At its last meeting, the CPSS Council approved a new policy, “Disclosure of Adverse Incidents”. The policy replaces the former policy, “Disclosure of Adverse Events”, and differs significantly from the previous policy. The policy was circulated for stakeholder consultation and many of the suggestions were incorporated into the new policy.
As set out on the CPSS website, policies “contain requirements set by the Council to supplement the Act and Bylaws. Policies are formal positions of the College in relation to defined areas of practice with which members must comply.”
The new policy confirms that all adverse incidents, including those that cause harm, have the potential for future harm, and some near misses must be disclosed to patients. Physicians have a legal duty to disclose errors made in the course of medical treatment.
A full and sincere apology may contribute to a successful disclosure discussion and, in Saskatchewan, legislation states that an apology does not constitute an express or implied admission of fault or liability and must not be taken into account in any determination of fault or liability.
The policy defines incidents which must be disclosed as follows:
Harmful incident: an incident that has resulted in harm to the patient (also known as an “adverse event”).
No-harm incident: an incident with the potential for harm that reached the patient, but no discernible or clinically apparent harm has resulted.
Near miss incident: an incident with the potential for harm that did not reach the patient due to timely intervention or good fortune (also known as a “close call”).
Physicians must ensure that both harmful and no-harm incidents are always disclosed. Physicians must consider whether to disclose near miss incidents, taking into account whether:
- a. the patient is aware of the incident and an explanation will reduce concern and promote trust;
- b. the patient should be educated to monitor for future similar incidents; and
- c. a reasonable person in the patient’s position would want to know about the incident.
The policy contains further guidance regarding to whom to disclose, when to disclose, what to disclose, who must disclose, post-graduate trainees, documentation, and subsequent physicians. The policy also contains examples of harmful incidents, no-harm incidents, and near misses and includes links to a number of educational resources for physicians.
If physicians have questions about the application of this new policy, please contact the Registrar’s Office for assistance.