OPEN DISCLOSURE FOR NURSES AND MIDWIVES

Open disclosure refers to the different practices and activities done by healthcare providers to address and discuss the harm done to them due to an adverse event while they are receiving care in your facility. This may be a single conversation or be done over a series of meetings.

For open disclosure to work, there is a need for the presence of some critical elements, which include:

• An express apology from the health service provider
• A clear and factual explanation of the events which have happened before without apportioning blames
• The ability of clients, family, or carers to voice their thoughts about how they feel or felt.
• A discussion to examine the negative impacts of the negative event.
• A clear explanation of what is being done to prevent the negative effects of such an event and ensure that the event does not happen again

 When is Open Disclosure to clients necessary?

• When there has been an adverse event that has resulted in harm to the client
• An adverse event with a potential for harm even when there is no apparent harmful effect on the client. This is because only by informing the client can you be sure there is no adverse effect which they are aware of but you are not.

Nb: For a near-miss incident, the decision to inform the client is at the discretion of the health facility based on whether they will benefit from the information.

OPEN DISCLOSURE FRAMEWORK

This framework was developed by the Australian Commission On Safety and Quality in Healthcare to ensure clearly stated key principles which must be adhered to to ensure consistency in the basis and pattern of communication following an incident.

These principles include:

1. Truthful and TImely communication: This states that a client and sometimes their carer should be provided with the necessary information about what happened truthfully. This may include the provision of information about ongoing processes and investigations. This should be communicated clearly and without ambiguity.
2. Acknowledgment: The healthcare service provider must acknowledge the occurrence of incidents as soon as possible and begin the process of Open Disclosure. This emphasizes that the provider is not to choose to live in denial at the expense of the client and risk causing harm to more clients in the future.
3. Apology/ Expression of Regret: The client should receive an apology for the harm that happened to them during the period of care. Given that this apology is not just a perfunctory action but an expression to help the client, carer, and family cope with the effects of the traumatic event, it should be stated in clear terms what is being apologised or regretted. Also, the necessary actions that have been taken or are being taken to address the situation should be stated. it is, however, not to include apportioning of blame or admission of liability 
4. Recognition of carer or patient expectations: clients and their carers have reasonable expectations upon using healthcare services. This should be recognized; hence it is expected you provide them with the facts of an incident and the implications of these facts on subsequent outcomes. This should be done with empathy and respect. It should also be appropriate for the client's needs.
5. Staff support: there should be a just, no-blame culture in health facilities with a premium placed on Open disclosure to ensure that staff are encouraged and supported to recognise and report incidents.
6. Risk Management and system improvement: Investigations of incidents and the subsequent results should be integrated to emphasize risk management and allow reviews of the system's effectiveness. This enables them to continually improve service delivery and prevent recurrences.
7. Good governance: Just having a system is not enough, hence a need for accountability and knowing those responsible directly to implement the results from investigations and actionable insight from quality improvement reviews. This might be an individual or a group of persons. This helps to prevent the recurrence of the incidents while also further improving the quality of service delivery.
8. Confidentiality: Health facilities are expected to provide their services with consideration for the consumer and staff privacy and confidentiality in compliance with relevant laws, including the Commonwealth and State and territory Privacy and health legislation records.

 KEY ELEMENTS OF THE OPEN DISCLOSURE FRAMEWORK PROCESS

This involves the different key elements which are required in the development of a functional Open Disclosure process. This include

1. Detection and incident assessment : 

This involves the processes of detecting, through various mechanisms, the adverse event to the client and preventing further harm to them through prompt care or intervention; assessment of the incident for both the degree of harm as well as the level of response; initiation of appropriate response and notification of appropriate authorities and personnel all while maintaining the confidentiality of both clients and staff. 

1. Signaling the need for open discussion : 

This involves acknowledging the adverse event to the client, their family, or care. Importantly, it includes an apology and expression of regret.

 Other actions taken at this level are to be taken at the administrative level for this step. This will include signaling the need for the disclosure and negotiation with the client's family or carer to determine the level of formality, place, and time and who should be present during the open disclosure, among other things.

1. Preparing for Open disclosure: 

This involves multidisciplinary team discussions to prepare for the open, gather all necessary information, and appoint who will lead the open discussion with the client, family, or carer based on the previous discussion with them.

1. Engaging in Open Disclosure: 

The names of everyone present and their roles should be provided to the client, family members, or carer. Implementation of each of the earlier stated open disclosure principles is done at this level. 

1. Providing Follow up:

Ensure follow-up by the management or appropriate facilities or institution while also agreeing on future care. Ensure to share the findings of your investigations. Also, share the changes you will be making or have made. Importantly, you should offer the client, family, or carer the opportunity to discuss the process with another health service provider or professional with the required skill.

1. Completing the Process: 

The incident and its adverse effect and the outcome of the open disclosure process should be communicated to every personnel necessary in the facility. You want to reach an agreement with the client, family, or carer or provide an alternative course of action for them; you want to provide them with the final written and verbal communications, including the result of investigations. This level is then completed by the completion of evaluation surveys.

1. Maintaining Documentation :

 At this step, you want to keep the documentation and client records up-to-date, keep records from the open discussion process, and all documents related to the open disclosure process, while also providing the client with these documents throughout the process.

Conclusion 

In conclusion, Open discussion is a process that improves the quality of services that clients receive at health facilities and helps prevent the frequency of incidents with harmful effects. Understanding this will help improve the quality of service you offer to your clients and the satisfaction they get from your facility.

An Outstanding Course On Open Disclosure For Nurses and Midwives

Understanding how to manage adverse situations is crucial to all health workers. It is the reason we have put together this excellent course on open disclosure for nurses and midwives. This online course will cover vital topics like detecting and analyzing incidents, signaling the need for open disclosure, preparing for open disclosure, engaging in open disclosure, dialogues, follow-up, completing the process, and preserving documentation. You can learn more about this course by visiting our website https://www.healthcarelink.com.au/cpd/listing/open-disclosure-for-nurses-and-midwives/10705.

 REFERENCES: 

Open disclosure | Australian Commission on Safety and Quality in Health Care

The Australian Open Disclosure Framework

Australian Open Disclosure Framework - Better communication, a better way to care

Open disclosure framework