Take a role in preventing, reporting medical errors
Take a role in preventing, reporting medical errors
CMs should be involved in patient safety initiatives
As a case manager, you should be aware of your hospital's policies on safety and medical errors and, as an advocate for your patients, take a role in ensuring that their care is safe and that they are informed about any errors that occur, case management experts say.
While hospital case managers shouldn't be tasked with disclosing medical errors to patients, they should make sure the issue is addressed, says John Banja, PhD, associate professor at the Center for Ethics at Emory University in Atlanta.
"The case manager might not be the right person to disclose the error, but he or she can be the right person to make sure the team is aware of their duty to disclose to the patient that an error has occurred, how it will be handled, what the patient can expect from themselves, and what they can expect the team to do to rectify the error," says Hussein Tahan, DNSc, RN, CNA, past chair and commissioner for the Commission on Case Manager Certification.
Every hospital should have an error disclosure policy with key elements that include a mechanism to determine if an error actually occurred and if the error caused harm, along with a policy on how errors are disclosed to patients, Banja says.
"How well they execute it varies from hospital to hospital. It's a common phenomenon for hospitals to have a disclosure policy, but patients are sometimes told about what happened in a way that they don't understand unless they are aggressive in questioning the doctor," he says.
A hospital may have an error disclosure policy in place and the physician may talk to the patient, but the patient may be none the wiser that an error is at the base of his or her problem, Banja adds.
"My impression is that risk managers understand the benefit of a good, ethical, and truthful discussion of error. However, there is recent literature that indicates that physicians still have trouble saying ‘error,' ‘mistake,' or ‘harm.' They may apologize, but they often use language that doesn't incriminate themselves, using words like ‘complication,' ‘incident' or mishap,'" he says.
In these cases, a case manager might realize that the client has been told something but he or she obviously didn't understand what really happened.
"Finding out that a patient has not been informed about an error or doesn't understand what happened puts hospital case managers in a difficult position, with no good options. It's not their job to disclose an error or to check out whether or not the patient has been informed," Banja says.
If you find yourself in this situation, go to your hospital's risk management department and tell them you believe an error has occurred and that the patient doesn't understand, he advises. They are the experts who can look at the legality of the situation and what steps need to be taken to correct the error.
"Ultimately, the case manager has to hope that the hospital has a policy that is ethical and rigorously follows it," Banja says.
It's important for case managers to make sure that what they are calling an error is really an error. That's why Banja advises case managers to take their concerns to the risk management department or directly to the physician rather than jumping in and informing the patient.
"When medical errors occur, we are ethically, morally, and legally obligated to disclose them. The patient and family should know what happened and how the health care team is going to take care of the error or even the delay in care. Case managers should make sure a conference is scheduled with the patient, family, and the health care team members, and that the situation is discussed," Tahan says.
Case management directors should look at patient safety as one of the new competencies that should be included in training/education and performance evaluation of case managers, he adds.
"A decade ago, educational training for case managers didn't focus well enough on national patient safety goals and the role of the case manager in creating a safe culture and making sure patient care is safe," Tahan points out.
Today's training and education curricula for case managers have safety as a major topic. Continuing education programs of case managers should include safety information as well, he adds. These include organization-based inservices, as well as national and regional conferences, he says.
"Case managers need to know what is going on nationally with national patient safety goals so they can focus on concerns above and beyond just variance and delay management," Tahan says.
Tahan suggests revisiting the job descriptions for case management positions and making sure they include clear statements about the responsibilities of case management in patient safety.
Establish an educational program for your case managers, explaining patient safety and what it means so they understand their responsibilities.
"Case managers should be provided with the knowledge they need to assume their role in assuring that national patient safety goals are followed. They need to know how these national goals dovetail with their job description and their day-to-day activities. Their performance evaluation should also include the case manager's impact on the safe culture and safe environment of care," he adds.
There are a number of reasons why medical errors should be disclosed to patients, in addition to the fact that it's the right thing to do and that the American Medical Association's Code of Medical Ethics obligates doctors to disclose harm-causing errors, Banja says.
Research indicates that hospitals with a policy of discussing errors with patients honestly and contritely are being sued less and the overall costs of malpractice litigation are less than at hospitals with a practice of concealing errors, he adds.
"This means that an ethics policy is also the most efficient and cost effective," he says.
"If patients find out that they suffered an error and the error was concealed, they experience a profound lack of trust for the hospital," Banja points out. "When patients are admitted, they are trusting the hospital with their life. When they experience an error and find out it was concealed, they often feel betrayed," he adds.
Hospitals should take a proactive approach to patient safety and medical errors and recognize the right of the patient to know what happened as soon as possible.
"Disclosing errors at the earliest opportunity is not only the right thing to do, it may save the hospital a tremendous amount of money in the long run," he says.
When a patient is not informed about the error in clear, concise language in a timely, compassionate, and contrite way, he or she may start to feel resentful.
"A lot of patients may not be aggressive in asking questions, but when the doctor leaves the room, the patient feels bewildered and confused about whether the doctor was implying an error was made. This is a very dangerous situation to place a patient in," Banja says.
If a patient and family feel the physician didn't tell them the whole truth, they're going to continue to be angry and upset and are likely to talk about their feelings with other people.
"That kind of conversation has a way of escalating tempers and could ultimately lead to a lawsuit. On the other hand, if the hospital does the right thing at the earliest moment, it can prevent a lot of downstream damage," Banja says.
There are extremely rare cases when an error did cause harm but telling the patient may cause more harm, he says.
For instance, a patient with schizophrenia was convinced that people were trying to poison him. He was given the wrong medication by error but wasn't harmed.
"It wouldn't be to his benefit to learn about that error, but cases like this are few and very far between," Banja says.
As a case manager, you should be aware of your hospital's policies on safety and medical errors and, as an advocate for your patients, take a role in ensuring that their care is safe and that they are informed about any errors that occur, case management experts say.Subscribe Now for Access
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