RM - Tip - JCAHO Patient Safety Standard

JCAHO Patient Safety Standard
January, 2002

This issue of NPM’s Risk Management Tip is devoted to calling your attention to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recently adopted patient safety standard R1.1.2.2 which states the following:

“Patient and, when appropriate, their families are informed about the outcomes of care including unanticipated outcomes.”

According to JCAHO, the underlying intent of this standard requires that the responsible licensed independent practitioner, or his/her designee, clearly explains the outcome of any treatments or procedures to the patient and, when appropriate, the family whenever those outcomes differ significantly from the anticipated outcomes. All JCAHO accredited institutions must establish a mechanism to ensure conformance with this newly adopted standard.

Regardless of whether or not an institution is accredited by JCAHO, NPM believes that patients are entitled to information related to unanticipated outcomes, whether positive or negative, and that the disclosure of such information is essential to creating a trusting relationship between the healthcare professional and patient. Accordingly, NPM encourages all of its insureds to play a proactive role in taking an interventional approach to dealing with the outcome of any treatment or procedures that differ significantly from the originally anticipated outcome.

What is meant by disclosure? Disclosure is the communication of information regarding the results of a diagnostic test, medical treatment, or surgical intervention.

What is meant by unanticipated outcome? An unanticipated outcome is any result that differs significantly from what was intended to be the result of a treatment or procedure.

What is considered to be a medical error? A medical error is any failure of a planned action to be completed or intended, or the use of a wrong plan to achieve this aim.

How should I respond when confronted with such a set of circumstances? When presented with or upon discovery of an unanticipated outcome, you are encouraged to take the following actions that may include, but are not necessarily limited to, the following:

Promptly notify NPM’s Claims Department of the unanticipated outcome, thereby giving us an opportunity to lend assistance to you in your efforts to mitigate or correct the unanticipated outcome or adverse event.

Begin an initial investigation of circumstances as promptly as possible, involving all parties that may have contributed to an unanticipated outcome. The process should be a collaborative one where the focus is to identify the root cause that led to the adverse event as opposed to seeking blame.

Determine if circumstances require withholding certain information due to individual state laws and act accordingly.

Without undue delay, offer a sincere expression of empathy and regret for what the patient has experienced to both the patient and, as appropriate, family members.

Involve the patient and, as appropriate, family members in reaching mutual agreement as to the planned course of care.

Promptly document the fact that discussion regarding the unanticipated outcome took place with the patient and, as appropriate, family members. Generally, documentation should include the following:

Date and Time of discussion
Name(s) and relationship(s) of all parties present
Documentation that there was discussion of the unanticipated outcome
If applicable, document assistance offered and response to the offer
Document responses given to any questions posed by the patient, family members, or legal representative
In those instances, where disclosure is withheld, document reasons why the decision to withhold information was made. (There may be times when this documentation may be kept separate from the medical record in order to protect the safety or welfare of the patient.)

In summary, NPM firmly believes that healthcare professionals and healthcare organizations have an ethical responsibility to inform patients of any unanticipated outcome, regardless of its nature. In furtherance of this position, NPM is committed to lend whatever assistance may be requested by our insureds in helping to fulfill this important aspect of the physician-patient relationship.