Susan Shepard, MSN, RN, and Carol Murray, RHIA, CPHRM

Each member of a healthcare team plays an important role in reducing the number of incidents that cause patient dissatisfaction.

Why Do Patients Sue?

The basic emotions leading to any medical liability action are surprise, disappointment, and anger. These reactions can be triggered by a wide variety of causes that include miscommunication and medication errors.

Communication Errors

Remember that patients may experience uncomfortable emotions, including uncertainty, embarrassment, shyness, and fear. A failure to respond appropriately can create negative feelings that have serious consequences and trigger a chain of events ending in litigation. By contrast, comforting words, gestures of kindness, or simple expressions of caring will often evoke positive patient reactions and promote favorable relationships.

Telephone Conversations with Patients

For many members of a professional medical or dental staff, the telephone is often the primary mode of patient communication. All medical and dental professionals should note the following points:

Be courteous and maintain professionalism. Remember that you cannot read your patients' nonverbal cues. Use your best listening skills.

• Make sure that any member of your healthcare team who has the slightest doubt about giving instructions or advice to a patient first checks with the provider. If the provider is not immediately available, the staff member should assure the patient that his or her call will be returned as soon as possible and should verify later that the patient's call was returned.
• Make sure that staff members obtain as much detailed information as possible on a patient's health problem and its degree of urgency before conveying it to the provider for evaluation.
• Establish procedures in your practice for providers and patient care staff to effectively manage urgent problems, scheduling difficulties, and unexpected visits.
• Ensure that patient requests, problems, and issues received by telephone are addressed in a timely manner.

Face-to-Face Encounters

The following tips can help you and your staff develop and maintain therapeutic interactions with patients:

Initiate personal contact with the patient by expressing cordial, individual attention.

• Make a favorable impression through your demeanor. Any interaction with any member of the team may represent the patient's first, last, and most enduring impression of the provider, hospital, or office.
• Explain unavoidable delays in the office schedule to the patient. If appropriate, offer to reschedule the appointment. Most patients will appreciate being informed.
• Maintain strict confidentiality. Do not discuss any patient problems outside the hospital or office practice. Even when discussing a matter pertaining to a patient with another staff member, do not do so in a public area or within hearing range of other patients.
• Staff should always alert providers to disgruntled or hostile patients so that the situations can be defused immediately. Patients frequently share information with healthcare support staff that they will not tell providers, so be sure providers are informed of any significant statements.
• Staff members should never give advice beyond their competencies or scopes of practice. Assure any patient of a prompt response to an inquiry and follow through as soon as possible to ensure the patient gets the appropriate information or referral.
• Encourage patients to write down their questions for providers or questions regarding the provider's instructions. Studies have shown that patients remember only a small portion of what they are told. Furnish written instructions or educational information to patients for review at home.
• Incorporate Ask Me 3 into your practice. This technique, which encourages patients to participate in their healthcare, has been shown to improve communication. Download free educational materials at www.npsf.org/askme3.

Methods to Enhance Consent

Although obtaining informed consent is the provider's responsibility, staff members often become involved in assisting or answering additional questions from patients. Everyone involved in obtaining consent should follow these guidelines:

Be supportive and reassuring, but do not promise too much when dealing with anxious patients.

• Take time to answer questions. Informed patients are less anxious and more cooperative.
• Take time to answer questions. Informed patients are less anxious and more cooperative.
• Remind patients of their instructions by using preprinted fact sheets for commonly performed procedures, tests, or treatments, including preparation requirements and instructions following discharge.

Steps to Avoid Medication Mistakes

Avoidable medication errors can result in severe patient injury. These steps can help reduce the risk of errors when administering medications:

Review all current medications with a patient at each visit and reconcile any discrepancies.

• Double- check the vial or bottle label against the order before drawing up a substance. Never use unlabeled vials or bottles
• Make sure you understand the amount of the dose ordered. Fifteen and 50 sound similar, but the difference in dosage can be catastrophic
• Ask a patient if he or she has an allergy to the drug or drugs to be injected or ingested before administering any medication by any route--even when there is no indication of drug allergy in the patient's chart.
• Know the location and proper use of oxygen and other resuscitative equipment and drugs for emergent conditions.
• Develop guidelines to manage prescription calls and refills, and always record the calls with the date and time in patient's charts.
• Ensure that all healthcare personnel who deal directly with patients are trained in cardiopulmonary resuscitation.
• Always verify the "six rights": the right drug, right date, right dose, right route, right frequency, and the right patient.

Summary

Improving office or hospital procedures and communications in healthcare are the responsibility of all personnel. By following the guidelines in this article, you can make a vital contribution to safe patient care.

By Susan Shepard, MSN, RN, Senior Director, Patient Safety and Risk Management Education, and Carol Murray, RHIA, CPHRM, Patient Safety Risk Manager II. Reprinted with permission from The Doctors Company (www.thedoctors.com)