Domain 6 - Key and Enabling Competencies

Recognize, Respond to and Disclose Adverse Events

Definition: Recognize the occurrence of an adverse event or close call and responding effectively to mitigate harm to the patient, ensure disclosure, and prevent recurrence.

1. Health care professionals who recognize the occurrence of an adverse event or close call are able to:

1.1. Define the terms harm, adverse event, close call, and the response that is appropriate to each

1.2. Distinguish between the harm resulting from an adverse event and the natural progression of the patient’s underlying medical condition

2. Health care professionals who mitigate harm and address immediate risks for patients and others affected by adverse events and close calls:

2.1. Assess the immediate safety and care needs for the physical and emotional well-being of patients and their families, and provide interventions as appropriate

2.2. Reduce or manage the risk of further harm to patients affected by adverse events and close calls

2.3. Provide appropriate support for individual health care professionals and teams involved in adverse events and close calls

3. Health care professionals who disclose the occurrence of an adverse event to patients and/or their families as appropriate and in keeping with relevant legislation:

3.1. Understand what information should be disclosed at the initial disclosure stage, the time frame for disclosure, and the relevant documentation, reporting, and analyses

3.2. Recognize the ethical, professional and legal obligation to disclose and report adverse events

3.4. Are aware of existing policies and procedures associated with disclosure and the extent to which these foster a culture of patient safety

3.5. Engage in honest communication and empathic dialogue with respect to disclosure

3.6. Recognize that there are situations that constitute special consideration regarding disclosure, for example, patients in vulnerable situations, patients who have a substitute decision-maker, patients with special communication requirements (e.g., those who are hearing impaired), and patients whose cultural perspective on disclosure differs from the provider’s

3.7. Understand the stages of disclosure

3.8. Determine who is responsible for the disclosure and who should be present when it is made

3.9. Recognize the role of expressions of regret and when an apology should be considered in postanalysis disclosure

3.10. Document unexpected outcomes, adverse events and the disclosure discussions

3.11. Provide ongoing follow-up as needed

3.13. Appreciate the legal implications arising from disclosure

4. Health care professionals who effectively report the occurrence of an adverse event or close call:

4.1. Recognize that the reporting of adverse events takes place across the continuum of care and includes primary, secondary and tertiary care centres

4.2. Anticipate the need to gain a better understanding of the adverse event, such as by considering what samples, clinical materials and equipment may be helpful in future investigations

5. Health care professionals who participate in timely event analysis, reflective practice, and planning for the prevention of recurrence:

5.1. Engage in personal and professional reflection regarding the adverse event

5.2. Recognize the importance of monitoring the outcome of event analysis

5.3. Apply lessons learned from the event analysis

5.4. Advocate for system change as warranted

5.5. Recognize the need for information exchange across health care organizations and as mandated by provincial/territorial legislation