Once again, many of us gathered together

to join the fun during the TMC Superhe-

roes Event at the Foyer last July 16.

From the Hall of Heroes Exhibit, we

trekked the Blue & Gold Road to JCIA

2009 as we were reminded of the stan-

dards we have to comply with. We also

learned the specific ways in which we

adhere to the International Patient

Safety Goals (IPSGs).

We also got to know our Superheroes

Capt. Read Back, Check Mate and Med

Recon Forte.

Another highlight of the event is the Su-

perhero Quiz where in those who passed

had their pictures taken on our Superhero

life size cut-outs and get a printed copy of

the picture for free! Hourly updates were

presented during the day to keep the com-

munity abreast with the quiz tallies.

At the end of the day, SSG came out as

the highest scorer with all its 30 partici-

pants passing the JCI quiz. But whether

we passed or failed the quiz, we all real-

ized that we can always be a TMC Super-

hero every time we deliver quality and

safe care to our patients in any small way

we can.

TMC Superhero ka ba?

QuIP Update is the

newsletter of TMC’s Quality

Improvement Program. It is

published by the Medical

Quality Improvement Office.

For comments and feedback,

call up local 6289, email

medqi@medicalcity.com.ph

or text 0915-764-4800.

This issue of the QuIP

Update contains

contributions from Dr. F

Valdes & Gino Camacho of

the CPP.

Who passed? Who failed? Average scores obtained by division Perfect score is 5; Passing score is 4

SSG 4.9

Medical staff 4.8

PSG-SSD 4.4

MSG-Admin 4.3

PSG-Nursing 4.2

FASG 3.7

Capt. Read Back re-

minds us to ask for a

read back every time a

verbal or telephone

order is given

Check Mate reminds

us to always verify and

check the various

checklists we are us-

ing.

Med Recon Forte re-

minds us to reconcile the

meds at certain times

during our patients’ con-

finement.

In every therapy or

treatment given to a

patient, there are

positive and nega-

tive outcomes that

may happen. The

goal of a healthcare

professional is to

maximize the thera-

peutic outcome and

minimize the ad-

verse effects.

Sometimes, despite

our best efforts un-

expected adverse

events happen to

patients. Such

events are often rare

and do not necessar-

ily imply any negli-

gence on our part..

Such unexpected

outcomes may have

been cited as a pos-

sible complication

when the attending

physician secured

the informed con-

sent. Nonetheless,

our patients’ trust in

our care and compe-

tence may be threat-

ened by such

events.

This issue is about

helping us and our

patients maintain a

trusting relationship,

When the unexpected happens, effective com-

munication with patients is crucial.

Maintaining your patient’s trust

when the unexpected happens

Do we have to disclose unexpected outcomes?

YES!

Because patients /

families have the right to

know!

Because patients/

families have to have the

right to participate in

their care. Because patients

can make rational deci-

sions about their care

only if they know the

facts about their current

condition.

Because timely dis-

closure preserves the

doctor/patient relation-

ship and rebuilds trust .

Because disclosure

is an ethical and profes-

sional requirement.

Because it simply is

the right thing to do!

Vol 6 , No 2

July 2009 QuIP Update

Business Name

8 basic steps in

responding to

an adverse

event

2

The role of the

AP in patient

disclosure

3

When some-

thing unex-

pected hap-

pens, WHAT

shall we tell our

patients

3

The initial dis-

closure: some

tips

4

Caring for the

health care

team after an

adverse event

5

One more time:

TMC patient

rights and re-

sponsibilities

6

TMC Superhero

ka ba?

8

Inside this issue :

Continued on page 2

THE MEDICAL CITY

including patients them-

selves, to integrate clinical,

corporate, ethical and legal

concerns.

This issue of the QuIP Update

focuses on how to disclose

adverse events to patients

and deal with its effects. Re-

member, informed patients

are more likely to remain our

partners in their safe journey

to health.

Vol 6 , No 2 Page 2

The Medical City’s re-

sponse to an unexpected

or adverse event consists

of 8 steps enumerated

below.

1. Caring for the patient

2. Preserving the evi-

dence

3. Documenting facts in

the medical record

4. Reporting the event

5. Disclosing factual

information

6. Analyzing the event to

prevent recurrence and/

or improve outcome

7. Following through

with subsequent disclo-

sure discussion(s)

8. Healing the Health

Care Team

Disclosure is the 5th

step in this process. It is

a concrete example of

how The Medical City

takes a bold and firm

stand on upholding the

rights of patients and

their families.

Doctors do have rights,

of course, but as physi-

cians of The Medical

City, they do not have

the luxury of “executive

privilege” about unex-

pected outcomes.

Communication with pa-

tients is crucial. Doctors

should inform patients of

all outcomes (positive and

negative). This builds trust

and accurately reflects the

quality of care TMC doctors

give to them. This also

keeps doctors aware of

their responsibility to de-

liver SAFE care always.

must take an active role

in their care through

good and bad times.

Then, we must tell our

patients how they will be

informed of an adverse

event should it happen .

The Medical City policies

on patient disclosure are

a result of painstaking

efforts by all levels and

sectors of the hospital,

which is the bedrock of

patient care.

To prepare for such a

rare occurrence, we

must tell our patients

that, despite our best

efforts, no treatment is

without risk or carries a

100% guarantee of suc-

cess. This fact, though

hard to accept especially

for very ill patients,

means that patients

8 Basic steps in responding to an adverse event

Maintaining your patient’s trust when the unexpected happens (from page 1)

Page 7

tion on the purposes and

procedures of the re-

search; and, be assured

that his/her refusal will

not compromise care.

4. To privacy while in

the hospital and confi-

dentiality of all informa-

tion and records regard-

ing his/her care

5. To participate in all

decisions about his/her

treatment and discharge

from the hospital

6. To complain without

fear of reprisals about

the care and services

he/she are receiving and

to have the hospital re-

spond to him/her

7. To authorize those

family members and

other adults who will be

given priority to visit con-

sistent with your ability

to receive visitors and

pertinent hospital poli-

cies.

8. To be informed of

the policies and proce-

dures on organ donation

and transplantation.

rights and responsibilities

Responsibilities of

the TMC patient:

1. To provide com-

plete and truthful infor-

mation about his/her

health, including past

illnesses, hospital

stays, surgeries, aller-

gies and use of medi-

cines/other forms of treat-

ment

2. To know the members

of his/her health care team

3. To be involved in the

decisions regarding his/her

health care

4. To ask questions re-

garding the nature of his/

her illness and its manage-

ment including options,

likely outcomes, benefits,

risks, and costs

5. To ask questions

whenever hi/she is not

sure of the information or

instructions given to him/

her

6. To tell the health care

team if he/she has prob-

QuIP Update

lems adhering to the plan

of care as agreed upon

7. To follow hospital rules

and regulations affecting

patient care, safety, and

conduct

8. To be considerate of

the rights of other patients,

staff and the hospital in-

cluding those pertaining to

noise control, smoking,

and visitors

9. To promptly pay all

bills related to his/her care

according to the hospital

policies

10. To recognize the effect

of lifestyle on your personal

health, and in so doing

make responsible deci-

sions in your daily life

From page 6

Vol 6 , No 2 Page 6

strate our core values of

integrity and compassion-

ate service.

For this issue of the QuIP

Update, let us go through

these rights and responsi-

bilities once again. Know-

ing and understanding

them will enable us to

uphold and protect them

as well for our patients.

The rights of the TMC

patient:

1. To be in-

formed of

a. His/her rights

as a patient in a

manner and lan-

guage that he/she

understands

b. The names

and departments of the doc-

tors and staff who will be

involved in his/her care in

the hospital

c. The nature of the pa-

tient’s illness, its likely

causes, manifestations and

course

d. The treatments pro-

posed to the patient, its

benefits, side effects, poten-

tial risks and costs

e. Other treatment options

relevant to the patient’s

condition, including the op-

tion to withhold treatment,

and the consequences of tak-

ing such options

2. To receive medical care

that is

a. Free from discrimination

as to ethnic origin, religion,

gender, disability, sexual orien-

tation and socioeconomic

status

b. Delivered with respect,

consideration and compassion

in a clean and safe environ-

ment free of unnecessary re-

straint

c. Appropriate to the pa-

tient’s medical condition and

consistent with the terms of

his/ her informed consent,

decisions, preferences and

values

d. Given in a timely manner

whenever the patient needs it

3. To be advised of, par-

ticipate in, or refuse to take

part in any medical re-

search; receive full informa-

Our present-day patients

are more informed than

patients of years ago. In-

formation is easily acces-

sible to them—internet, TV

talk shows, magazines,

gym mates, and many

more. Decisions about

many of their concerns,

including their health, are

based on these informa-

tion.

The Medical City recog-

nizes this and aims to

make the patient a true

partner in the manage-

ment of their care. TMC

believes that informed

patients are more likely to

make rational decisions.

A concrete way of making

our patients our partners

is the implementation of

our policy on patient

rights and responsibilities.

The policy espouses that

our patients have a funda-

mental right to be treated

with respect, compassion

and courtesy in a safe

environment. This en-

sures that their personal

well being is protected in

a private and confidential

manner.

Through this policy, we, as

TMC staff, can demon-

One more time: TMC patient

Continued to page 7

QuIP Update Page 3

During patient disclosure,

the Attending Physician (AP)

is in charge! He/She has the

main responsibility of talk-

ing to the patient. Aside

from the AP, the hospital

may assist and request the

following people to attend

the initial disclosure meet-

ing:

Other health care pro-

vider(s) involved in the

adverse event

Provider(s) with respon-

sibility for ongoing care

Leaders of the Medical

Services Group

Only factual documented information

will be disclosed.

The extent of factual information to be

disclosed should be determined by how

much is needed for a patient / family to

make rational decisions about their

care at the time of disclosure.

Timing is very important. Any perceived

delay may cause distrust, blame, and

more anger.

What will NOT be disclosed to the pa-

tient?

The following should not be disclosed to

The role of the AP in patient disclosure

the patient and his/her family:

Speculation and blame

Results and findings of protected

Peer Review, Sentinel Event inves-

tigations and administrative delib-

erations

Confidential information about

Medical City operations or its staff

When something unexpected happens, WHAT shall we tell

our patients?

The hospital will assist the

persons involved in disclo-

sure discussion in prepar-

ing, coordinating or con-

ducting discussion, de-

pending upon the health

care provider’s

communication skills,

rapport with patient and

family, and any language

barriers.

When will the disclosure

occur?

As soon as an adverse

event occurs and disclo-

sure is deemed neces-

sary, the AP will assess

the needs and the

readiness of the pa-

tient/family so that he/

she determines the

content, timing and

manner of disclosure.

Vol 6 , No 2 Page 4

Informing a patient and

his/her family that an

unexpected outcome hap-

pened is always a difficult

time for any doctor. The

organization is always

behind the TMC health

provider during such

events to provide support

personnel who are experi-

enced and trained in open

disclosure and who have

excellent communication

and listening skills.

Below are some of the

tips for our health care

providers during the initial

disclosure meeting:

Solicit and Respond to the

Patient’s/Family’s Feel-

ings and Questions

Contain your own

emotional response

Focus on the pa-

tient’s needs

Convey receptive atti-

tude

Open posture: arms

uncrossed, concerned

expression, eye con-

tact

Empathic listening

The initial disclosure: some tips

Name and vali-

date patient’s

concerns and

feelings (“I can

understand your

anger…”)

Avoid defensive

or accusatory

reaction if care is

questioned

Plan for Follow-up Care and

More Discussions and Com-

municate the Plan

If the cause of unantici-

pated outcome or prog-

nosis is not yet known,

assure patient/family

that additional facts will

be shared when avail-

able

Give an estimate of how

long analysis process

may take if asked.

Patient expectations may

not be realistic , so set

the limits too

Involve the administra-

tion personnel con-

cerned for other issues

( e.g. financial issues

and concerns)

If expectations are not

met this can lead to

breakdown of trust, fear

of abandonment or

cover-up, patient

dissatisfaction, and

worse, lawsuits

Make appointment

for phone call and/

or visit to update

patient

“I will call you in two

weeks (for example) to

give you an update.”

Encourage patient/

family to call if they

have questions or

have not heard back

from the provider

Give the name of the

contact person in

the hospital that will

assist them further

in the future.

QuIP Update Page 5

Caring for the health care team after an adverse event Staff involved will be trained and supported in dealing with the conse-

quences of disclosure.

Staff involved needs to acknowledge and cope with the effects of the

adverse event on the health care team members

Staff involved may need to discuss feelings about the adverse event

with family, close friends or colleagues.

Staff involved needs to be given time to heal

Staff involved needs to preserve the confidentiality of information

about the event even when pressured by third parties.

Staff involved needs to distinguish between discussion of his/her feel-

ings and facts of care

In case of ANY adverse event

Call Safety hotline Local 8777

Or inform Medical or Nursing Ser-

vices Group heads, Unit Head

AND Department Chair

Or submit a Sentinel Event Report

to the Risk Management officer

through the Medical Quality Im-

provement Office (MQIO)

Do Not Place in Medical Record or

“Discuss” in Medical Record

Do Not Photocopy any part of the

chart or any document pertaining

to the event

All such documentation should be

submitted to the RMO/MQIO.

The reception area of the

doctor’s office was filled to

capacity, but the doctor was

working at his usual snail’s

pace. After waiting two

hours, an old man slowly

stood up and headed for the

door. When everyone

stopped talking to look at

him, he announced, “I guess

I’ll just go home and die a

natural death.”

Source: Medical Blooper ©2008 Accord

Publishing.