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Honesty Is the Best Policy

Why we have to tell the truth, even if we'd prefer not to

Healthcare Professional Digest speaks with Peggy Pressley, RN

As a boy, George Washington chopped down one of his father's cherry trees. When his father asked if he'd done it, young George replied, "I cannot tell a lie. I chopped down the cherry tree.”

Even before Abraham Lincoln was president of the United States, he'd begun to earn the moniker Honest Abe. As a young man, he walked several miles back to a store to return the extra few cents he was given in change.

The stories are well-known. And although the authenticity of them may be called into question, the moral of these stories isn't -- you have to be honest, no matter what. For healthcare providers, this is especially true. Mistakes can have serious repercussions for patients as well as employers. And being up front -- immediately -- about what has happened is imperative.

Recently, Healthcare Professional Digest spoke with Peggy Pressley, RN, about the value of reporting mistakes promptly. Here's what she had to say.

Healthcare Professional Digest: What kind of mistakes are healthcare providers likely to make?

Peggy Pressley: A medication error, whether it's an incorrect dose or incorrect medication given, frequently occurs and needs immediate correction. Other errors include allowing a patient to fall or anything that involves accidental harm to a client. Behaving in a hostile manner and being verbally abusive are lapses in judgment that also need to be addressed.

HPD: What should healthcare providers do if they make one of these mistakes?

Pressley: The first thing they should do is "fess up.” If they're working in a facility, they should let the charge nurse or supervisor know what happened. The charge nurse or supervisor will notify the physician. An Interim employee should notify his or her Interim office immediately.

In cases where a medical error has occurred in a facility, they should also fill out a variance report. For home care, the provider must complete an occurrence report if a medical error, a fall or other type of incident takes place. An occurrence is defined as any act or omission in the furnishing of care or service not consistent with routine care that results in or has reasonable potential to result in an adverse outcome to a patient or client.

HPD: Are they also required to notify the patient's family if this is a home care situation?

Pressley: Healthcare providers aren't required to talk to the family, since the Interim supervisor will contact them. But since the family is sometimes present, or at least in the home, when an incident occurs, healthcare providers may want to explain to them what happened and then say that they will be reporting the occurrence to their supervisor, which they should do within 24 hours.

HPD: Why is this timing important?

Pressley: Many clients do not receive 24-hour care, and it would be difficult to establish a timeline of incident and responsibility if every occurrence is not reported. Therefore, witnessed and unwitnessed incidents need to be reported. Of course, it's also important to report an incident soon after it occurs because a medical error can harm the patient. There are legal issues and HIPAA regulations to consider as well.

HPD: What if a mistake threatens the healthcare providers' jobs and/or licensure?

Pressley: When in the field, healthcare providers need to know the policies and procedures for occurrences. They should be encouraged to report an incident and to be truthful. We hate to see human errors in healthcare, but it's better to report what has happened than to hold it in and have someone find out about unreported incidents.

HPD: What if healthcare providers see someone else making a mistake? What should they do?

Pressley: If they can stop the mistake before it happens, they should. Make sure to take the employee to the side to discuss better options of how to do the task or procedure. Then, go to your director or supervisor and explain you've seen something you're concerned about.

HPD: This is a little off topic, but if clients or their families ask providers about potential outcomes, and the outlook isn't good, should they tell them the truth? 

Pressley: It depends on what the physician has told the family. If I'm unsure, I redirect them to the physician for follow-up; otherwise, I try to follow what the physician has said. I will be as honest as I can be, but the patient/physician relationship needs to be maintained for the benefit of the patient.

Peggy Pressley, RN, has been the Interim Home Care supervisor with Interim HealthCare's Asheville, NC, office since September 2009. Prior to joining Interim, she was a nursing supervisor for 15 years with a Medicare home health agency and also worked in long-term care and hospital settings. She earned her associate degree in nursing at Asheville Buncombe Technical College and has been a member of the nursing profession for 30 years.

Peggy Pressley, R.N.
Interim Home Care Supervisor
tel: 828-274-2082
ppressley@interimhealthcare.com