‘The Code’ So what does this mean and where did it come from ? Gillian Davies 2009

The Health & Disability Commissioner Te Toihau Hauora, Hauatanga is an independent agency set up to: Promote and protect the rights of consumers who use health and disability services. Help resolve problems between consumers and providers of health and disability services Improve the quality of health care and disability services.

HDC rose out of things that did or did not happen within practice NWH-and the subsequent Cervical Cancer inquiry (1988)– what was done or not done. Patients - who were unaware of the treatment they were, or were not, given. Health Care Professionals - who didn’t feel it was their place or feel supported to speak up.( aka….accidents waiting to happen)

It is consumer centered legislation … It protects the rights of the consumers of all health and disability services It sets out consumer rights and provider duties It enables resolution of the complaints through advocacy & HDC.

It covers a wide range of providers – whether public or private, regulated or non regulated….

That big red poster on the wall?  The 10 Code rights are there to regulate quality of care and it applies to all providers of health and disability services.  The Code of Rights is about QUALITY of care.  It is there to ensure safety and quality improvement and for public protection to support the long term interest of health consumers.  The Commission focuses on systems and quality improvement –”… rather than only seeking to identify individual scapegoats when things go wrong.” (Merry&Seddon NZMJ21/7/06)

OK – so what are these rights??

1. The right to be treated with Respect. Every consumer:- Has the right to be treated with respect Has the right to have their privacy respected Has the right to be provided with services that take into account the needs, values & beliefs of different cultural, religious, social and ethnic groups including the needs, values and beliefs of Maori.

What might this look like in your own daily practice ?

2. The right to freedom from Discrimination, Coercion, Harassment and Exploitation “ But I would never do this…” OK ….- maybe not deliberately.

3. The right to Dignity & Independence. Avoid creating barriers...

4. The right to services of an Appropriate Standard. Services provided with reasonable care and skill That comply with legal, professional, ethical and other relevant standards. In a manner consistent with his or her needs. Provided in a manner that minimises potential harm and optimises the quality of life. Co-operation among providers to ensure quality and continuity of services.

5. The right to Effective Communication. ….given in a form, language and manner that they can understand the information given. What might this look like? Health literacy, voice, sign language, assumptions, not using a medical ‘code’ language An environment that enables both the consumer and provider to communicate openly, honestly and effectively. Privacy, time, respect, ask if you don’t know…

6. The right to be fully informed Explanation of his or her condition in a manner that they will understand. Of the options available and there benefits, risks, side effects and costs. Teaching or research – students, research etc Ask – don’t assume. “Do you understand what is going to happen to you as a result of what we have been talking about?”

6. Continued …. The results of tests The results of procedures Before making a choice every consumer has the right to the information that a reasonable consumer, in that consumers circumstances needs to make an informed choice or give informed consent.

7. The right to Make an Informed Choice and Give Informed Consent. This is a right that trips off our tongues – we know it is important – however it is so easy to assume on a busy day that by ‘turning up’ for the blood test, vaccination, depo injection, minor surgery that the patient made the choice and by rolling up their sleeve has given us informed consent. Not so.....

7. Continued... “Every consumer must be presumed competent... Unless there are reasonable grounds for believing that the consumer is not competent.” “...every consumer has the right to refuse services or withdraw consent to services” (imagine the courage needed) “Every consumer has the right to make a decision about the return or disposal of body parts or bodily substance s that may be removed or obtained in the course of a health care procedure” (Code of Health & Disability Services Consumers Rights

8. The Right to Support Every consumer has the right to have a person or persons of their choosing present, except where safety may be compromised or another consumers rights may be infringed. What is a Chaperone.... ? Can you spell it? What other word might be easier to understand on the poster on the wall ??? Health Literacy

9. Rights in respect of Teaching or Research

10. Right to Complain Every consumer has the right to complain about a provider in any form appropriate to that consumer.( HDC advocacy service can help) Every provider must facilitate the fair, simple, speedy, and efficient resolution of complaints. (5 days…)

What are the legal issues for us as health care professionals offering a service ? We have a duty to provide services in a way that ensures that the consumers rights are upheld. We must practice and comply with all legislation of the HDC and all professional legislation for your area of practice.

Documentation Documentation Documentation This is vitally important in all interactions with every consumer. Progress notes Consent forms X rays ECGs for comparison Computer notes Incident reports / significant event / complaint Charts / results / care plans Appointment logs/appointment book/computer

Nursing Council Competencies Domain Two: Management of Nursing Care Competency 2.3 Ensures documentation is accurate and maintains confidentiality of information Domain Four: Interprofessional health care and quality improvement. Competency 4.1 Collaborates and participates with colleagues and members of the healthcare team to facilitate and coordinate care.

The wider view “Professional vigilance is the essence of caring in nursing” (Dr Elizabeth Finn HDC office)

Take Home Messages Understand the Code of Rights is about the QUALITY of care. Document – because if it is not documented – you didn’t do it !! Protect the patient and protect yourself. Walk a mile in their shoes The HDC process is about resolving a complaint and ensuring the systems are put in place to prevent the same thing from happening again to someone else.

Looking for further information?? HDC PO Box 1791 Auckland 09)  Nursing Council of New Zealand  NZNO (or similar organisation)  The Art of Great Care

The End.....Questions?