Dene Lodge Dental Practice is committed to providing a high standard of care to patients.
The effects of harming a patient can have devastating emotional and physical consequences for patients, their families and carers. It can also be distressing for the professionals involved. Being open and honest about what happened; discussing the incident/complaint/claim fully, openly and compassionately can help all those involved cope better with the consequences of harm, whether potential or actual, in managing the event and also in coping in the longer term. In addition, being open and candid when things go wrong ensures that the investigation gets to the root cause of the event and promotes organisational testing.
This policy is designed to improve the experience of patients who are inadvertently harmed during their treatment and to promote better communication between staff and patients. It applies to all team members, who are expected to familiarise themselves with the recommended procedures for being open.
Dene Lodge Dental Practice is committed to “Being Open” and candid; about communicating with patients, their relatives and carers about any failure in care or treatment, whether they be the results via a Patient Safety Incident (PSI) Concern or complaint Claim.
This policy deals with the information and methods of sharing that information with patients, relatives and their carers, staff and other healthcare organisations. The extent to which it is enacted will be determined on the grading of the severity of the event.
Members of the practice are aware of the need for effective communication between patients and/or carers who may be involved in a safety incident and must develop the necessary skills needed for communicating with patients and/or their carers following a patient safety incident. This policy has been developed to help staff communicate to a patient and/or their carer what happened in an incident that led to moderate harm, severe harm or death.
The purpose of this policy is to provide a best practice framework, based on the guidance of the National Patient Safety Agency (NPSA), to create an environment where patients, their representatives and staff feel supported, and have the confidence to act appropriately and for ensuring that all communications with relevant people are open, honest and occur as soon as possible after an event.
Process for acknowledging, apologising and explaining when things go wrong
The first step of the process is the recognition of an incident and when the level of harm dictates that it is appropriate. This can be identified by any of the following mechanisms:
Following identification of an incident, a preliminary team discussion should be undertaken to establish as soon as possible to the incident, once the patient is safe:
Identifying who should be responsible
In determining who will be responsible for communicating with the patient/family/carers, the individual should:
When should the initial discussion be held?
The initial candid “Being Open” discussion with the patient and/or their carers should occur as soon as possible after recognition of the incident. Initially, it is worth noting that something that has gone wrong but that the cause is not yet known.
It must be communicated to the patient and their family/carers that we will be taking the event extremely seriously, that the event will be investigated and that the findings of the investigations will be shared with them.
Through sharing the report and meeting with the patient and their family/carers, the patient will have the opportunity to influence the investigation. Factors to consider whe timing this discussion include:
Provision of additional support
Support of the patient, their family/carers
Patients, their family/carers should be provided with support as is necessary during the process of “Being Open”. At any face to face meeting, they should be encouraged to be accompanied by another family member/friend/representative. Where appropriate, an independent advocate or interpreter should be offered. The patient is also at liberty to request a second or independent review and this should be facilitated. Information on how patients can access additional support services and other relevant bodies should be offered. External bodies which may be able to produce support for the patient:
Where the patient is assessed not to have capacity
Where the patient has a formal assessment of lack of capacity, the principles of “Being Open” still apply. In circumstances where the patient has a registered person with lasting power of attorney (LPA), it may be a legal requirement that they are informed. If there is no LPA for the patient, it is best practice that the family and or carers for the patient are informed of the incident. The occurrence of this conversation and grounds for it must be recorded in the patients’ medical record.
Department of clinical law
Where the duty to be candid raises specific, ethical or legal considerations, the Department of clinical law can be contacted for advice.
It can be very traumatic for healthcare staff to be involved in an event. Dene Lodge Dental Practice is committed to ensuring that staff feel supported through the “Being Open” process. Staff are also encouraged to seek advice from their relevant professional body. Staff are encouraged, if appropriate to seek advice from their trade union representative. Staff will not be unfairly exposed to punitive disciplinary action, increased medico-legal risk or threat to their registration. Where there is evidence to believe that punitive disciplinary action may follow or criminal act has occurred. Incidents relating to employee performance or conduct should be referred to Ms A Tran and manage in accordance with “Disciplinary Policy”
Risk management and systems improvement
Dene Lodge Dental Practice supports the root cause analysis (RCA) approach to looking at the causes of patient safety incidents. The focus is on improving systems of care.
Details surrounding an event are confidential. Full consideration should be given to maintaining the confidentiality of the patient, carers and staff involved, in line with the “Data protection confidentiality policy”
It is good practice to inform the patient, their family and carers about who will be involved in the investigation, and give them opportunity to raise any objections. Communication outside the clinical team should be strictly on a “need to know” basis. Equally the relatives may need specific questions answered by the investigation process and should be given the opportunity to raise these.
Continuity of care
Patients have the right to expect that their care will continue, and that they will receive all of their usual treatment with the care, respect and dignity that they are entitled to. If the patient has a preference for their care to be delivered by another team, the appropriate arrangements should be made.
Requirements for documenting all communication
All discussions and communication with the patient, their family or carers should be carefully detailed in the patient medical noted. This should include:
Processes for encouraging open communication between organisations, teams, staff, patients/carers.
“Being Open – A duty to be candid” forms part of education programmes. These encourage staff to “be open” with their patients, their relatives and carers, and make explicit their requirement to do so. Where the incident, complaint or claim involves outside agencies (e.g. other healthcare providers, the Commissioners or social services) whether raised by Dene Lodge Dental Practice or the other agency, there is an obligation to fully co-operate with them and to communicate collaboratively with them.
Dene Lodge Dental Practice
9 London Road
01483 575 865
Monday - Friday:
8:30 - 1:00,
2:00 - 5:00