As you may know, the Standards of Practice set out the minimum standards in paramedic services. Each regulated member is required to understand and comply with these Standards, but how does this translate in the day-to-day work of EMRs, PCPs and ACPs?
In an effort to help regulated members understand and apply the Standards to real life situations, we will be sharing scenarios that give context to the Standards and ideas on how to implement this into practice.
The following scenario will attempt to address disclosure of harm.
2.2 Disclosure of Harm
Appropriate disclosure of harm (an outcome that negatively affects the patient’s health and/or quality of life) must be communicated to the patient. Disclosure of harm addresses the patient’s immediate and future medical needs, the investigation (if required) of the circumstances that led to the patient suffering harm, and necessary steps to prevent recurrence of the harm if an untoward and avoidable event occurred.
- If the regulated member is the only healthcare professional treating the patient, it is the regulated member’s responsibility to disclose that information to the patient/alternate decision maker.
- In a multi-provider setting, the regulated member must collaborate with other members of the team (in the hospital setting this will also include the administration) to identify the most suitable person(s) to disclose to the patient.
- Disclosure must occur whether the harm is a result of a complication of care, an error or an adverse event, progression of disease and whether the harm was preventable.
Scenario:
Jenny is a casual ACP working on an ambulance in suburban-rural setting, just outside of Edmonton. Jenny is working with her PCP partner, Kathleen, who recently completed her mentorship. Early in their shift, Jenny and Kathleen are called to a 42-year-old male experiencing an anaphylactic reaction in the community of Alberta Beach. Upon arrival, Jenny and Kathleen are ushered into a home residence by the patient’s wife who seems to be very distressed, explaining that her husband must have eaten something with peanuts. They walk into the kitchen and find a 42-year-old man in the tripod position, experiencing severe shortness of breath as well as swelling and hives to his face and neck. Jenny and Kathleen begin patient assessment and initiate care.
During the course of immediate intervention, Jenny instructs Kathleen to draw up a dose of epinephrine and administer that as soon as possible while she (Jenny) is initiating the IV and setting up the cardiac monitor. Unbeknownst to Jenny, Kathleen is feeling very overwhelmed and flustered in this moment. Kathleen has never provided care to a patient experiencing such severe anaphylactic symptoms, and she begins to experience cognitive overload. While Kathleen is familiar with the dosage of epinephrine that she is to give, Kathleen mistakenly administers the epinephrine intravenously, rather than intramuscular. Before Jenny realizes what Kathleen is doing, she witnesses Kathleen unscrewing the syringe from the IV line.
Jenny immediately attempts to confirm the six rights of medication administration with Kathleen, who quickly realizes the mistake she just made. Both practitioners verbalize to one another that there has been a medication error and quickly reassess their patient to monitor for any changes. While he is still in distress and experiencing tachycardia post medication administration, it seems that his condition is starting to trend in the right direction. Kathleen and Jenny continue to monitor for life-altering symptomology due to the medication error.
While Jenny and Kathleen prepare the patient for transport, Kathleen (in collaboration with Jenny) advises both the patient and his wife of what just occurred – ultimately disclosing to them the harmful medication error. Jenny, being the ACP and senior practitioner, goes on to disclose that the harm was a result of an error and was preventable, as well as the steps they (as practitioners) must do to follow up this adverse event. Both the patient and his wife are unhappy with the medication error but understand and appreciate the disclosure of the harm he experienced. Both paramedics will also be following up this incident with appropriate reporting to the hospital, employer, and ensure appropriate documentation in the care report.
In this example, Jenny and Kathleen both demonstrate their knowledge and adherence to the Standard 2.2 Disclosure of Harm, where a regulated member must appropriately disclose harm. Disclosure of harm addresses the patient’s immediate and future medical needs, the investigation (if required) of the circumstances that led to the patient suffering harm, and necessary steps to prevent recurrence of the harm if an untoward and avoidable event occurred.