Risk Management & Disclosure

1. Risk Management&Disclosure Kirsten Thomson, November 2012

2. My Portfolio • Patient Safety Learning System (PSLS) • Risk management • Education affiliation agreements • Insurance

3. PSLS • Add and deactivate users • Provide training • Provide final approval to all events reported in system • Trending and analysis • Review for potential claims

4. Risk Management • Critical incident and Section 51 quality reviews • Point person for legal affairs • Contract risk/indemnification • Maintain risk policies and procedures • Consult on risk of other department P&P • Risk evaluation of new projects/initiatives • General risk advice

5. Insurance - HCPP • Our “insurer” and risk advisors • Provide NH with liability, property, directors & officers, and some crime coverage • Physicians covered by HCPP only for administrative work • We report serious adverse events • They provide legal counsel

6. Reporting Events • PSLS • Can only be done on computers connected to the NH network • Department channels • Department head, chief of staff, department manager • Directly to me

7. What kinds of events to report • NH policy 2-1-3-030-P Patient Safety Management System (PSLS) “NH employees and medical staff will report, document and manage all client-related incidents and near misses on the PSLS incident reporting system.” • Events that caused harm (critical incidents – loss of life, limb or vital organ) “An event is an incident/error/mistake or any happening that is not consistent with the routine operation of the facility/service or the routine care of a particular patient” • Events that you might report to CMPA

8. “Must Report” Events Surgical events 1. Surgery performed on the wrong body part 2. Surgery performed on the wrong patient 3. Wrong surgical procedure performed on a patient 4. Unintended retention of a foreign object in a patient after surgery or other procedure 5. Intraoperative or immediately postoperative death in an American Society of Anesthesiologists Class I patient

9. Product or device events 6. Patient death or serious disability associated with the use of contaminated drugs, devices, or biologics provided by the health care facility 7. Patient death or serious disability associated with the use or function of a device inpatient care, in which the device is used for functions other than as intended Patient Safety Event Management (PSLS) 2‐1‐3‐030‐P 8. Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a health care facility

10. Patient protection events 9. Infant discharged to the wrong person 10. Patient death or serious disability associated with patient elopement/disappearance 11. Patient suicide, or attempted suicide resulting in serious disability, while being cared for in a health care facility

11. Care management events 12. Patient death or serious disability associated with a medication error (wrong drug/ dose/patient/time/rate/preparation/route) 13. Patient death or serious disability associated with a hemolytic reaction due to administration of ABO/HLA incompatible blood or blood product 14. Maternal death or serious disability associated with labor or delivery in a low risk pregnancy while being cared for in a health care facility 15. Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a health care facility

12. 16. Death or serious disability (kernicterus) associated with failure to identify and treat hyperbilirubinemia in neonates 17. Stage 3 or 4 pressure ulcers acquired after admission to a health care facility 18. Patient death or serious disability due to spinal manipulative therapy

13. Environmental events 19. Patient death or serious disability associated with an electric shock or electrical cardioversion while being cared for in a health care facility 20. Any incident in which a line designated for oxygen or gas to be delivered to a patient contains the wrong gas or is contaminated. 21. Patient death or serious disability associated with a burn incurred from any source while being cared for in a health care facility. 22. Patient death or serious disability associated with a fall while being cared for in a health care facility. 23. Patient death or serious disability associated with the use of restrains or bedrails while being cared for in a health care facility.

14. Criminal Events 24. Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed health care provider. 25. Abduction of a patient of any age. 26. Sexual assault on a patient within or on the grounds of the health care facility. 27. Death or significant injury of a patient or staff member resulting from a physical assault (e.g. battery) that occurs within or on the grounds of the health care facility.

15. What happens following an event? • Critical incidents undergo quality review • Reported to HCPP; legal counsel may be assigned • Non-critical incidents are tracked and trended • PSLS no harm events

16. Disclosure • NH Disclosure of Adverse Events policy (4-2-0-030-P) “Any adverse event where there is harm, injury or complication due to health care service delivery should be disclosed to the Client.” “Northern Health physicians, managers, health care providers and administrators must work together to ensure that appropriate disclosure to clients or their representatives is a routine part of the response to an adverse event.” “Disclosure of near misses is a matter of clinical and professional judgment. If it could assist the client in the future to know that a mistake was nearly made, it should be disclosed”

17. Disclosure • Canadian Patient Safety Institute (CPSI) – Canadian Disclosure Guidelines “Patients are entitled to information about themselves and about their medical condition or illness, including the risks inherent in healthcare delivery.” Current literature, national and international leading practices, and ethical, professional and legal considerations all support open and honest disclosure of patient safety incidents, as it is important for all concerned.”

18. Disclosure - CPSI “Healthcare providers have ethical obligations to be open and honest when communicating with patients. Most professional codes of conduct specifically require disclosure. Patients have a right to relevant information about all aspects of their care and healthcare providers have a corresponding obligation to provide that information to patients without being asked and to answer their questions.”

19. Disclosure – Accreditation Canada • Includes a Required Organizational Practice for disclosure “Organizations must implement a formal and transparent policy and process of disclosure to patients, which includes support mechanisms for patients, family and care of service providers.”

20. Disclosure - CMPA “An adverse event is one which results in unintended harm to the patient and is related to the care and/or services provided to the patient rather than to the patient’s underlying medical condition” “The CMPA has for many years encouraged member physicians to disclose to patients the occurrence and nature of adverse outcomes as soon as is reasonable to do so after their occurrence. This is an ethical, professional and legal obligation.”

22. References • NH Policy 4-2-0-030-P Disclosure of Adverse Events (Nov 2011) • NH Policy 2-1-3-030-P Patient Safety Management System (PSLS) (March 2011) • CMPA Disclosing adverse events to patients: strengthening the doctor-patient relationship (May 2008) • CPSI Canadian Disclosure Guidelines: Being Open with Patients and Families (2011)