NQF updates list of safe practices, urges disclosure
Risk managers who have been pushing for more full disclosure of adverse events now have more backing and can argue that informing patients is a significant step closer to being considered the standard of care. Disclosure to patients and family was one of the more significant additions to the recently updated list of "safe practices" endorsed by the National Quality Forum (NQF) in Washington, DC.
In 2003, NQF endorsed 30 safe practices that should be universally utilized in applicable health care settings to reduce the risk of harm resulting from processes, systems, or environments of care. To ensure the practices reflected new evidence and innovation, NQF recently updated the list of practices, adding three new practices and materially changing 23 practices from the initial list. Another four practices remain unchanged. (Detailed specifications and information on the recommendations may be found at www.qualityforum.org. Click on "News" and then the Oct. 16, 2006, announcement titled "NQF Updates Endorsement of Safe Practices for Better Healthcare.")
The key change for risk managers is the addition of this safe practice: Following serious, unanticipated outcomes, the patient and, as appropriate, family should receive communication about the event.
Road map to quality
The NQF web site provides support for implementing the safe practices, including examples of effective strategies and tools for measuring success, notes Melinda Murphy, RN, MS, CNA, senior vice president of NQF. Some of the practices were changed to more accurately reflect the intent of the goal, plus current thinking on the topic, she says. For instance, one practice was changed to note that the health care provider should not just "create" a culture of safety but also "sustain" it once the change is made.
"The updated list makes it clear that none of this work is based in one person, which should resonate with risk managers," Murphy says. "There can be a tendency to say that this is all the responsibility of the risk manager or the quality manager, but this updated list should make it clear that this is the whole organization's responsibility. The risk manager and top administration play key roles."
Murphy says the list, even with the updates, should not come as any surprise to risk managers who already are addressing patient safety in a proactive, systematic manner. For many, the updated list may serve as reinforcement that you are doing the right thing, and it may provide backup if anyone doubts the necessity of a strategy you promote, she says. "If you are in an organization that is not so highly evolved, the list can be a road map of where you want to go," Murphy says. "It can help you make incremental changes and intervene, as well as how to make sure your intervention is working."
Disclosure a key change
The new safe practice regarding disclosure already is creating a sensation in the health care community, Murphy says. Many risk managers welcome the NQF's backing of an idea that sometimes meets resistance.
"With that safe practice there is the expectation that there will be education for clinicians on how to disclose, and that that support will be provided in a nonthreatening, nonpunitive way," Murphy says.
The American Society for Healthcare Risk Management (ASHRM) in Chicago was involved with updating the NQF list and encouraged the addition of the new practice on disclosure, says executive director Elizabeth Summy, CAE. "This is about the culture of organizations, and we support that," she says. "We commented on the proposed changes and communicated our position on these topics. Overall the tone and approach from the NQF was excellent, and we're glad to see this kind of support for the work of risk managers."
Summy directs risk managers to a useful ASHRM resource for encouraging full disclosure A "pearls" document outlining strategies and tips costs $20 for ASHRM members and $25 for non-members. For more information, go to www.ashrm.org. Choose "resources" and then "pearls." A free preview of the document is available on-line at www.ashrm.org/ashrm/resources/files/Pearls.Disclosure.TOC.pdf.
"That is a new resource that became available in just the past few months, and it has some ideas about how to structure the practices in your organization," Summy says. "We know that most organizations have a disclosure policy and are starting to move this issue forward, so we are looking at determining what are the best practices and how to disseminate those."
Sources
For more information the updated list of safe practices, contact:
- Melinda Murphy, RN, MS, CNA, Senior Vice President, National Quality Forum, 601 13th St. N.W., Suite 500 N., Washington, DC 20005. Telephone: (202) 783-1300.
- Elizabeth Summy, Executive Director, American Society for Healthcare Risk Management, One N. Franklin St., Chicago, IL 60606. Telephone: (312) 422-3989. E-mail: [email protected].
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