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Risk Reference Sheet Risk Reference Sheet RISK REFERENCE SHEET RISK REFERENCE SHEET Abuse of Patients Abuse of patient claims reported to HIROC cover a broad spectrum including, reported, suspected, and witnessed incidents of physical and sexual assault, harassment, threats and financial abuse of patients by other patients, staff, volunteers, visitors or healthcare practitioners. Abuse can have lasting physical and psychological effects. In order to adequately respond to such claims, it is essential to be able to demonstrate that the healthcare organization and its staff met relevant standards of care, implemented appropriate policies and respond promptly to reports of abuse or circumstances where the potential for abuse might be reasonably anticipated. The failure to report and take timely action in response to reported or witnessed incidents is a common finding in HIROC claims. CASE STUDY 1 COMMON CLAIM THEMES A 47 year-old patient notified a nurse of being sexually assaulted by a System fellow patient on the way back to the unit following a smoke break. The nurse notified the physician-on call and the hospital’s Sexual Assault and • Facility design and layout Domestic Abuse team. Shortly thereafter, the nurse contacted several challenges (e.g., limited ability to other units in attempts to locate the alleged assailant. A patient fitting the properly monitor patients, failure patient’s description of the alleged assailant was located by the healthcare to identify furniture or other items team and moved to a secure area pending arrival of the police. The next available that could be used or morning, the patient who reported the sexual assault left the hospital misused to harm others). against medical advice. No further investigation was carried out by the • Inconsistent background and police hospital. Four months later, the patient filed a complaint with the hospital’s checks for employees, independent Patient Experience Manager concerning the hospital’s failure to conduct health practitioners, volunteers and a formal investigation, and permanent psychological trauma from the third party/contract/agency staff. incident. Senior leadership was immediately notified of the complaint and a critical incident investigation was initiated. • Perceived and actual systematic tolerance of unprofessional, Expert review of the case was not supportive of the decision by the inappropriate and disruptive healthcare team on duty at the time, noting that they felt they could ‘handle’ behaviour by regulated and and investigate the incident without the need to report to management. It unregulated care providers. was revealed that the alleged assailant was an in-patient with a known history of inappropriate sexual behavior. Previous sexual incidents had occurred in the hospital, however, incidents were never escalated or documented by the care teams. Based on the information documented, it was not clear what level of investigation took place, including what steps had been taken to relocate the alleged assailant and preserve the evidence. CASE STUDY 2 While receiving care at a rehabilitation facility, a patient with a history of mental illness and increasing confusion was found attempting to feed fecal matter to their room-mate. Expert review of the incident was critical of the care provided by the involved healthcare providers. The primary nurse assigned to the patient had failed to document observations of the patient’s unusual behaviours that posed a threat to other patients. It was also discovered that despite a documented history of failing to comply with scheduled medication administration and significant cognitive deterioration that the patient was placed in a shared room when a single room assignment was warranted. Canadian Case Examples Confidential. For quality assurance purposes. 1 RISK REFERENCE SHEET Abuse of Patients COMMON CLAIM THEMES cont’d Knowledge and judgement • Failure to escalate, follow up, and intervene on reports • Failure to adequately identify, document, and/or of sexual abuse or “suspicious” behavior: monitor a patient at risk of harming others. o Hesitancy to report “suspicious” behavior • Failure to adhere to restraint policies and proper involving co-workers (e.g., second guess what restraint practices (including restraint prevention they witnessed); strategies). o Assumption that ‘false reports’ are common in • Inadequately performed patient risk assessments areas such as mental health facilities; o Lack of awareness and compliance with local abuse prevention and response protocols. MITIGATION STRATEGIES Reliable Screening, Hiring and Privileging Processes o Is currently or has ever been involved • Adopt a standardized process for applicant in any regulatory body investigation background checks including: resulting in a referral to a disciplinary or quality committee, and/or a decision of a o A release form to enable any third party to regulatory body affecting the applicant’s release information related to the applicant; licensure or registration; o Standardized criteria for references to rate o Has ever been (or has been since last the applicant; appointment), found liable in any Canadian o Ensuring all references are personally or foreign court of competent jurisdiction contacted (ideally verbally) prior to hire or as a result of a breach of the standard of granting of privileges; care, professional misconduct, etc.; o Ensure individuals new to the organization o Has ever been (or has been since last have background police checks and appointment), charged or convicted with regulatory college checks (e.g., vulnerable a criminal offence in Canada or foreign sector and criminal records checks). jurisdiction, including the reason; • Ensure the application process as well as the o Has voluntarily or involuntarily relinquished annual performance review for non-physician any professional license or registration. regulated health professionals requires the • Conduct robust reference checks when there are applicant to agree to disclose whether the unexplained gaps in a resume or if the candidate applicant: was terminated from previous employment. o Is named as a defendant in any civil legal • Require that all employees, independent action arising from their professional health professionals, agency and float staff conduct, competence or capacity, including and volunteers to annually sign-off on the whether the claim is resolved by settlement organization’s ‘abuse of patient while in care’ and or judgement requiring a payment on their ‘code of conduct’ policies. behalf; Confidential. For quality assurance purposes. 2 RISK REFERENCE SHEET Abuse of Patients • Adopt a zero tolerance approach toward any Responding to Reported, Suspected or Witnessed form of patient abuse while in care that includes Sexual and/or Physical Abuse of a Patient the following principles (but is not limited to): • Adopt a standardized response protocol and/or o Patients who report an incident of physical, checklist to support decision making following sexual or financial abuse while in care are suspected, reported or witnessed sexual or entitled to be heard, their right to dignity physical abuse of a patient, including: and confidentiality respected and protected o Immediate response upon receiving a throughout the process of communication, report or witnessing of a sexual or physical investigation and organizational response, abuse (e.g., removal from present or regardless of whether the event is perceived imminent harm, patient care and support, as being ‘false’, and should be treated with internal notification requirements, compassion and understanding; evidence preservation including witness o Respecting the patient’s right to choose identification); the support services and care they feel are o Implementing the incident response most appropriate, the extent to which they protocol (e.g., offering support, communicate about their experience/the documentation of what is known about the incident, if at all, the right to be protected incident, notification of family with patient’s from reprisal for reporting an incident and, consent, processes for conducting the their right whether they report the incident investigation, mandatory and permissive to the Police (if an appropriate option); external reporting obligations, staff support, o Ensuring the organization’s investigation notification and cooperation with the police procedures are transparent; (including consent consideration); o Staff are expected to immediately o Incident review, debrief and closure (e.g., report patient abuse incidents they have documentation of the investigation and witnessed or have knowledge of, or where learnings, communicating the results of the they suspect that abuse of a patient has investigation with the patient as per their occurred or may occur while in care. communication preferences). • Implement multifaceted strategies to support and encourage early reporting of suspected/actual Environmental Design and Physical Layout patient abuse while in care (e.g., whistleblowers • Conduct periodic environmental design and hotline, reporting without reprisal, as much physical layout risk assessments to prevent confidentiality as possible). and minimize abuse of patients while in care, in • Ensure early development of formal care plans or particular (but not limited to) clinical areas such violence risk assessments for patients exhibiting as mental health units, emergency departments abuse or with a history of physical or sexual and memory and aging programs. abuse, aggressive and/ or combative behaviours. 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