HAZARD: Notes and Documents are not alerted or acted upon by clinicians

[pacharanero]

Description

It is important that patients are made aware that information entered in the Notes and Documents section will not routinely be reviewed by the clinicians looking after their care. It is sadly somewhat common in system for patients to have an expectation that the clinicians providing care have the capability and resource to review every change made to connected health systems like Apps.

This is not the case, but it is important that patients are left in no doubt as to the reality of this. Harm could occur if a patient was expecting a medical intervention to result from reporting some information solely through the Notes or Documents feature.

Cause

The patient saves a Note or a Document containing what they believe is crucial information, and which might have genuinely important consequences.

Effect

The patient believes this will result in an intervention 'automatically' occurring, in the absence of formally seeking medical attention.

Hazard

The medical attention does not arrive, and the patient is either disappointed in the service, resulting possibly in a complaint (least risky scenario) or the patient suffers harm because of the problem they reported only through the Notes or Documents upload.

Harm

Examples would be:

• The patient uploads a document with private health check blood tests to the Documents section, and does not in any other way alert the clinicians to the presence of this document. Later they are annoyed that nobody has read and reviewed the blood tests and the make a complaint

• The patient expresses a wish to self-harm in the Notes section, believing that this will result in a call from 'someone' who is monitoring the records 24/7. The call doesn't come and the patient proceed to self-harm, resulting in later emergency medical treatment being required.

• The patient reports severe central chest pain and shortness of breath in the Notes section, believing that the notes are monitored or will alert someone. The patient waits several hours before calling an ambulance, by which time it is too late to attempt some of the standard treatments for their heart attack, resulting in a worse outcome.

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Assignment: Assign this Hazard to its Owner. Default owner is the Clinical Safety Officer @pacharanero Labelling: Add labels according to Severity. Likelihood and Risk Level Project: Add to the Project 'Clinical Risk Management'

• Subsequent discussion can be used to mitigate the Hazard, reducing the likelihood (or less commonly reducing the severity) of the Harm.
• If Harm is reduced then you can change the labels to reflect this and reclassify the Risk Score.
• Issues can be linked to: Issues describing specific software changes, Pull Requests or Commits fixing Issues, external links, and much more supporting documentation. Aim for a comprehensive, well-evidenced, public and open discussion on risk and safety.

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[pacharanero]

Hazard Review

This hazard could, in the worst imagined scenario, result in avoidable death(s). It is therefore mandatory to mitigate the hazard.

Mitigation

This scenario is common to a wide range of new and old modalities of asynchronous communication - from telephone answering machines to fax machines to email to apps. It is by no means a new problem in healthcare and sadly harm does occasionally occur.

The only mitigation open to any of these systems is to try to ensure that patients are aware that the messages are not monitored. In the case of the Albert app this is relatively easy (compared to eg email or fax) because we can prominently display a reminder in the Notes and Documents sections that says something like:

"Notes and Documents are for your own reference and are not routinely reviewed or monitored by clinical staff. If you believe you need medical attention you must seek medical attention via NHS 111 or your GP, or in the case of a genuine emergency, dial 999"