When I was asked by the risk team at MDDUS to contribute as a guest blogger I thought it would be interesting to be involved in what sounds like a useful exercise to allow members to share experiences to help reduce their risk – and of course the risk to our patients. Personally, I find that the most interesting sections of MDDUS publications are the case histories which bring medico-legal work to life.
For me, team communication is essential to maintain high-quality care, ensuring the entire multidisciplinary team are fully updated about patient progress and that any potential delays are identified and dealt with to facilitate early discharges, especially in light of the ever-increasing pressure to reduce lengths of stay and bed occupancy.
After we finish our daily ward round we have a multidisciplinary team "board round" where we discuss the clinical, nursing, therapy and discharge plans for each patient. These involve the medical team, the ward sister and at least one member of the occupational and physiotherapy team. The discussions were traditionally held at the nurses’ station, where a white board lists patient names and the most pertinent pieces of information relating to their admission. This information can be covered by means of an extra panel that can be swung closed on a hinge, to protect confidentiality.
This set-up was routine practice until fairly recently. Soon after one of our board rounds, the ward sister informed me that a very upset patient had overheard our discussion about her case and felt that we were being prejudiced about her condition. Additionally, the patient's relative who had a nursing connection, expressed concern that we were not respecting confidentiality issues.
On hearing about these issues, and with the threat of a formal complaint, I contacted both the patient and the relative to offer my apologies and to inform them that we would review our practice and update them about any changes we would make to avoid a recurrence. These actions were well received by both the patient and the relative, and my apologies were accepted. Reflecting on this, I felt that the apology was well received because I demonstrated not only regret but an intervention to prevent such a situation from arising again.
Now we hold our board rounds in the multidisciplinary team office on the ward, which is out of earshot of patients and relatives. The issue was discussed and minuted in our departmental meeting, and we have had no further such incidents.
This is a risk that many healthcare professionals are exposed to, perhaps unknowingly, and I would urge colleagues to review the location of their board rounds. GMC confidentiality guidelines on protecting information state: "Many improper disclosures are unintentional. You should not share identifiable information about patients where you can be overheard, for example in a public place". The acute medical unit is the hub of the hospital and innumerable members of staff, patients and visitors pass through each and every day so it is most certainly a public place.
A footnote and a word of caution ought to be added, however, as we are now increasingly reliant on a paper-based patient handover list, which has its own risks as confidential information can be mislaid. The above quoted guideline goes on to state: “You should not leave patients’ records, either on paper or on screen, unattended or where they can be seen by other patients, unauthorised healthcare staff, or the public”. This risk will be mitigated somewhat when the organisation moves over to electronic health care records, but we need to remain vigilant.
These kinds of breaches and their implications frequently result in patient complaints across the spectrum of healthcare environments.
Hopefully our experience may prompt others to review their systems or share other positive experiences on how they have reduced risk in their own organisations…
consultant physician, acute medical unit