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Candour guidance: Be candid when things have gone wrong

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16. The professional duty of candour applies when you become aware that something has gone wrong and a patient in your care has suffered physical or psychological harm or distress, or there might be implications for their future care. This might include minor incidents that cause temporary distress (for example, use of incorrect eye drops which might cause an undesired effect such as blurred vision) or more serious incidents (for example, failure to detect signs of disease or abnormality).

17. Being open and honest means you must inform the patient about what has gone wrong. This will usually mean speaking to the patient as soon as possible after you realise something has gone wrong with their care.

18. You do not need to wait until the outcome of an investigation before speaking to a patient.  The patient must be told:

that something has gone wrong;

what happened;

the likely short and long term effects;

what can be done to put matters right; and

what can be done to avoid recurrence and improve patient care.

19. You must also offer an apology. Saying sorry does not mean admitting liability or wrongdoing but it is important to patients that you express regret for any harm, distress or adverse consequences to their health and wellbeing.

20. Offering an apology is an important part of being candid as it shows that you recognise the impact of the situation on the patient and that you empathise with them.

21. Patients may find it more meaningful if you personally apologise for something going wrong. 

22. When speaking to a patient you should consider the following:

a. You must share information in a way that the patient can understand.

b. You should give information that the patient may find distressing in a considerate way, for example, asking them if they would like to have someone with them.

c. You should respect your patient’s right to privacy and dignity, making sure that conversations take place in appropriate settings where possible.

d. If there is an on-going investigation you should be clear that the facts have not yet been established. Tell them only what you know and believe to be true, and answer any questions honestly and as fully as you can. 

e. You should make sure the patient knows whom to contact to ask any further questions or raise concerns.

f. You should record the details of your apology in the patient’s clinical record. In certain circumstances, a verbal apology may need to be followed up by a written apology.

23. If you are unable to apologise to the patient, or those close to them, with the required care and compassion, you must:

a. make sure that an appropriate person takes on the responsibility to talk to the patient. This could be within your own optical team or a different healthcare professional who is working with you in delivering care for the patient, for example, an ophthalmologist; and

b. develop your skills and experience in this area to fulfil this role in future.

 
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