Disclosure Checklist

AHRQ Communication and Optimal Resolution Toolkit

Purpose: To provide guidance to individuals who are conducting initial or followup disclosure conversations, including key disclosure communication skills.

Who should use this tool? Disclosure Lead and any staff who will be engaged in disclosure conversations.

How to use this tool: Use Part I of the checklist to prepare for the initial disclosure conversation, which should occur within 60 minutes after a Communication and Optimal Resolution (CANDOR) event is identified. Part II can be used to conduct all followup communication. Remember the key disclosure communication skills listed at the end of the checklist.

Complete
Part I – Initial Disclosure Conversation
 
  • Within 60 minutes after the CANDOR event is identified, advise the patient and/or family that an adverse event may have occurred.
 
  • Tell the patient/family that the organization will conduct an Event Investigation and Analysis to understand what happened and will share the results.
 
  • Affirm that the first priority is to take care of the patient and meet their health care, social, and emotional needs.
 
  • Ensure that the family is treated compassionately and provided with the necessary resources to help support their needs.
 
  • Designate an organizational contact person the patient and family can reach with questions or concerns.
 
  • Activate the Care for the Caregiver support system to provide support for staff who were involved in the event.
Complete
Part II - Disclosure Communication
  GET READY
 
  • Review the event with team members, as applicable, so that you are familiar with relevant information.
 
  • Discuss the goal for the disclosure conversation with other team members that might be involved in the communication.
 
  • Strongly consider including one or more team members in the disclosure with the patient to help debrief, remember, and document the discussion.
 
  • Anticipate the patient's emotional response, and plan how you will respond empathically.
 
  • Consider whether a surrogate/family member should be present.
 
  • Anticipate likely questions from the patient/family.
 
  • Rehearse (in person or by phone)  the discussion with another CANDOR Disclosure Lead.
 
  • Recognize that this is likely to be one in a series of discussions with the patient/family about the event.
 
  • Consider your own feelings and seek support, as needed.
  SET THE STAGE
 
  • Turn off/sign out beepers and phones, if possible (or silence, if not possible).
 
  • Find a quiet, private area for the conversation.
 
  • Sit down.
 
  • Describe the purpose of the conversation.
  LISTEN AND EMPATHIZE THROUGHOUT
 
  • Assess the patient's/family's understanding of what happened.
 
  • Identify the patient's/family's key concerns.
 
  • Actively listen to the patient.
 
  • Acknowledge and validate the patient's feelings.
  EXPLAIN THE FACTS
  What happened?
 
  • Identify the adverse event early in the disclosure.
 
  • Explain what happened in a way that is easy to understand.
 
  • Explain what is known about why the adverse event occurred; do not speculate.
 
  • Tell the patient whether the adverse event was preventable, if known.
 
  • Explain your role in the event to the patient/family; avoid blaming others or "the system" for the event.
  What are the potential consequences?
 
  • Tell the patient/family what will be done now to care for the patient and how the event may impact his/her long-term health care.
 
  • Tell the patient/family what the organization is committed to doing to mitigate the impact on the patient's long-term health.
  APOLOGIZE
 
  • Say you are sorry for the adverse event in a sincere manner early in the conversation.
  IF THE EVENT WAS PREVENTABLE (DUE TO ERROR)
 
  • Tell the patient/family what should have happened.
 
  • Tell the patient/family what will be done differently to prevent a similar event from happening to another patient, or that a plan will be developed to this effect.
  CLOSE THE DISCUSSION
 
  • Discuss next steps and plan for a followup conversation.
 
  • Ask if there are any final questions and provide responses; if unable to answer, promise to follow up with the answers.
  AFTER THE CONVERSATION
 
  • Debrief the conversation with colleagues who were present and the CANDOR Disclosure Lead. Review key elements of discussion, and establish consensus about what was said and next steps. Discuss what went well and what could be done going forward to enhance communication.
 
  • Document the disclosure conversation in the medical record, including only the facts of the conversation and followup plans.  If you are not certain what to document, contact a CANDOR Disclosure Lead or risk manager.
 
  • Consider ways to involve patients in post-event learning.

 

Key Disclosure Communication Skills
  • Show empathy
    • ALLOW the patient to express his/her emotions.
    • ACKNOWLEDGE the patient's emotions.
    • VALIDATE the patient's emotions by saying that their response is understandable.
  • Be honest
    • EXPLAIN the facts about the adverse event without the patient having to do a lot of probing.
    • GIVE direct answers to the patient's questions.
      • If you do not know the answer to the patient's questions, state this directly and explain your plan to learn more and keep them updated.
  • Utilize effective communication strategies
    • SHOW sincere interest in the patient's questions and concerns.
    • USE good non-verbal expression (e.g., eye contact).
    • AVOID medical jargon.
    • CHECK for the patient's understanding of the information throughout the conversation.
    • BE yourself!

 

Return to CANDOR Contents

Page last reviewed February 2017
Page originally created April 2016
Internet Citation: Disclosure Checklist. Content last reviewed February 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module5-checklist.html