Disclosure of adverse events policy
The disclosure policy is consistent with St. John’s Rehab Hospital’s mission, vision, values and philosophy of patient-centred care, to ensure that patients and/or their substitute decision-maker(s) and their family members are properly informed about their health care. In keeping with our mission, vision, values and philosophy of patient-centred care, we are committed to providing the best possible care to our patients. Despite dedicated efforts to prevent them, not all harm is preventable. Adverse events occasionally occur.
Not all negative client outcomes are caused by adverse events; they may also be caused by the natural course of disease or by unpreventable risks of treatment. Although we acknowledge that there are many sources of incidents which can result in adverse events (e.g. accidents) this policy and procedure addresses adverse events initiated by the health care process rather than by the negative outcome caused by an anticipated in disease or illness.
This policy reflects St. John’s Rehab Hospital’s commitment to compliance with legislative requirements, specifically, Amendments to Regulation 965 (Hospital Management) under the Public Hospitals Act, which came into effect on July 1, 2008. This policy also reflects St. John’s Rehab Hospital’s culture of discovery and accountability regarding patient safety. In the interest of maintaining relationships of trust, St. John’s Rehab Hospital is committed to disclosing to patients and/or their families / substitute decision-maker(s) any adverse events and significant adverse events that have occurred and affected, or may affect their health in the future.
POLICY:
- Adverse events and significant adverse events (also referred to as “critical incidents”) shall be disclosed to the patient, family or substitute decision-maker(s) in accordance with this policy and procedure except where it is not in the best interests of the patient to do so.
- An adverse or significant adverse event shall be disclosed if it caused the patient harm, required additional interventions to treat an adverse outcome(s) or to prevent harm arising from an incident. The disclosure must include:
- The material facts of what occurred with respect to the significant adverse event;
- Consequences for the patient of the significant adverse event as they become known; and
- The actions taken and recommended to be taken to address the consequences to the patient of the significant adverse event, including any health care or treatment that is advisable.
- An adverse event shall be managed in accordance with the hospital's Reporting and Tracking of Incidents, Sentinel Events and Near Misses policy. Adverse Drug Reactions shall be managed in accordance with the hospital's Adverse Drug Reaction Reporting policy.
- A significant adverse event is also considered to be a sentinel event and shall be managed in accordance with the Reporting and Tracking of Incidents, Sentinel Events and Near Misses policy.
- Non-significant events and near misses shall be managed in accordance with the Reporting and Tracking of Incidents, Sentinel Events and Near Misses policy.
- Disclosure to the patient and/or substitute decision maker(s) is discretionary for non-significant events and near misses.
- Disclosure is made to the patient if the patient is capable. If the patient is incapable of understanding a discussion of this nature, disclosure is made to the patient’s substitute decision-maker(s) in accordance with The Health Care Consent Act (1996).
- Significant adverse events that are discovered after a patient’s discharge shall be disclosed.
- In the case of an error, attempts to rectify and prevent further incidents will be the primary focus. The obligation to disclose continues as information, including facts and/or consequences, is learned regarding the incident, the patient’s condition and future treatment.
- The hospital shall disclose any systemic steps being taken or that have been taken to avoid or reduce the risk of similar significant adverse events occurring in the future.
- St. John’s Rehab Hospital encourages an environment of reporting and disclosure of adverse events. Disclosure of an adverse event shall be treated in a non-punitive manner wherever possible. The disclosure policy and procedure supports physicians, staff and students’ honesty, professionalism and efforts to continually improve health care safety and quality.
- In cases where an investigation reveals the need for individual corrective action, the fact that disclosure was done promptly and according to policy shall be taken into consideration.
- The failure to disclose, as specified in this policy, may be viewed as a breach of trust. Disclosure promotes the client’s participation in health care decisions. It promotes a continuing and trusting relationship between the patient and the health care practitioner.
APPLICATION OF POLICY:
This policy applies to all physicians, staff (regulated and non-regulated health care providers), Sisters of St. John the Divine, volunteers and clinical students and relevant managers with privileges, employed or contracted by St. John’s Rehab Hospital.
DEFINITIONS:
Disclosure: The Canadian Patient Safety Dictionary defines disclosure as the imparting by health care workers, to patients or their significant others, of patient information pertaining to any health care event affecting (or liable to affect) the patient’s interests. The obligation to disclose is proportional to the degree of actual harm to the patient (or realistic threat of such) arising from an untoward event.
Adverse Event: An unexpected and undesired incident directly associated with the care or services provided to the patient resulting in an adverse outcome, or potential adverse outcome, for a registered patient that includes harm, injury or complication.
Significant Adverse Event: Significant adverse events are occurrences that did or could have resulted in negative or serious patient outcomes (including death or major permanent loss of function) and are not due to the patient’s illness. They are unintended injuries or complications that are likely to have been caused by health care management that do, or have the potential to, negatively impact a patient’s health (psychological or physical) or quality of life.
Critical Incident: A critical incident is defined in Regulation 965 of the Public Hospitals Act as any unintended event that occurs when a patient receives treatment in the hospital that: a) results in death, or serious disability, injury or harm to the patient; and b) does not result primarily from the patient’s underlying medical condition or from a known risk inherent in providing treatment.
Non-significant Events and Near Misses:
Non-significant events and near misses are minor incidents that do not have an actual or foreseeable negative impact on patient outcomes. No extra procedures are needed to prevent negative patient outcomes. These events are not significant from the patient’s perspective.
Most Responsible Physician / Clinician: The physician or clinician who is responsible for coordinating, managing and directing the patient’s care.