Family Notification in Seven Quick and Easy Steps

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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.

Laura Greenwald, CEO/The Next of Kin Education Project The Seven Steps Information Kit can be downloaded free of charge at The Reminder Products can be purchased at our NOKEP store

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