A concept that has not really gained much traction in health care is that of Open Disclosure. This is when a patient is informed about an adverse event. A bit more than “Oops, do you want the good news or the bad news?” Open disclosure is an ethical obligation to implement a number of steps.
There must be notification to a patient about what has occurred. An apology or expression of regret is clearly made. The patient is given a factual explanation of what happened and discussion of the potential long-term outcomes the patient could experience is included. Finally, there must be evidence of what steps are being taken to prevent such a thing happening again.
In Australia there has been, since 2008 the National Open Disclosure Standard, a guideline that covers every state. This is not a law, no legislation directs Open Disclosure must occur but a number of legal cases in tort and contracts have upheld the notion it is expected where it is known that an adverse event has occurred. There have been calls for legislation to make it mandatory, but as yet it remains state health department policy or recommendations.
The national standards, health department guidelines and policies on Open Disclosure are aimed at doctors. What about the responsibility of a nurse? When you look at the world of nursing, our own ethical standards and the ideals of nursing professionalism, there is reason to contemplate the idea and even consider if there needs to be clear policies in our organisations for nurses to follow.
Nurses would no doubt have the same anxiety and ambivalence that doctors have about Open Disclosure. Fear of litigation is of course, the biggest anxiety but studies identified embarrassment at acknowledging an error, and uncertainty as to how much information should be disclosed are also significant barriers. In fact, there is some indication that Open Disclosure has reduced the incidence of litigation here and overseas.
In law, there are protections for apologies. Insurers cannot displace their obligations on the basis of an admission and apology for an adverse event. Legally it can be argued in most states that an apology does not imply fault or of itself indicate liability. Certainly there will be moves to build legal certainty into the Australian system to ensure Open Disclosure does happen and at no risk of proven legal liability to the doctor.
My point is, as nurses we are committed to the intent of Open Disclosure guidelines, true we are always frightened about “legal consequences for opening our mouths” but really our profession is committed to honesty and ethical behaviour in ensuring patients who experience an adverse event, who are the victim of an error will get appropriate and rapid care and the cause of the error will be known and avoided in future. For us, Open Disclosure is perhaps simply just ethical nursing.