The Art of Skillful Disclosure

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Much attention has been given to the topic of patient safety since the landmark report by the Institute of Medicine.1 Patient safety is the prevention of patient harm and freedom from accidental injury in the healthcare setting.2 The neonatal intensive care unit is a highly complex, stressful, and technological environment that places patients, families, and providers at risk for medical errors (MEs) that can cause patient harm and result in adverse events (AEs). Both ME and AE are often used interchangeably, but there are distinct differences. An ME is an act of commission (doing something wrong) or omission (failure to do the right thing) that unreasonably increases risk of an undesirable patient outcome. An AE is classified as preventable (when patient harm is related to an ME) or nonpreventable (when patient harm occurs in the absence of an ME). Therefore, an ME that causes patient harm is a preventable AE.1,3 While AEs may have a devastating impact on patients and families, healthcare providers are also at risk for experiencing traumatic emotional consequences. Although most MEs are attributable to system flaws rather than individual performance, AEs must be identified and studied to understand root causes and systematically implement safety improvements. Full disclosure of an AE is critical and may be beneficial for both patients, families, and providers.3 However, knowing who, what, how, when, and where to disclose (skillful disclosure) is often not part of medical or nursing education. Understanding disclosure, its historical context within healthcare, and the importance of full and open communication should be part of every neonatal provider's education/training plan.
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