Tips for healthcare operators to maximise safety during trying times

Top ten tips
The COVID-19 outbreak is testing the limits of healthcare systems and particularly of staff, which is bearing the mental load of the crisis.

One way that healthcare facility operators and managers can protect their staff from yet more emotional distress once the crisis is over is to try and reduce complaints and claims against staff in the first place. A rigorous set of safety guidelines and protocols which is urgently reviewed now and amended in conference with clinicians on the ground where possible to ensure they are fit for purpose is essential. By having these, along with gently but firmly reminding staff of their obligations and the main areas of risk in terms of patient safety, Providers will go some way to lessening the likelihood of a peak in claims relating to the coronavirus outbreak and associated changes in practice it has forced. 

The most practical and crucial safety points include:

1. Safeguarding

Failure to safeguard children and vulnerable adults causes many distressing claims. Ensure that you have policies:

  • Covering adult and child safeguarding.
  • Which are accessible to all staff on site.
  • That staff are aware how to identify and report concerns – pay particular attention to your staff who are being transferred from other wards or units or coming out of retirement and may be unfamiliar with the increasingly stringent rules. Likewise, newly qualified medical students. Ultimately, push the point that if any member of staff is worried about a patient they are under a duty to raise the issue through the correct channels.
  • Make all staff aware of who the safeguarding lead is and how to contact them; all the more important when individuals may be self isolating so ensure that deputies are also identified and fully briefed.

2. Infection Control

Management of infection and infection control within health centres would seem an obvious point but this is of critical importance at this time more than any. We anticipate claims from patients who may contract coronavirus when being treated for another health issue. Moreover, it may be tempting to overlook the transmission of other infections at this time such as MRSA.

Ensure you have:

  • Nominated IPC lead.
  • Training/regular audits.
  • Systems in place to segregate coronavirus patients.
  • Changes of protective wear for staff – this is a real challenge at the moment due to the current lack of resources. 

3.Recruitment

Appropriate checks must be carried out when recruiting new staff – whether administrative, clinical, managerial or operational. The crisis is not an excuse to take short cuts. It has been confirmed by the various regulators that revalidation will be delayed by a year. However, you still need to ensure that you:

  • Keep careful interview notes, proof of identification, qualification and references.
  • Check registration with an appropriate professional body and that the clinicians have 3 years of good standing.
  • Conduct Barring Service.
  • Have all the appropriate disclosure.
  • Induct staff and ensure that they are capable of performing the roles they are being assigned. We commonly see claims arising where individuals are working outside of scope, particularly, for example, where an organisation has had to ‘step in’ to offer services at short notice. During the Pandemic more staff will inevitably be working in unfamiliar territory. Ensure they have as much support as possible and emphasise the importance of supervision and the crucial importance of staff seeking supervision and input from more experienced colleagues.

4. Premises

Public and Employer liability will not halt at this time. Ensure that premises are still being well managed and maintained. Check that:

  • Risk assessments are carried out for, in particular:
    • Legionella.
    • Fire hazards.
    • Cyber attack vulnerability and IT system robustness during this period of high use.
    • MRSA and similar infections.
  • Incidents are tracked and trend MQRs are generated. (Monthly quality reports).

5. Chaperones

We see many claims which could have been avoided had a clinician had a chaperone present or had there been a proper translator available. Always bear in mind that it is helpful to have two clinicians present who can corroborate the consultation; patients often bring a relative in, who, in the context of a civil claim, support one another’s recollection of the interaction. Thus it is important that staff are being trained as chaperons and you provide:

  • Patient information involving chaperone services, (in several languages), available in waiting areas.
  • Staff with the ability to explain and provide chaperone services to patients when required.
  • Reminders to staff about offering chaperones.

6. Consent

Alleged failure to consent patients adequately is one of the most commonly pleaded claims. It is crucial to remind staff:

  • Of the importance of consenting properly.
  • To explain to patients the risks associated with undergoing treatment and what will happen if treatment does not happen.
  • That they still have to offer the option of doing nothing treatment-wise;
  • To encourage patient ‘tell back’ to check that they understand the treatments offered and the options available and feel fully able to make a decision.
  • Not to assume patient understanding or that other colleagues have consented adequately.
  • Specify personal considerations in respect of the specific patient as an individual and separate these clearly from the more general limitations and considerations. For example, risk factors will differ according to any existing co-morbidities.
  • That DNRs are valid.

7. Streaming Times

Alleged failure to consent patients adequately is one of the most commonly pleaded claims. It is crucial to remind staff:

  • Of the importance of consenting properly.
  • To explain to patients the risks associated with undergoing treatment and what will happen if treatment does not happen.
  • That they still have to offer the option of doing nothing treatment-wise;
  • To encourage patient ‘tell back’ to check that they understand the treatments offered and the options available and feel fully able to make a decision.
  • Not to assume patient understanding or that other colleagues have consented adequately.
  • Specify personal considerations in respect of the specific patient as an individual and separate these clearly from the more general limitations and considerations. For example, risk factors will differ according to any existing co-morbidities.
  • That DNRs are valid.

8. Records

Please emphasise that if something is not written down, as far as a Court is concerned, it remains true that the primary assumption will be that it did not happen, however convincing a witness your clinician makes. Your staff do not want to be in the stressful position of having to prove what there ‘normal practice’ is or what they ‘almost certainly’ would have said or done. Thus individual care records need to be carefully written, maintained, and shared. Moreover, sadly, we see too many claims as a result of lack of access to other organisation’s records on a particular patient. For example, if a patient does not offer the information that they had previously attended A and E regarding the same issue with which they are now presenting to the UCC, a clinician may be less concerned about that issue. It is also crucial that staff are familiar with GDPR obligations.  To perform better in these areas:

  • Review random care records to check they are adequate.
  • Make sure that clinicians record all observations clearly and specify the safety netting advice they offer.
  • Staff must document where patients are non-compliant and / or refuse a course of recommended action.
  • Encourage sharing between providers, sharing information with patients’ GPs.
  • Remind staff when they open patient records to scroll back and review all previous recent attendances at any organisation included on the system and to check medical history including medication and conditions of note.
  • Remind staff to ask patients if they have attended another provider or called another provider in respect of the concerns they are raising currently.
  • Report incidents to the National Reporting and Learning System (NRLS) and the Care Quality Commission (CQC) so that adequate lessons can be learnt.
  • Check that staff are trained on key GDPR requirements, while still sharing essential information.

9. Controlled Drugs

Systems must be in place for managing medicines, including controlled drugs and vaccines:

  • Adequate levels of the drugs are required.
  • Stocks of controlled drugs must be carefully monitored and secured with stringent policies in place for access thereof.

10. Red Flags

Awareness of ‘Red flag’ complaints can save lives and prevent expensive claims. Currently coronavirus is being prioritised over some other conditions. Ensure that staff remain vigilant and are particularly cautious of:

  • Patients presenting with shortness of breath, ‘coffee ground’ vomit, ‘tar-like faeces, very low or very high temperatures, children who are reported to be making ‘grunting noises’, patients who have not passed urine for 18 hours, non -blanching, mottled rashes, acute confusional state or relatives who describe patients as ‘simply not themselves’, recent chemotherapy.
  • Potential cardiac arrest. We have seen a number of instances where clinicians advise that driving a patient to hospital might be faster than an ambulance. Whilst this can of course be the case, it must be emphasised that ambulances possess all the relevant life- saving equipment and so personal transport should only be a measure of last resort – and documented as such.
  • Patients sometimes refuse ambulances. If the clinical view is that an ambulance is required, we would always recommend that it is dispatched in any event so that the clinician / Provider cannot be criticised after the event should something happen to the patient.
  • Sepsis ‘Red flags’, often missed by GPs and medical staff.
    • Often misidentified as the Flu due to the Flu like symptoms.
    • Sepsis often escalates quickly, making it essential that Sepsis is caught quickly and treated.
    • Often develops after surgery, so staff must always ask if the patient has recently undergone surgery.

We hope that these tips will go some way towards keeping patients safe and staff performing to the best of their ability at this critical time. We have numerous case studies of causes of claims and would be happy to offer training or advice in these areas. Please do not hesitate to contact Flora McCabe with any queries arising from this article or if you wish to arrange more support, an audit of records or assistance with dealing with SI investigations.

Similar articles

Covid-19 testing
Insight

COVID-19 testing in the business: proceed with care

As someone who has a spouse donning personal protective equipment (PPE) and working in an NHS ‘hot hub’ every day, testing has been a constant topic of discussion at home for the last ten weeks. Like me, I am sure you have been following the UK government’s attempts for 100,000, now 200,000 tests a day and have been buoyed by recent news indicating antibody tests are arriving and even vaccines might be just around the corner.

City of London
Insight

Protecting unoccupied property amidst COVID-19

Many of our real estate sector clients and their tenants will be following Government advice and have arranged for their employees to conduct business from home, rather than at their usual place of work. This is likely to become more widespread as time goes by, with a large number of premises becoming unoccupied or occupied intermittently.

FCA Test Case Update
Insight

FCA Test Case hearing concludes – key arguments and judgment details

The coronavirus pandemic has led to widespread disruption and business closures resulting in substantial financial loss. Many policyholders believe that their respective insurers wrongfully denied claims on their business interruption insurance over the cost caused by the COVID-19 outbreak.

Event Cancellation
Insight

Governments limit financial risk for event organisers in the pandemic

European governments are setting up Covid-19 cancellation funds to give organisers planning security for events due to take place in the second half of 2021.