Family Notification in Seven Quick and Easy Steps

[Guest guest]

The Seven Steps to Successful Notification is an easy-to-use system based on

time-tested tools successfully used by hospitals nationwide. It provides your

hospital staff with all of the steps necessary to:

? Identify and locate your unconscious patient’s next of kin or surrogate

decision maker.

 

? Improve patient care by locating your patient’s medical history, personal

physician, and insurance information.

? Provide the facility with a documentation of the steps taken to find the

patient’s next of kin, to make the notification, and identify the staff members

responsible for making it, thereby releasing you from subsequent liability.

? In states with Next of Kin Statutes, provides proof that the facility has

met its statutory responsibility.

Let’s see the seven steps in action, through the eyes of the nurse manager of

Care Central’s Trauma Unit, Carolee Cummins.

Carolee comes on duty this morning just as a hit and run is pulling up at the

emergency bay. She meets the gurney and runs along side, paying rapt attention

to the paramedic’s bullet, while she and her staff do their own evaluation. The

paramedic’s last comment stops her cold. This pretty thirtysomething, woman who

is in grave danger of bleeding out, has no identification with her. Carolee

starts a John Doe chart for her patient and turns her attention back to the

trauma.

1) Patient Status Confirmed

When a patient like this comes in, Carolee is glad that she and her team use

the Seven Steps System. She looks down at her chart page and begins the

notification process right in the trauma room, by answering the first question.

Is the patient unconscious or physically unable to give informed consent? Had

her patient been alert and oriented, she would simply have checked the box

marked no, skipped the notification section on the chart and proceeded as usual.

After the team confirms that the patient is unresponsive to everything but deep

pain, Carolee checks “yes” and asks one of the aides to check the waiting room

to see if any family members came in with their patient. “No”, the aide

confirms, “she came in alone”. And so the notification and documentation

procedure begins.

2) Examine Personal Effects For Emergency Contact Numbers When Care Central

began to use the Seven Steps, they appointed the nurse manager on duty, as the

point person for NOK notifications. So as point person, Carolee begins to look

for the young woman’s emergency contact numbers or clues to those numbers, by

examining her personal effects. Most of the time, Carolee finds the emergency

information quite easily, right in her patient’s wallet, on a driver’s license,

emergency contact cards, insurance cards or personal phone books. When she finds

what she’s looking for, Carolee documents on the chart that the contact has been

found, and skips down to Step 5.

In this case her search only takes a moment - the only thing the woman had

with her were her house keys. If she had a wallet or a purse, it was destroyed

in the accident. Carolee goes through the pockets of her patient’s jogging

shorts and finds one small clue to her identity - a few message blanks from work

that she must have stuffed in her pocket to take care of later. They’re all made

out to Katherine McCauley. Progress.

If Step 2 had turned up nothing and her patient had still been a Jane Doe,

Carolee would have skipped down to Step 7, involving Social Service in her

search. But since Carolee’s patient now has a name, she goes directly to Step 3.

3) Retrieve Patient’s Home Number

Now she’ll have to get a bit more creative. As Katherine found out the hard

way, life can present major challenges for patients, not to mention an emergency

department staff. A quick run to the store without taking your ID, interrupted

by a sudden heart attack, can put even the most conscientious person into

jeopardy. In upcoming sections of this Kit, you’ll find details on traditional

and untraditional ways of find that contact information quickly and easily. But

for now Carolee, goes through her mental checklist of ways she’s found contact

information in the past: checking the speed dial of a patient’s cell phone for

numbers labeled “home” or “work”; the contact pages of a Filofax, or the address

book of a PDA. Even a briefcase can contain a patient’s business card, or a

company letterhead on documents.

If Carolee had found a home number or an emergency contact on any of these

items, she would have gone right to Step 5. Since Katherine has none of these

things with her, Carolee documents that fact and proceeds to Step 4.

4) Seek Other Sources For Contact Information

Carolee almost never gets to this section, but when she does, she knows it’s

time to crank her investigative skills into high gear! Since she knows her

patient’s name, her next step will take her to the hospital’s medical records

department.

Chances are, if Katherine lives in the area, this probably isn’t her first

visit to Care Central. Even if the old records don’t include the patient’s next

of kin or surrogate decision maker, Carolee will be able to get it, by phoning

Katherine’s home number, physician or insurer.

If Carolee still hadn’t been able to find information on her patient, she

would have gone directly to Step 7 and turned the investigation over to Social

Service or to the police (depending on her facility’s policy).

But Carolee quickly locates Katherine’s name on a year old chart, when she was

admitted for the birth of her son. Success! Now on to Step 5.

5) Oversee Or Make The Notification Call

Normally, Carolee would turn the actual notification phone call over to one of

her RNs. But she’s so invested in Katherine at this point, that she places the

notification call to Katherine’s home herself.

Since her first priority is notifying the patient’s next of kin or surrogate

decision maker, her aim is to get a hold of the right person as soon as

possible. She is disappointed to hear the answering machine pick up. Carolee

hates doing a notification this way. She leaves a message for Katherine’s

husband, hoping that he’ll pick it up quickly. Many times the only person

Carolee has been able to reach is a relative or friend, so she is always careful

to document the name and relationship of any person she talks to. Occasionally

the only information she finds is the patient’s family physician or insurance

company.

In that case she makes sure they know that she needs to speak with the family

ASAP and then follows up within an hour or so. Carolee has learned the hard way,

never to assume that a third party is going to take care of a notification.

Since Care Central is the facility treating the patient and is the one in need

of medical history to give Katherine the best care possible, it’s Care Central’s

responsibility to make sure the notification takes place.

Even though Care Central’s responsibility is technically met the moment

Carolee left the message for Katherine’s husband, she feels that it’s a good

practice to follow up with another phone call if Katherine’s husband doesn’t

arrive or return the hospital’s phone call within the next two hours. She

documents the results, initials that the section is complete and notes the time

that the call occurred.

The entire process has taken Carolee less than ten minutes, and by using Care

Central’s special chart page, Carolee’s hospital now has a documented account of

her efforts. If her patient or her patient’s family were ever to question that

notification was attempted, the hospital will be able to prove that their

regulations were properly followed.

6) Need To Follow Up? Recall Main Contact Or Second Number

Answering machines and voice mail are wonderful and no one can imagine life

without them - unless it’s an emergency and you can’t get a hold of the person

you need to speak with!

Two hours later, the husband still hasn’t arrived and Katherine’s condition is

worsening. Doctors are wondering if she has an undetermined, underlying

condition that is keeping her BP from stabilizing despite their efforts. Carolee

quickly proceeds to Step 6. Carolee found Katherine’s work number on the old

chart, but before she tries it, she redials the home number. A breathless Scott

answers. Only minutes before, he’d forgotten an important brief and ran back

home to get it, allowing him to pick up Carolee’s message. A short while later,

he arrives at the hospital and fills the trauma team in on his wife’s medical

history. Changes in her treatment are immediately made and hours later,

Katherine, now alert and stable, is on her way to a full recovery.

Had Carolee not been able to reach anyone at Katherine’s home, she would have

called the second number, then documented the results on the chart, with the

time and her initials. If she still hadn’t been able to reach anyone in person

or if the relative hadn’t shown up at the facility, she would have noted that on

the chart and proceeded to Step 7.

7) Shift To Social Service Or Police Every once in a while, despite Carolee’s

best efforts, she has to shift her notification efforts to social service. Even

so, she has met the hospital’s legal responsibility by making reasonable efforts

to notify her patient’s next of kin.

The bad news is that her patient still needs intervention. By shifting the

notification process over to her social service department or to the police,

Carolee is confident that everything possible will be done to find her patient’s

family. In upcoming sections, you’ll find tips and tools to help you deal with

identifying Jane/John Does and handling the effort quickly and easily.

For a free copy of the complete Seven Steps to Successful Notification System,

in PDF download format, visit the Next of Kin Education Project web site. A

sample version of the form is also available on our web site, along with forms

you can purchase to use in your own facility. Along with the Information Kit,

we’ve created patient chart pages and notification worksheets using the Seven

Steps, that you can purchase and customize to use as part of your own charting

system. You’ll find them on the NOKEP web site along with reminder products like

mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff’s

fingertips.

 

 

 

No need to miss a message. Get email on-the-go

with Mail for Mobile. Get started.