| Now that we have Mandatory Disclosures of | | | | to the nursing office on every shift. Whenever |
| Medical Mistakes, Shouldn't We Require Disclosure | | | | such a situation exists, the patients and family |
| of Hospital Hazards? | | | | members are not being given full disclosure and |
| A number of states have already passed laws | | | | the hospital advertisement continues to give the |
| requiring hospitals to disclose medical and nursing | | | | impression that the hospital is fully capable of |
| errors to patients or their next of kin. The Joint | | | | delivering the highest possible quality of care. |
| Commission on Accreditation of Health Care | | | | Case in point: |
| Organizations has instituted the post incident | | | | The following is part of an advertisement on the |
| disclosure requirement as a standard of care in | | | | web site of a hospital in New York City |
| administrative policy. Although it is nice to see a | | | | "The _______ Hospital has identified a number |
| trend away from covering up medical blunders, | | | | of clinical areas for which the provision of |
| how does this help prevent them? What about | | | | cutting-edge care depends upon superb |
| disclosing conditions that are likely to cause injury | | | | coordination and the devotion of extraordinary |
| such as a severe nursing shortage on a particular | | | | institutional resources... Brings together the |
| unit? Are there no "truth-in-advertising" laws that | | | | specialized doctors, staff, technology and support |
| require full disclosure if the hospital administration | | | | structures that are needed for delivery of care |
| knows in advance that it cannot provide services | | | | that is second to none anywhere." |
| in accordance with its representations? | | | | This well known institution does provide |
| Notwithstanding the fact that a full staff is no | | | | state-of-the-art technology and when the units |
| guarantee against mistakes, an unsafe staffing | | | | are fully staffed they are usually well run. |
| level is the most visible indicator of general | | | | However, there have been many instances of |
| deterioration in the quality of care. The following is | | | | unsafe staffing levels in all of the critical areas, |
| a partial list of problems arising out of not having | | | | regular floors and the labor and delivery unit. |
| enough nurses on duty: | | | | Additionally, the hospital employs a staffing |
| Patient calls for assistance remain unanswered; | | | | coordinator who posts the staffing schedules two |
| Bedsores; | | | | months in advance. Therefore, when a severe |
| Medication errors; | | | | shortage exists for any shift the hospital |
| Injuries from falling; | | | | administration knew about it two months earlier. |
| Failure to follow physicians orders; | | | | Yet the advertisement makes the reader believe |
| Incompetent nursing care from lack of | | | | the best possible care is being provided and |
| supervision; | | | | consumers are unaware that there is a problem. |
| Failure to report changes in clinical condition; | | | | Since the quality of care as advertised can only |
| Narcotic overdose from patient controlled | | | | be upheld with a full compliment of nursing staff, |
| analgesia; | | | | severe shortages that were known in advance |
| Fetal hypoxia during childbirth. | | | | without disclosing the consequential increased risk |
| Hospitals have a standard number of staff | | | | of iatrogenic complications compromises the |
| required for each unit based on a full census. The | | | | patient's safety and robs him/her of the |
| actual numbers can be less when there are | | | | opportunity to avoid the injury. Furthermore, |
| empty beds (except for labor and delivery units). | | | | advertising extolling the high quality of care in the |
| However, there is a risk that the beds would fill | | | | face of such known staffing shortages is |
| up during a particular shift. For example, a | | | | tantamount to misrepresentation. |
| twelve-bed surgical intensive care unit usually | | | | Conclusion |
| requires at least six nurses (one nurse for two | | | | In a nutshell, if all hospitals were required to give |
| patients). Sometimes more are needed for | | | | full disclosure to the public of dangerous conditions |
| one-to-one nursing. If there are less patients at | | | | such as any units for which their nurses filed an |
| the beginning of the shift a fewer number of | | | | unsafe staffing report, the patient's family |
| nurses would obviously still be safe unless the | | | | members would have the opportunity to take |
| supervisor authorizes additional admissions without | | | | steps to protect their loved ones. Moreover, the |
| adding more nurses. In many hospitals where | | | | requirement for such disclosure would motivate |
| there are chronic shortages, having three to four | | | | hospital management personnel to correct existing |
| nurses in a full twelve-bed unit is common and the | | | | hospital hazards and prevent new ones. This |
| staff nurses are sending unsafe staffing reports | | | | would indeed be an "intervention for prevention". |