Reviewed date: Jan 2025 EJ
Review date: Jan 2026
Amendments:
Introduction:
The effects of harming a guest can have devastating emotional and physical consequences for the guest themselves, their families and carers. It can also be very distressing for the employees or volunteers involved. Being open and honest about what happened and discussing the incident fully and openly can help all of those involved cope better with the consequences of harm, whether potential or actual. In addition, being open and candid when things go wrong ensures that any investigation can get to the root cause of the event and leads to learning for the organisation. The Duty of Candour is a contractual requirement for all bodies delivering patient care.
Scope:
The Duty of Candour is a legal duty to be open and honest with guests/service users, or their families when something goes wrong that appears to have caused or could lead to significant harm in the future.
This policy applies to ALL staff and volunteers with in Leuchie House. This policy will always apply in the event that a guest is admitted to hospital whilst under the care of Leuchie House.
Definitions –
| Openness | enabling concerns and complaints to be raised freely without fear and any questions asked to be answered |
| Transparency | allowing information about the truth about performance and outcomes to be shared with staff, patients, the public and regulators |
| Candour | any patient harmed by the provision of a healthcare service is informed of the fact and an appropriate remedy offered, regardless of whether a complaint has been made or a question asked about it |
| Notifiable safety incident | any unintended or unexpected incident that occurred in respect of a guest during the provision of a regulated activity that, in the reasonable opinion of a health care professional, could result in, or appears to have resulted in: a) the death of the service user, where the death relates directly to the incident rather than to the natural course of a service user’s illness or underlying condition; or b) severe harm, moderate harm or prolonged psychological harm to the guest |
| Moderate harm | harm that requires a moderate increase in treatment, and significant, but not permanent, harm. E.g. an unplanned return to surgery, an unplanned readmission, a prolonged episode of care, extra time in hospital or as an outpatient, cancelling of treatment, or transfer to another treatment area |
| Severe harm | a permanent lessening of bodily, sensory, motor, physiologic or intellectual functions, including removal of the wrong limb or organ or brain damage, that is related directly to the incident and not related to the natural course of the service user’s illness or underlying condition. |
| Prolonged psychological harm | psychological harm which a guest has experienced, or is likely to experience, for a continuous period of at least 28 days |
| Relevant Person | usually the guest who has been harmed or affected; if the guest has died, or is deemed to lack capacity, the relevant person is their next of kin |
This policy aims to ensure that:
∙ the guests right to openness from Leuchie House is clearly understood by all staff;
∙ this right is integrated into the everyday business of Leuchie House;
∙ Leuchie House learns from mistakes with full transparency and openness;
∙ Guests and their families and carers can trust Leuchie House to share information with them in an open and collaborative way;
∙ Leuchie House staff ensure appropriate support is offered to the guest, their family/carers and colleagues.
Notification
The duty of candour legislation states that the relevant person should be notified as soon as reasonably practicable but it should be considered good practice to notify the relevant person within 10 working days of the procedure start date.
This notification can be by various methods including telephone, face to face or by letter. It is important to remember that where a duty of candour procedure start date is more than a month after the incident, the organisation must provide the relevant person with an explanation of why this is.
The meeting to notify the relevant person of the incident should be with the relevant manager or an appropriate person should be nominated to undertake this role.
The Meeting –
All facts as known at the date of the meeting must be provided truthfully
Manage the expectations of the relevant person by explaining how the incident is being investigated and when the investigation will be completed and its conclusions available
If possible, agree with the relevant person what further enquiries into the incident are appropriate
Provide an appropriate apology. The meeting must be documented and the relevant person offered a copy of the documentation. Appropriate support should be provided to the relevant person. This might include, for example, emotional support, providing access to any necessary treatment, or signposting to advocacy and support services.
Explain to the relevant person that new information may emerge during the course of an investigation and that they will be informed of this. Agree the most appropriate method for doing this and provide them with all reasonable opportunities to be involved in the progression of any investigation. Advise the relevant person who to contact during the course of the investigation should they require further information and how to do this.
Advise the relevant person of the timeframe for completing an investigation (within 28 days of the event). The relevant person should be provided with a copy of the investigation report within 10 working days of the investigation being closed and signed off.
Apology
In addition to any apology provided at the time of the incident, as part of the duty of candour procedure the organisation must offer the relevant person a written apology (this can be by electronic communication if that is the relevant person’s preferred means of communication) in respect of the incident. The organisation must provide a written apology if the relevant person wishes it.
The written apology should be personal and be provided at an appropriate time during the duty of candour procedure, taking account of the facts and circumstances in relation to the particular incident.
This should take account of the circumstances relating to the relevant person and, wherever possible, the known personal meaning or impact of the unexpected or unintended incident.
There may still be misconceptions and misunderstanding that the provision of an apology equates to an admission of liability and that organisations should never offer apologies for this reason – but that is not correct.
Section 23(1) of the Act states that “an ‘apology’ means a statement of sorrow or regret in respect of the unintended or unexpected incident.” The Act sets out that ‘an apology’ or other step taken in accordance with the duty of candour procedure does not of itself amount to an admission of negligence or a breach of a statutory duty.”
Monitoring and review – To ensure that Leuchie House learns from incidents covered by this policy and uses them to identify and implement improvements, the following will happen: –
A log of all Duty of Candour incidents will be kept and the relevant departmental manager will record all learning outcomes as part of the documentation of the incident.
The Operations team will review the log on a monthly basis to ensure all relevant actions have been taken and any required improvements embedded.
The Leuchie House Board will receive quarterly reports highlighting all incidents.
Examples of notifiable safety incidents
(taken from CQC Duty of Candour Guidance – Adult Social Care section)
Example 1.
An OT completed an assessment with a care home resident whose mobility was deteriorating. The OT advised that grab rails were needed in the person’s bathroom before it was safe for them to use the bath and that in the meantime staff should assist the person to have a strip wash each morning. The manager failed to update the person’s care plan or inform the care staff of this change, so staff supported the person to take a bath the following morning as usual. The person slipped when getting out of the bath and sustained a broken arm. The arm was put in a plaster cast and the person needed full assistance for all aspects of their care for 6 weeks until the cast was removed. The person made a full recovery.
This would be an example of an incident leading to a service user requiring further treatment to prevent the service user experiencing prolonged pain.
Example 2.
A new member of staff on induction was shadowing another care worker delivering care to a person who needed to be hoisted. Two trained members of staff were required to operate the hoist safely and the new member of staff had not yet been trained in moving and handling. The new care workers were asked to assist with the manoeuvre and did not attach one of the loops of the sling to the hoist properly. As a result, during the manoeuvre, the person slid out of the sling and onto the floor. The person sustained a broken hip requiring surgery.
This would be an example of an incident leading to a service user experiencing changes to the structure to the body.
Example 3.
A person with a learning disability was prescribed antipsychotic medicines. They were assessed as needing full staff support in the management of their medicines. Over a period of two weeks they became increasingly anxious and distressed. When the person’s medicines were checked it was discovered that their antipsychotic medicines had not been ordered the previous month and did not show on the MAR chart. This was because the correct procedure for ordering and the checking in of medicines had not been followed and the error had gone unnoticed for 18 days. This resulted in a prolonged deterioration in the person’s mental health for more than 28 days.
This would be an example of an incident leading to prolonged psychological harm.
Created Feb 2020 EJ