NEXT Being Open: Duty of Candour 2016 This overview is for Clinical staff. If you are non-clinical staff, please complete the Overview for non-clinical staff However, if you are a manager, team lead or above, you should complete the detailed version. NEXT

Being Open: Duty of Candour 2016 This basic overview is for all clinical staff. Approx. 20 mins START

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Being Open: Duty of Candour 2016 Navigation Toolbar

Introduction I I Francis Report recommendations: 181: statutory obligation to observe a duty of candour on healthcare providers who believe or suspect that treatment or care provided by it to a patient has caused death or serious injury to inform that patient…as soon as practicable and to provide such information as the patient may reasonably request. 182: statutory duty on all directors of healthcare organisations to be truthful in any information given to a healthcare regulator or commissioner, either personally or on behalf of the organisation where given in compliance of a statutory obligation to provide it. “Being Open” / “Duty of Candour” involves: Acknowledging, apologising and explaining when things go wrong. Conducting a thorough investigation into any incident and reassurance that lesson have been learnt Providing support for those involved I “Promoting a culture of being open in all communication is therefore a prerequisite to providing high quality healthcare and improving patient safety.” SEPT Policy on communication patient safety events “Being Open”. I Navigation Toolbar

Course bjectives To understand the principles of ‘Being Open’. To have an overview of the ‘Being Open’ process and the benefits of this. To be able to implement this knowledge in your practice with different patients. Navigation Toolbar

Question ‘Being Open’ involves: Approaching, acknowledging and explaining Acknowledging, explaining, deterring Acknowledging, apologising and explaining Approaching, blaming, explaining Navigation Toolbar

is a request for compensation. Definitions Duty of candour Legal requirement for all clinicians, managers and healthcare staff to inform patient/relatives of any actions which have resulted in moderate or severe harm or death. Patient safety event is any unintended or unexpected incident that could have or did lead to harm for one or more patients receiving NHS funded healthcare. Serious incident (SI) is a serious incident or near miss which may require further investigation including those reported via Safeguarding Children and Safeguarding Adults procedures. Definitions Complaint is an expression of dissatisfaction received by the Trust verbally or in writing either directly from or on behalf of existing or former service users, carers, relatives, visitors or other users of Trust facilities Root cause analysis is a structured approach and reporting system for investigations of patient safety events or incidents. Claim is a request for compensation. Navigation Toolbar

Who has responsibility? Directors and Senior Management will have an overarching responsibility within their own service area for monitoring and implementation of the policy, but all staff have a responsibility to ensure they follow the principles. Managers and other Persons in Charge / Team Leaders / Ward Managers and Senior Sisters, where identified as the nominated Contact point have responsibility to ensure the procedures and principles of the ‘Being Open’ policy are followed and monitored. Individuals have a responsibility to ensure that the principles contained within the ‘Being Open’ policy and associated guidelines are followed; in that they: Must ensure that they report all patient safety events, complaints or claims to their line manager immediately. Have responsibility to ensure as part of continuing professional development they acquire, maintain and disseminate knowledge and skills to carry out where required the principles of “Being Open”. Through, clinical supervision and post event reviews, can expect to receive support tailored to their individual need. I Navigation Toolbar

The ‘Being Open’ policy and procedures are only relevant to directors. Question The ‘Being Open’ policy and procedures are only relevant to directors. TRUE FALSE Navigation Toolbar

Ten key Principles P R I N C I P L E S Acknowledgement Truthfulness, Timeliness and Clarity of Communication Apology Recognising Patient and Carer Expectations Professional Support Risk Management and Systems Improvement Multi-disciplinary Responsibility (MDT) Clinical Governance Confidentiality Continuity of Care Navigation Toolbar

Of the ten key principles, which is most important? Question Of the ten key principles, which is most important? Confidentiality All of them Principles 1-5 Apology Navigation Toolbar

What response is appropriate? INCIDENT LEVEL OF RESPONSE Patients are not usually contacted or involved in investigations and these types of incidents are outside the scope of the Being open policy. Individual healthcare organisations decide whether ‘no harm’ events (including prevented patient safety incidents) are discussed with patients, their families and carers, depending on local circumstances and what is in the best interest of the patient. No harm (including prevented patient safety incident) Unless there are specific indications or the patient requests it, the communication, investigation and analysis, and the implementation of changes will occur at local service delivery level. Reporting to the risk management team will occur through standard incident reporting mechanisms and be analysed centrally to detect high frequency events. Review will occur through aggregated trend data and local investigation. Where the trend data indicates a pattern of related events, further investigation and analysis may be needed. Communication should take the form of an open discussion between the staff providing the patient’s care and the patient, their family and carers. Apply the principles of Being open LOW HARM Moderate harm, severe harm or death A higher level of response is required in these circumstances. The risk manager or equivalent should be notified immediately and be available to provide support and advice during the Being open process if required. Follow being open principles and the duty of candour process Navigation Toolbar

Pr cess Overview Incident detection or recognition Provide written records of all ‘Being Open’ discussions Record investigation and analysis related to incident Documentation Incident detection or recognition Preliminary team discussion Initial ‘Being Open’ discussion Written communication Follow up discussions Process completion Detection and notification through appropriate systems Initial assessment Verbal and written apology Written communication must follow the initial discussion Provide update on known facts at regular intervals Discuss findings of investigation and analysis Provide known facts to date Inform on continuity of care Establish timeline Offer practical and emotional support Share summary with relevant people This must be provided within 10 working days of the incident Prompt and appropriate clinical care to prevent further harm Respond to queries Monitor how action plan is implemented Identify next steps for keeping informed Choose who will lead communication Communicate learning with staff NEXT NEXT NEXT NEXT NEXT Navigation Toolbar

Documenting and Recording All communication surrounding any incident must be recorded within appropriate documentation using Trust guidance. This will include service user case notes, ward report book, complaint and claim files and incident report forms. It is important to record discussions with the patient, their family and carers. The required patient safety event documentation includes: A copy of the relevant medical information Incident reports Records of the investigation and analysis process I Written records of the ‘Being Open’/Duty of Candour discussions should consist of: The time, place and date of the meeting Name and relationships of all attendees The plan for providing further information to the service user, their family and carers Offers of assistance and the response from the service user, their family and carers Questions raised by the family and carers and the answers given Plans for follow up meetings and progress notes relating to the clinical situation and an accurate summary of all the points explained to the service user, their family and carers Copies of letters sent to the service user, their family, carers and GP Copies of any statements taken in relation to the patient safety event A copy of the incident report, the original complaint (where appropriate) and the original claim (where appropriate) I Navigation Toolbar

Healthcare organisations & teams Benefits of being open Healthcare organisations & teams Patients A reputation of respect and trust for the organisation and/or team Receive a meaningful apology and explanation when things go wrong Know that lessons learned from incidents will help prevent them from happening again Feel their concerns and distress have been acknowledged Reinforces a culture of openness and gives staff confidence in how to communicate effectively when things go wrong Reduce the trauma felt when things go wrong Have greater respect and trust for the organisation A reputation for supporting staff when things go wrong, with staff feeling supported in apologising and explaining to patients, their families and carers Reassured that the organisation will learn lessons to prevent harm happening to someone else Improves the patient experience and satisfaction with the organisation Navigation Toolbar

Patient issues to be considered An unexpected patients death It is even more crucial that communication is sensitive, empathetic and open. Involve the family and carers in deciding when it is appropriate to discuss what has happened as well as considering the role of a family liaison officer to support this. Condolences should be issued as soon as possible, together with an explanation that the coroners’ process has been initiated. Give a realistic time frame for when more information may be available. I Patients with cognitive impairment Where a service user has a condition(s) that limits their ability to understand what is happening to them and they have an authorised person to act on their behalf (Power of Attorney), then the ‘Being Open’ discussion should be held with them. If there is no POA, refer to the Trust Policy MCP01 Mental Capacity Act 2005 to determine the most appropriate person to hold the discussion with. Where possible the patient should still be involved. I Navigation Toolbar

Patient issues to be considered Patients with learning difficulties Where a service user has difficulties expressing their opinions verbally and they are not cognitively impaired then in the “Being Open“ process they should be supported by alternative communication methods, (writing questions down etc.) and an advocate should be appointed. These can include carer’s family or friends of the service user. I Service users with different language or cultural considerations Before discussing a patient safety event, it would be worthwhile to obtain advice from an advocate or translator on the most sensitive way to discuss the information. The service user’s family or friends should not be used to translate and the employment of professional translators is required. I Service users with different communication needs A number of service users will have particular communication difficulties, such as hearing impairment. Plans for the “Being Open” meetings should fully consider these needs. I Navigation Toolbar

Patient issues to be considered Children At the age of 16 a child has the right to make decisions about their treatment and their right to confidentiality is vested in them rather than their parents or guardians. It is however considered good practice to encourage children to involve their families in decision making. Where a child is judged to have cognitive ability and emotional maturity they should be involved directly in the “Being Open” process. Where children are deemed not, consideration needs to be given to whether information is provided to the parents alone. In these instances the parents’ views on the issue should be sought. I Patients who do not agree with the information provided Sometimes, despite the best efforts, the relationship can break down. Patients may not accept the information provided or may not wish to participate in the “Being Open” process. In this case, the following strategies may assist: Deal with the issue as soon as it emerges and where appropriate and the service user agrees involve family and carers from the beginning of “Being Open” discussions; Write a comprehensive list of the points that the service user; their family and carers disagree with and reassure them you will follow up these issues Ensure the Line managers and the MDT are made aware of the difficulties at all times Offer another contact person with whom they may feel more comfortable with Ensure the service user; their family and carers are fully aware of the formal complaints procedures I Navigation Toolbar

What happens if we get this wrong? Legal Duty of Candour requires openness and specifically requires the notification process to take place in a particular way If not then the CQC may take regulatory action for breach of a fundamental standard In extreme cases the Trust could be prosecuted under the criminal law and fined Individuals who fail to comply may face disciplinary action from their employer or regulatory action from their professional body Navigation Toolbar

serious.incident@sept.nhs.uk 01268 407739 Associated Documents The Trusts documents of Policy and Procedural Guidance associated with this policy are: CP2 and CPG2 Complaints Policy and Guidelines. CP10 Negligence and Insurance Claims Policy. Adverse Incident Reporting including Serious Incident Policy CP3 Clinical Risk Assessment and Management CLP28 CPG53 (Procedure for Staff on Dealing with Issues of Concern about Health Care Matters) CP53 (Policy for Staff on Whistle Blowing – Public Concern about Health Care Matters) Mental Capacity Act 2005 Policy MCP01 These documents can be found on the SEPT intranet site and under the ‘Policies’ tab. If you have questions regarding this and/or require further guidance, please contact the Serious Incident team: serious.incident@sept.nhs.uk 01268 407739 Navigation Toolbar

Remember, if you want to find more information / evidence about this subject or anything else which is relevant to your work or study, join your local healthcare library. For staff in Essex contact Basildon Healthcare Library. www.btuheks.nhs.uk library@btuh.nhs.uk 01268 524900 EX3594  It may be that you work in a different area, for example Luton. Details of all the Health Libraries in the East of England can be found at this site… You are welcome to join any of these. www.eel.nhs.uk Navigation Toolbar

IT Training IT training is available in: Word Excel Use a computer?   Make sure you use I.T. well! IT Training IT training is available in: Word Excel PowerPoint Publisher Outlook Explorer General skills For information on locations, dates, times, availability and for any other questions please contact: Jay Thornton : james.thornton@sept.nhs.uk : 01268 568068 Navigation Toolbar

Review of Objective(s) Before completing the test, please ensure you have acquired the relevant knowledge against the modules objective(s) below: “To understand the principles of ‘Being Open’ and the policies that accompany this. To be competent in your knowledge and application of the Trust’s being open procedures.” If not, please take this opportunity to revisit the presentation content. Navigation Toolbar

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