Lessons Learned

“Other” conditions in database

November 2013

If you have run an Event Type summary report in our ECRI database, you have noticed that the largest category by volume is “Other” for the CHPSO aggregate. As we have been reviewing events classified as “other” we have noticed some common themes: non-team promoting behavior (physician), poor coordination of care, and delay in care related to insufficient staffing. Over the next few months, we will look closer at each of these issues.

Disruptive and non-team promoting behavior

Here are a couple of examples of the types of reports we are receiving about behavior that is disruptive for the health care team, as well as for the patient.

  • A physician attempted unsuccessfully 9 times to place a nasogastric tube. He refused assistance from nursing staff. The patient experienced a vagal response and a code blue was activated.
  • During rounds a pharmacist asked if the patient should be on GI prophylaxis because he had a nasogastric tube in place and had recent abdominal surgery. The physician’s response was to draw up his fingers like a gun and “shoot” the pharmacist for asking the question.

Suggested strategies to address this problem

In 2008, the Joint Commission identified disruptive behavior as a problem and issued the Sentinel Event Alert “Behaviors that undermine a culture of safety”. The following year, they added a new Leadership standard for all accreditation programs that addressed disruptive and inappropriate behaviors in two of its elements of performance (EP):

  • EP 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors
  • EP 5: Leaders create and implement a process for managing disruptive and inappropriate behaviors.

In addition, six core competencies are to be addressed in the credentialing process under the Medical Staff chapter, including interpersonal skills and professionalism.

Additional suggested actions

  • Educate all team members –both physician and non-physician- on appropriate professional behavior defined by the organization’s code of conduct. The code and education should emphasize respect and include training on basic business etiquette (particularly phone skills) and people skills.
  • Hold all team members accountable for modeling desirable behaviors, and enforce the code consistently and equitably among all staff –regardless of seniority or clinical discipline– in a positive fashion through reinforcement as well as punishment.
  • Make use of mediators and conflict coaches when professional dispute resolution skills are needed

Determine what steps your organization has taken to implement these Joint Commission recommendations and whether or not they are reinforced when addressing disruptive and inappropriate behavior.

References:

Gessler R, Rosenstein A, Ferron L. How to Handle Disruptive Physician Behaviors. Am Nurse Today. 2012;7(11):8-12.
Sentinel Event Alert, Issue 40: Behaviors that undermine a culture of safety. July 9, 2008. Available at http://www.jointcommission.org/sentinel_event_alert_issue_40_behaviors_that_undermine_a_culture_of_safety/

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