L8. Engaging with Patients and Carers.pdf

Engaging with Patients and Carers Patient Safety Lecture no. 8 COLOR INDEX Main Text Important Male Slides Female Slides Dr’s Notes Extra  Understand the ways in which patients and carers can...

Engaging with Patients and Carers Patient Safety Lecture no. 8 COLOR INDEX Main Text Important Male Slides Female Slides Dr’s Notes Extra  Understand the ways in which patients and carers can be partners in healthcare: - Preventing harm. - Learning and Healing from an adverse event. Understand basic communication techniques. Learn elements of informed consent. Recognize the basics of open disclosure after an adverse event. This lecture was presented by Dr. Ruaim Muaygil For the required reading from Blackboard click here  Patient and Carer Engagement ➥ Engaging with patients and carers is important, and every patient has the right to receive information about the care they are receiving. ➥ Through informed consent, patients, in collaboration with healthcare providers, make decisions about interventions. ‫ﻛﻞ ﻣﺮﯾﺾ ﻟﮫ اﻟﺤﻖ ﺑﺎﻧﮫ ﯾﻌﺮف ﻋﻦ ﺣﺎﻟﺘﮫ ﺑﺸﻜﻞ ﻛﺎﻣﻞ‬ Promoting patients’ involvement in their own care Patients who play active roles in the management of chronic health conditions enjoy better outcomes. Patients and their families can be made aware of opportunities to engage in adverse event prevention by: ➥ Awareness raising about the risks of preventable harm. ➥ Encouragement to speak up to providers about safety concerns. Ways to Engage Patients Will be explained next slides Actively encourage Show empathy, patients and carers to honesty and respect Communicate effectively share information. for patients and carers. Show respect for Understand the basic Obtain informed consent cultural and religious steps in an open differences. disclosure process.  Patient and Carer Engagement Benefits of Patient and Carer Engagement Patient and carer engagement in healthcare can bring numerous benefits; ◎ Patient stories are inspiring: ◎ Patients’ experiences play a role in: ‣ Improved Diagnosis ‣ Patient stories about adverse events are powerful message. ‣ Informed Treatment Decisions ‣ Health care provides must engage with these ‣ Better Care Provider Decisions stories and incorporate new understanding in their ‣ Proper Treatment Administration practice. ‣ Identifying Adverse Events Aiding Good Communication Communication Element of SPIKES Open Disclosure Techniques & SEGUE Cultural Informed Communication After an Adverse Helpful Questions Framework Competence Consent Tool Event / Statements How can we ask patients to describe their feelings? I imagine this is difficult news. Does this news frighten you? You appear to be angry. Can you Tell me more about what you are tell me what you are feeling? feeling about what I have just said. I’ll try and help you Is there anyone you would like me to call?  Aiding Good Communication Communication Element of SPIKES Open Disclosure SEGUE Cultural Techniques & Informed Communication After an Adverse Framework Competence Helpful Questions Consent Tool Event Gaining Informed Consent: ◎ Consent is more than a signature on a form, it is a process not an event. Elements of informed consent include: It’s Not paper things but a process (Each single time you meet with the patient you’re still getting the consent) Elements which inform the patient: ➥ Disclosure of information by the health-care practitioner. ‫ﻧﻘﻮل ﻟﻠﻤﺮﯾﺾ ﻛﻞ ﺷﻲء ﯾﺤﺘﺎج ﯾﻌﺮﻓﮫ ﻋﻦ ﺣﺎﻟﺘﮫ‬ ➥ Understanding or comprehension of the information by the patient. Decision making capacity (‫ﯾﻜﻮن اﻟﻤﺮﯾﺾ واﻋﻲ )ﻛﺒﯿﺮ ﺑﺪون أﻣﺮاض ﻋﻘﻠﯿﺔ‬ Elements that enable the patient to make a decision: ➥ Free and voluntary choice by the patient. ➥ Comprehension, and in ethical terminology this is often referred to as “Decision making capacity”. What information do patients need? 1 2 The diagnosis, including degree of Risks of the treatment. uncertainty. 3 Benefits of the treatment. 4 Information on recovery time. 5 Name, position, qualifications, and 6 Availability and costs of any experience of health workers who service required after discharge are providing the care and from hospital, such as home care or treatment. rehabilitation services.  Aiding Good Communication From slides! Communication Element of SPIKES Open Disclosure SEGUE Cultural Techniques & Informed Communication After an Adverse Framework Competence Helpful Questions Consent Tool Event ◎ SPIKES is used to guide in communicating bad news in “end-of-life” situations, but may also be used more generally. MCQ Element Definition S Setting Privacy, significant others, sit down, listen. P Perception Ask patients what they think is going on. I Invitation Ask patients how much they want to now about their diagnosis and treatment. K Knowledge Help patients anticipate disturbing news. E Empathy Listen for and identify the emotions, identify the source, acknowledge emotion, be quiet. Strategy & S Summarize key information, encourage questions, assess understanding, share plan. Summary Communication Element of SPIKES Open Disclosure SEGUE Cultural Techniques & Informed Communication After an Adverse Framework Competence Helpful Questions Consent Tool Event S E G Set the Elicit Give stage information information How much they know Understand U E End the the patient encounter perspective  Aiding Good Communication Communication Element of SPIKES Open Disclosure SEGUE Cultural Techniques & Informed Communication After an Adverse Framework Competence Helpful Questions Consent Tool Event Cultural competence: is the knowledge, skills and attitudes necessary to provide care in a way that respects and honors cultural values: ➥ Be aware and accept cultural differences. ➥ Be aware of one’s own cultural values. ➥ Recognize that cultural beliefs impact how patients perceive their health, treatment options, and health practitioners. Communication Element of SPIKES Open Disclosure SEGUE Cultural Techniques & Informed Communication After an Adverse Framework Competence Helpful Questions Consent Tool Event Do patients want disclosure of adverse events? ◎ Studies have shown that a majority of patients want: The assurance of An explanation of An admission of prevention of Punishment and what happened. responsibility. An apology similar events to compensation. others in the future. ◎ Common barriers to disclosing adverse events include: Causes of why health care workers have difficulty to admit their mistakes Want to avoid Causing more Loss of reputation, job, distress to patients insurance Fear legal action confrontation Open disclosure after an adverse event involves communicating openly and promptly. This approach is distinguished from the expected bad outcomes of the disease or injury. Key Principles of Open Disclosure include: ➥ Open timely communication ➥ Acknowledgement of the incident ➥ Expression of regret/apology ➥ Recognition of reasonable expectations ➥ Support and confidentiality for staff IMP Dr.: It is not related to bad outcomes that we expect from a disease, but for Example, at the end of a surgery the medical team forgot a piece of gauze in the abdomen = Adverse Event and we need to disclose it in openly time communication to tell the patient about the error and give apologies and reasonable expectations  Aiding Good Communication Communication Element of SPIKES Open Disclosure SEGUE Cultural Techniques & Informed Communication After an Adverse Framework Competence Helpful Questions Consent Tool Event The Harvard Framework for Disclosure MCQ Element Definition Preparing Review facts, identify and involve participants, choose appropriate setting. Initiating Determine patient and family readiness, level of medical understanding. conversation Simple description, speak slowly, explain current outcome, describe next steps. Presenting the facts Sincerely acknowledge the patient's and family’s suffering. Active listening Allow ample time for questions, do not monopolize the conversation. Acknowledging After listening to the patient and their family, acknowledge their concerns and validate what you have their feelings. This helps build trust and shows empathy. heard Answer any questions the patient and their family may have to the best of your ability. If Responding to you don't know the answer, it's okay to say so, but assure them that you will find out and any questions follow up with them. Concluding the Summarize, repeat key questions raised, establish the follow-up. conversation Documentation Describe the event, describe the discussion.  MCQs Q1. Which of the following is a component of SPIKES? A. Setting B. Equality C. Process D. System Q2. One of the key principles of open disclosure? A. Acknowledgement B. close timely C. fear of legal actions D. avoidance of the incident communication Q3. Which of the following belongs to the Harvard framework of disclosure? A. Passive listening B. Active listening C. losing attention D. friends engagement Q4. Which of the following is a step in “SPIKES” communication tool? A. Planning B. Pass C. Performance D. Perception Q5. What is an important element of informed consent? B. Disclosure of C. Free and voluntary D. Comprehension of A. Signature on a form information choice information Q6. What is the purpose of open disclosure after an adverse event? A. To expect bad B. To acknowledge the D. To punish and C. To avoid legal action outcomes of the disease incident compensate A1. A A2. A A3. B A4. D A5. B A6. 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