Increasing Patient Care And Reducing Liability In Seven Simple Steps

When an unconscious patient arrives in the ED, every hospital agrees that timely next of kin notification is vital Not only is it important to have a family member present to comfort the patient, but to make informed decisions for his care and provide the medical history that can make the difference between life and death From a liability standpoint, as we know all too well, having a family member making medical decisions, often means that if complications do arise, the family will be much less likely to sue, than if they hadn’t been in attendance

Although most hospitals make notification calls quickly, between personnel shortages and overworked staffers, that call can often be delayed or forgotten

That’s exactly what happened to Elaine Sullivan, a very active seventy-one-year-old woman, who slipped and fell, while getting into the bathtub When paramedics arrived, they realized that injuries to her mouth and head had made her unable to communicate, or as the hospital later discovered, to give informed consent for her own care

Although stable for the first few days, she began to slip into critical condition On the seventh day, Elaine died But that tragedy was soon overshadowed by another Despite having her daughter’s phone number and contact information clearly indicated on the front of her chart, the hospital failed to notify her family that she’d been hospitalized until six and a half days after her admission, only hours before she died, unnecessarily and alone

Elaine Sullivan was my grandmother

In her case, placing that phone call right away, would have saved her life Not only would my mother Janet and I have had the time to fly back to Chicago to be at her bedside, but we would have made sure she received the care she needed We also would have been able to give the physicians treating her, the medical history they needed to prevent the complications and drug interactions, responsible for her death

After researching our own case and others like it, we realized that failing to notify a patient’s next of kin wasn’t an isolated problem – it’s something that’s been experienced by countless families nationwide According to the CDC, nearly one million patients come into the ED every year unconscious or physically unable to give informed consent And with the growing number of emergency room admissions and baby boomers turning into senior citizens, the problem is only going to escalate We began meeting with medical and trauma professionals, to create an easy-to-implement solution to this growing problem, by bringing together the best practices of successful trauma teams from hospitals nationwide The result is the Seven Steps to Successful Notification System

The complete system is presented in The Seven Steps Information Kit, which is available for download, free of charge, on the NOKEP web site It’s filled with tools your staff can use on the patient care floor to identify and locate your unconscious patient’s family or surrogate decision makers, identify John Does and improve patient care and satisfaction by locating patient’s medical histories quickly and easily, while complying with HIPAA standards

Even better, following the Seven Steps system provides the facility with a documentation of the steps taken to find the patient’s next of kin, make the notification, and the staff members responsible for making it This releases you from subsequent liability, while providing proof that your facility has met its statutory responsibility

Here is a quick look at the Seven Steps

Step 1: Patient status confirmed

The moment that your staff realizes that an ED patient is unconscious or physically unable to give informed consent, and that there is no family member or surrogate decision maker in attendance, a nurse or physician is tasked with following the notification process through to completion The staff member indicates the patient’s status on his chart along with the time, date and the staffer’s initials

Step 2: Examine the patient’s personal effects for emergency contact numbers

If the patient doesn’t have emergency contact information in his or her wallet, the staff member looks for it in the patient’s personal effects The System has a comprehensive checklist of places to locate this information, from the usual to the downright creative

Step 3: Retrieve patient’s home number

If the patient doesn’t have emergency contact information, the staff member then looks for the patient’s home number, going to step five if they find it and four if they do not

Step 4: Seek other sources for contact information

Next, the staff member looks for the patient’s emergency contact information or home phone number on records from previous admissions at the facility, or by calling his personal physician’s office, or other locations on the checklist If the staff member finds the information, he proceeds to step five – if not, step seven

Step 5: Oversee or make the notification call

When a contact has been identified, the staffer places a call to make the notification They note on the chart when the call was placed, whom they contacted, the phone number and the result

Step 6: Need to follow up? Recall main contact or second number

If a message had to be left for the contact, or the contact doesn’t come into the hospital within two hours, the staff member places one more call, to the first or a secondary contact If no one is reached, the staff member proceeds to step seven

Step 7: Shift to social service or police

When no contact name or number can be located, or if the staff member doing the notification, is unable to speak directly to the contact, they give the information to the social service department or to the local police department, as per your facilities’ policy, for follow up

Along with the Information Kit, the non-profit Next of Kin Education Project has created patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system You’ll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff’s fingertips

Just as doctors, nurses, and staffers from every department make up a team to improve the health of the patients in their care, family and friends can play an important part in contributing to the patient’s well being As a medical professional, you are a diagnostician, a caregiver and a healer But most of all, you are the patient’s advocate And so is his family This Kit contains tools that will help you and his family work together to increase his care, trust and take patient satisfaction to a whole new level

Laura Greenwald, CEO/The Next of Kin Education Project nokepinfokit@junocom

The Seven Steps Information Kit can be downloaded free of charge at http://clikto/7steps

and the Reminder Products can be purchased at our NOKEP store http://wwwcafeshopscom/7steps

Tags | attendance, condition, critical, days, family, grandmother, history, interactions, member, paramedics, personnel, standpoint