Patient brochure must be worded carefully
Patient brochure must be worded carefully
Nearly every health care facility has a patient safety brochure these days, and they almost always come out of some department other than risk management. So do you really know what is in your organization's patient safety brochure? Do you know what you are telling patients, or worse, what you might be promising them?
There is little research available on the impact of patient safety brochures, according to statements from the Institute for Safe Medication Practices (ISMP) in Huntingdon Valley, PA. But at least one study has suggested that patient safety brochures have the potential to cause unintended consequences that actually can degrade patient safety.1 In that study, the researchers noted that patient safety brochures often encourage patients to get involved in preventing errors without giving them any practical advice for doing so.
"Some messages suggest an inappropriate shifting of responsibility onto patients. Advice that involves checking on or challenging health professionals' actions appears to be particularly problematic for patients," wrote the researchers from the University of Aberdeen, Foresterhill, in Aberdeen, Scotland. "Such behaviors conflict with the expectations many people have and think health professionals have of patients' roles."
Group aims for clear advice
Those issues were considered when the Committee to Reduce Infection Deaths (RID), a New York City-based, not-for-profit educational campaign, designed its patient safety brochure, says Betsy McCaughey, PhD, chairman of the committee and former lieutenant governor of New York. (Editor's note: To view the brochure, go to the group's web site at www.hospitalinfection.org and choose "RID's 15 Steps" from the menu on the left.)
"I've seen so many patient safety brochures that are mind-numbingly vague and old-fashioned," she says. "They're preventing patients from taking part in improving patient safety, even when they very much want to."
McCaughey says the most important goal was to convey to patients the latest, most effective research on preventing infections. She pulled the latest research from medical journals, information that usually is not shared with patients, and put it in the brochure from the patient's point of view. McCaughey, who wrote the brochure herself, drew from numerous sources to compile the 15 recommendations for patients, and she always emphasized the most current research.
"These aren't just common-sense things or old wives' tales. This is the very best, most up-to-date research that is available to health care professionals, presented to patients in a way that helps them actually use it," she says. "That can be done with a brochure in any area of patient safety. Take the new research and transfer it into the patient's point of view."
McCaughey worked with critical care nurses and other health providers to ensure that the information in the brochure was accurate and substantive. She wanted the brochure to be accurate and patient-friendly. "But not dumbed down," she notes. "There's a difference between writing something so that people can understand it and talking down to them.
The RID brochure is revised at least yearly, or more often if necessary because of new research. McCaughey advises risk managers to make sure their own patient safety brochures are updated in a similar fashion.
Brochure can raise legal issues
Risk managers also should be involved in the approval process for patient safety brochures to make sure they don't create potential legal liability, says Richard King, JD, an attorney with the law firm of Montgomery McCracken in Philadelphia and previously in-house counsel for a hospital system. In particular, he says, the brochure must avoid anything that sounds like a guarantee of clinical outcomes or claims that the facility has a perfect safety record.
"It's normal to want to tout your commitment to safety and your safety record, but overpromising can be construed as a guarantee or promise of a specific outcome," he says. "When an adverse outcome then occurs, that type of language in a patient safety brochure plays right into the hands of a plaintiff's lawyer."
The best policy is to "underpromise and overperform," King says. You don't ever want a plaintiff to tell a jury that your organization promised everything would be fine and the patient relied on that promise to his or her detriment, he says.
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ISMP offers tips on good brochures The Institute for Safe Medication Practices (ISMP) in Huntingdon Valley, PA, recently developed this list of questions that can help you determine if your patient safety brochure is effective:1
Reference 1. What does your patient safety brochure really say about patient safety? Nurse Advise-ERR 2007; 5:1-2. |
King has helped health care providers edit patient safety brochures to downplay claims of a superior safety record, which he admits can be difficult sometimes when hospital leaders are proud of their accomplishments. Even if your organization has an excellent safety record, you still must be careful what words you use in relating that accomplishment. In general, King says, you should avoid using extreme words such as "never" or "always" or phrases such as "can't happen" or "won't happen." Even though you may word the phrase carefully so that it is technically accurate, the patient may infer more.
Avoid semantic argument
Finding the line can be difficult, King says. For example, it may be acceptable to say your organization "strives" for zero errors but it might be risky to say you have zero tolerance for errors. A fine distinction? Yes, but the latter may imply that you never expect to have an error, while the former only implies that you do make your best effort to avoid them.
Err on the side of caution. Remember that patients will never read something with the same level of scrutiny and diligence that you used when writing it, King says.
"The plaintiff's lawyer will come back and say 'Right in your brochure you say that none of these errors will occur,' he explains. "The best you can do then is try to argue the semantics and exactly what the words mean, and you'll never come off looking good if you do that with a jury. It's a nightmare in terms of litigation."
Reference
1. Entwistle VA. Advising patients about patient safety: Current initiatives risk shifting responsibility. Jt Comm J Qual Patient Saf 2005; 31:483-494.
Nearly every health care facility has a patient safety brochure these days, and they almost always come out of some department other than risk management. So do you really know what is in your organization's patient safety brochure?Subscribe Now for Access
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