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every level of authority. Analyze honest mistakes for the opportunity to change systems or processes to prevent harm in the future.


If an allegation of sexual abuse occurs, employees should already know and


have acknowledged their requirement to report incidents immediately to the   the patient and involved parties per company procedures. Initiate a prompt investigation following written investigation procedures.


“In counseling situations, educate patients about therapeutic boundaries, referencing the appropriate professional code of conduct, and making clear some things are never acceptable.”


When possible, set up procedures so that unsupervised individual   or in closed spaces with unobstructed windows in view of others.


Audit documentation               treatment, and gain their consent in writing. Second, take progress notes  care, including any deviations from normal practice or boundary crossings.


For example, if during an interaction a patient begins sobbing about the loss of a loved one, a clinician might give the patient a brief hug followed by a hand on his shoulder. Even if the hug were intended simply as a gesture of sympathy, it is not standard practice, and it could potentially be misconstrued by the patient as arising from something other than therapeutic intention.


In cases where a deviation from normal care is therapeutically indicated, be sure to document the clinical reasoning. For example, a patient who begins feeling anxious in the exam room is then walked to 


Improve incident management For an incident management and complaint resolution process to be  the culture of the organization. Empower and encourage employees to report incidents and near misses without fear of reprisal.


Punish openly reckless and intentionally harmful behaviors, and 


Measure patient satisfaction and conduct employee exit interviews An organization that collects patient satisfaction surveys at the time   information and act on issues before they have had time to escalate.   an opportunity to address concerns about potential abuse or high-risk behavior. 


ABOUT MICHELLE FOSTER EARLE Michelle Foster Earle is the president of OmniSure Consulting Group,   medical professional liability insurance companies to help medical practices, hospitals, healthcare facilities, and providers of healthcare and social services nationwide reduce risk, improve performance, and avoid lawsuits. She has earned designations in healthcare management, is a licensed General Lines Property and Casualty agent in Texas, and is an Associate in Risk Management. Foster Earle would  research and contribution to OmniSure’s Sexual Abuse Liability Risk Assessment Tool, from which much of the information in this article is obtained. She can be contacted at michellef@omnisure.com


FURTHER INFORMATION American Medical Association’s Code of Medical Ethics http://www.ama-assn.org/ama/pub/physician-resources/ medical-ethics/code-medical-ethics.page


Federation of State Medical Boards. Addressing Sexual Boundaries: Guidelines for State Medical Boards http://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/ GRPOL_Sexual%20Boundaries.pdf


National Prison Rape Elimination Act (PREA) Resource  http://www.prearesourcecenter.org/


Patient Safety and the Just Culture: A Primer for Health Care Executives http://psnet.ahrq.gov/resource.aspx?resourceID=1582


 http://www.nsopw.gov/


Annual 2014 | HEALTHCARE RISK MANAGEMENT REVIEW | 69


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