ONLY RESPONSE NEEDED X2 -LISTED TO DIFFERENT PEERS
Initial Response-
Instructions:
When developing new clinical interventions or practice changes, a systems approach can help maintain a culture of safety and minimize liability. For this discussion, answer the following question prompts:
- Outline the potential risks associated with the one of the proposed practice changes examined in your Unit 3 Gap Analysis.
- When harm does occur, what is your organization's/system's policy on disclosure?
- Locate and discuss your state's apology law and provide an overview of what it encompasses.
- Are there formal policies within your organization/system about what to do when harm occurs? Are these aligned with your state's apology law?
Please be sure to validate your opinions and ideas with citations and references in APA format.
Your initial response is due by Wednesday at 11:59 pm CT.
Estimated time to complete: 2 – 4 hours
Peer Response
Instructions:
Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:
- Compare and contrast your initial posting with those of your peers.
- How are they similar or how are they different?
- What information can you add that would help support the responses of your peers?
- Ask your peers a question for clarification about their post.
- What most interests you about their responses?
Please be sure to validate your opinions and ideas with citations and references in APA format.
All peer responses are due by Sunday at 11:59 pm CT.
Estimated time to complete: 1 hour
Reply from Zemen Aberra
Zemen Aberra
Herzing University
Professionalism and Leadership for Advanced Practice (NU726-7K)
Dr. Sandra Chen-Walta
Maintaining a Culture of Safety Discussion
Prolonged antibiotic delivery in patients with suspected sepsis has a considerable impact on patient outcomes, making it a serious safety issue. One recommended practice improvement from my Unit 3 Gap Analysis is the use of Electronic Health Record (EHR)-based sepsis notifications to encourage early detection and treatment. While this strategy has the potential to significantly reduce delays, it is not without risk.
Possible Risks of Recommended Practice Changes
Incorporating EHR-based sepsis alerts carries concerns such as alert fatigue, which occurs when clinicians start disregarding or overriding alerts due to frequent or nonspecific warnings (Hwang et al., 2020). Furthermore, if the alarm system fails to detect early sepsis or produces false positives, it may result in unnecessary antibiotic administration, elevated resistance, or missed intervention opportunities. Integration challenges and reliance on EHR data accuracy may further restrict the tool's effectiveness, potentially harming patients if key clinical indicators are missed (Shappell & Rhee, 2020).
Disclosure Policies in My Organization
When harm occurs, Dignity Health – Sacramento adheres to the CommonSpirit Health system-wide Disclosure of Unanticipated Outcomes policy. When unexpected complications occur, this policy promotes timely, empathetic, and honest communication with patients and their loved ones. The organization advocates for complete disclosure, which is consistent with Just Culture values, and provides openness while supporting healthcare professionals involved in the event (CommonSpirit Health, 2024).
California's Apology Law Overview
California's apology legislation is detailed in California Evidence Code Section 1160, which states that any expression of compassion, empathy, or general generosity offered by a medical professional to a patient or family is inadmissible as proof in a civil lawsuit. However, declarations admitting mistakes or negligence may still be admissible (California Code, EVID 1160, n.d.). This statute enables healthcare workers to express compassion without fear of legal repercussions, but warns against expressing direct admissions of fault.
Alignment of Organizational Policies and State Law
Dignity Health's disclosure procedures are consistent with California's apology law, enabling healthcare professionals to provide patients with empathic communication and support following unfortunate occurrences without expressly admitting fault (California Code, EVID 1160, n.d.). Training in efficient communication throughout disclosures ensures that providers adhere to legal and ethical limitations while preserving confidence with patients and families. These policies demonstrate a dedication to a safety environment that balances transparency and legal safeguards (Kwame & Petrucka, 2021).
References:
California Code, EVID 1160. (n.d.). Division 9. Evidence affected or excluded by extrinsic policies [1100 – 1162] https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=1160&lawCode=EVID
CommonSpirit Health. (2024). Commonspirit health Governance policy addendum [Report]. https://www.dignityhealth.org/content/dam/dignity-health/documents/california-december-2024/CA-Addendum.pdf
Hwang, M., Bond, W., & Powell, E. (2020). Sepsis alerts in Emergency Departments: A Systematic review of accuracy and quality measure impact. Western Journal of Emergency Medicine, 21(5). https://pmc.ncbi.nlm.nih.gov/articles/PMC7514413/Links to an external site.
Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nursing, 20(1). https://pmc.ncbi.nlm.nih.gov/articles/PMC8414690/
Shappell, C. N., & Rhee, C. (2020). Leveraging electronic health record data to improve sepsis surveillance. BMJ Quality & Safety, 29(9), 706–710. https://pmc.ncbi.nlm.nih.gov/articles/PMC9011359/
Natalie ScriboniMay 28 8:32pmManage Discussion by Natalie Scriboni
Reply from Natalie Scriboni
NU 726: Unit 4 Discussion Examination of Policies and Regulations – Maintaining a Culture of Safety – Natalie Scriboni
One of the proposed changes from my Unit 3 Gap Analysis involves ensuring consistent reassessment and documentation of pain after interventions, including both pharmacologic and nonpharmacologic approaches. This change addresses a critical gap in practice, as pain is often reassessed verbally but not consistently charted. Failure to document pain reassessment poses several risks. The most vital risk is inadequate pain management (Dach et al., 2024). Risks also include missed signs of complications, communication issues, and incomplete charting (Dach et al., 2024). The literature emphasizes the importance of documenting reassessments to support continuity of care and reduce harm (Samara et al., 2024; Rowe & Best, 2024).
When harm does occur at my organization, MedStar Union Memorial Hospital (MUMH) follows a formal Sentinel Event Policy that reflects a systems-based approach. The policy mandates immediate notification of the supervisor and Risk Management (Medstar Union Memorial, 2023). Then, a thorough analysis of the event occurs, and the Patient Communication Consult Service (PCCS) is notified. The PCCS helps to support and inform patients and their families (Medstar Union Memorial Hospital, 2023). This structured process ensures transparency while supporting staff.
Maryland’s apology law allows healthcare providers to express sympathy, compassion, or apology without these words to be used as an admission of guilt in court (Thomson Reuters Westlaw, 2025). However, if a provider admits fault, such as saying they made a mistake, that statement can be used in legal court (Thomson Reuters Westlaw, 2025). The law helps to encourage emotional support and communication for patients and providers.
In addition, MUMH has formal procedures in place when harm occurs, including disclosure processes and a system-wide promise for safety through risk management (Medstar Union Memorial, 2025). The Risk Assessment Plan is a key part of the organization that helps identify and resolve potential hazards. This procedure is aligned with Maryland’s apology law as it reduces the likelihood of harm and ensures staff are prepared to communicate compassionately.
References
Dach, A., Anderson, R., & Borandi, J. A. (2024). An Integrative, Non-Pharmacological Pain Management Approach In Severe Lumbar Spine Degeneration: A Case Report. Integrative Medicine: A Clinician’s Journal, 23(6), 14–20.
MedStar Union Memorial. (2025). Environment of care: Risk assessment [Internal hospital policy document]
MedStar Union Memorial Hospital. (2023). Sentinel event policy: MedStar Union Memorial Hospital and MedStar Samaritan Hospital. [Internal hospital policy document].
Rowe, S., & Best, K. M. (2024). Individualized numeric rating scale to assess pain in critically ill children with neurodevelopmental disabilities. American Journal of Critical Care, 33(4), 280–288. https://doi.org/10.4037/ajcc2024343Links to an external site.
Samara, H., O’Hara, L., & Singh, K. (2024). Nurses' knowledge and attitudes about adult post-operative pain assessment and management: Cross sectional study in Qatar. Nursing Reports, 14(3), 2061–2071. https://doi.org/10.3390/nursrep14030153Links to an external site.
Thomson Reuters Westlaw. (2025). Maryland code and court rules: Apologies or expressions of regret by health care providers. https://govt.westlaw.com/mdc/Document/Links to an external site.N744BF500A64911 DBB5DDAC3692B918BCviewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)