing their emotions, or the fear of a potential lawsuit.
With the objective of reassuring and supporting healthcare professionals in this often difficult process, but also to meet the legitimate expectations and needs of patients, the Haute Autorité de Santé (French National Authority for Health) has published a guide on this subject, which we are sharing with you.
Anapproach focused on the patient-caregiver team and on improving care safety
According to the French National Authority for Health, an undesirable event is defined as "an event or circumstance associated with care that could have led to, or has led to, harm to a patient, and which we hope will not happen again"*.
All adverse events involving harm to a patient, whether "near misses" or incidents with no physical consequences, should be reported.
The reporting of a healthcare-associated harm is primarily a patient-centered approach. In order to participate in improving the safety of care, providing transparent and comprehensive information to the patient is fundamental.
To rebuild and maintain this relationship during this difficult time, communication is a key element. However, it cannot be improvised and must be adapted.
Following an accident, one of patients' expectations is to understand what happened and why it happened. With this in mind, the care team should meet in the immediate aftermath of the accident in order to understand what happened. This is the hot debriefing, which will help defuse the emotions in the care team, and to reconstruct and understand the facts.
With the hot debriefing completed, it is appropriate to prepare the announcement to patients or their relatives.
This announcement calls for non-technical skills that should be developed and highlighted.
The Haute Autorité de Santé has formulated some advice in its guide "Announcement of a damage associated with care" which helps to structure the announcement and avoid some pitfalls:
- Introduction of the healthcare professionals present
- Recognition of damage,
- Description of the facts,
- Expression of regrets and apologies,
- Consultation with the patient on the continuity of care,
- Offer of support proposals
- Finalization of the interview with a proposal for subsequent appointments and guidance on possible avenues of appeal.
To assist healthcare professionals in disclosing harm associated with care, SafeTeam Academy shares, in addition to these tips, the importance of personalizing your own method. If you do not have one, methods such as the SPIKES method exist and can also be used. What does SPIKES stand for?
- Setting: suitable location, key people present,
- Perception: ask the patient about their perception of the situation,
- Invitation: ask the patient how much information they want to know,
- Knowledge: expose the medical facts, in cases where the news is not good, expose it immediately before moving on to the facts,
- Emotions: Being empathetic and comforting,
- Support: explain the strategy and the sequence of events.
SPIKES is a "generic" guide to breaking bad news. For those who don't like the English language, you'll find the translated version "EPICES" in this Swiss Medical Journal article.
These situations are always unique and sometimes complex; training for them is essential.
And let us remember the human dimension of these announcements, particularly in the quality of communication and the consideration of emotions, both of patients and caregivers.
As Walter Baile and Robert Buckman, two authors of Spikes, stated in the title of one of their correspondence: "Breaking Bad News: More Than Just Guidelines"*
SafeTeam Academy and the announcement of harm associated with care
Patients affected by care-related harm have many expectations. They want to know, understand, and be informed. However, supporting patients through these difficult times cannot be improvised, and in the face of such emotionally charged situations, healthcare professionals sometimes find themselves helpless.
In its initial developments, SafeTeam Academy chose to address this topic and offer a module on disclosing harm associated with care to enable healthcare professionals to anticipate these situations.
Through an immersive video, caregivers will be able to question their practices regarding team debriefing after an incident and the announcement of harm related to care. They then attend the debriefing of Anne ROCHER, a clinical psychologist working in intensive care and a business leadership coach, who is an expert on these issues.
As with all SafeTeam Academy training courses, the goal is to stimulate learners' reflection on areas for improvement, whether individual, collective, or institutional.
If you too would like to play your part in improving the reliability of care within your facilities, SafeTeam Academy training courses are for you! To find out more, write to: contact@safeteam.academy
