By FAY ROZOVSKY who
is president of The Rozovsky Group Inc. and author of Consent to Treatment: A Practical Guide
The important question for risk managers to ask is, "How are patients involved in the shared decision-making process?" Effective communication requires a three-step process:
Communication time-out. This crucial--yet seldom performed--initial step gives providers an assessment of each patient's unique communication needs and impediments to understanding. It lays the essential groundwork for a two-way conversation by determining favored modes of communication for each individual patient. With a quick time-out checklist, nurses identify how patients prefer to receive information (written, verbal or pictures) and any communication limitations (physical, cultural or language barriers). The goal is to assess exactly how each patient best receives information, taking into account cultural, speech, audio and visual factors.
Teach-back. This step demonstrates comprehension of the treatment discussion on the part of the patient. Once a "communication time-out" opens the lines of communication, the National Quality Forum-recommended safe practice of "teach-back" process is used to verify comprehension of the patient/provider dialog. The straightforward tactic is deceptively powerful: Patients are asked to state, in their own words, what they understand and what they expect in regard to their suggested procedures and alternatives. One study in the Journal of the American College of Surgeons highlights the effectiveness of a computer-assisted teach-back technique for enhancing understanding among patients. In addition, the teach-back helps to establish at the outset that patients are full partners--instead of mere recipients--in their care.
Documentation. The final step is to ensure an accurate record of the treatment discussion and its outcomes. The Centers for Medicare & Medicaid Services advocates the use of detailed, procedure-specific consent forms--forms that among other components include a "listing of the material risks of the procedure or treatment that were discussed with the patient or the patient's representative." Well-documented informed consent is also critical to mitigating liability. Documentation of the informed consent discussion has been found to be key to reducing indemnity risk in cases alleging inadequate informed consent.
Each aspect of the three-step communication process has a purpose in helping to deliver high quality patient care, and also in preventing unrealistic patient expectations that often lead to malpractice claims. It is a layered discussion that ensures patient-centered conversations tailored to the needs of each unique patient. Using the consent communication process to promote patient safety serves to reduce health professional liability risk exposure. And, unlike many of the innovations in contemporary healthcare to enhance patient safety, the consent communication process is a cost-effective, powerful tool that can be implemented quickly by care providers.
October 1, 2011
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