The Washington Manual Internship Survival Guide Read Online Free

attending physician and risk management (see Table 8-1 ). Reporting adverse events not only is important to patient care but also helps identify major system flaws.
    DEFINITIONS
    •    Adverse event: any incident, therapeutic error, iatrogenic injury, or other undesirable occurrence that caused probable or definite harm to a patient.
    •    Disclosure of adverse events: an honest and empathetic discussion of clinically significant facts between providers and the patient about the occurrence of an adverse event that resulted or could have resulted in patient harm.
    •    Sentinel event: unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Requires immediate investigation and response.
    HOW TO RESPOND TO A POTENTIAL INCIDENT
    •   Arrive as soon as possible.
    •   Avoid assigning blame to an individual.
    •   Never argue in public or in the chart.
    •   Document the facts.
    •   Report injuries.
    •   Never state in the medical record that an incident report was completed.

    HOW TO REPORT AN ERROR
    •   Call risk management at your institution.
    •   Complete an incident report.
    •   Discuss the situation with your resident and attending as soon as possible (see Table 8-1 ).
    HOW TO DISCLOSE AN ADVERSE EVENT
    •   Speak with your resident, attending physician, and risk management first.
    •   Your attending should coordinate disclosure efforts and speak with the patient and family.
    •   If more than one service is involved, confer and collaborate on the disclosure conversation. The medical care team should deliver a consistent message.
    •   Give the patient and family an honest, straightforward, and prompt explanation of what occurred.
    •   You can apologize for the error.
    •   If the cause of error is uncertain, do not speculate or hypothesize. State the facts. Tell the patient that further investigation is necessary.
    •   Identify who will be involved with ongoing care. You may need to transfer the patient’s care if the patient–physician relationship has been compromised.
    •   Tell the patient and family what steps are being undertaken to prevent further error.
    •   Allow time for questions.
    •   Speak in layman’s terms.
    •   Be aware of body language.
    •   Document the discussion with the family
•  Time, date, and place
•  Names and relationships of those present
•  Documentation of discussion of event
•  Patient/family response
    DOCUMENTATION
    •   Documentation is vitally important whenever there has been an adverse event.
    •   Prior to writing a note, give yourself a few minutes to recap what happened. Remember: “If it wasn’t documented, it wasn’t done.”
    Do
    •   Record changes in patient’s condition and response to treatment.
    •   Add addendums when necessary.
    •   Write legibly.
    •   Use factual and objective language.
    •   Use only approved abbreviations.
    •   Chart patient nonadherence.
    •   Show your thought process.
    •   If you consider something potentially serious and rule it out, say so and why.
    •   Write plans for future treatment.
    Don’t
    •   Alter documentation.
    •   Use imprecise terms.
    •   Write negative comments about the patient or family.
    •   Document disputes with other care providers.
    INFORMED CONSENT
    •   This includes the type of procedure, reason or indication for the procedure, benefits and risks of the procedure with disclosure of incidence and severity of complications, and explanation of any alternative procedures.
    •   Must be obtained from a competent patient, legally appointed guardian, or durable power of attorney for health care.
    •   When a patient is unable to consent, then consent can be obtained from a spouse, parent, adult children, siblings, or grandparents.
    •   Two physicians can give consent in a life- or limb-threatening emergency.
    •