Toolbox for Patient Care

***For other patient advisement topics and information, please refer to the Core Language Template for Patient Advisement Letters on the Patient Advisement Letters page.***

Verbal Advisement for Abusive Behavior: Please try to do all verbal advisements in REAL TIME. 1) First lead with empathy. Validate with active listening and ask clarifying questions. Give reassurances that you are there to listen to what their issue or frustration is and to assist in solving the problem. Use this early technique to de-escalate and reduce the temperature; 2) Then explain that while we are here to help discuss and help with their issue or concern, we need to remind them of UCSF’s conduct expectations e.g., that all interactions must be calm and respectful. No form of verbal abuse is acceptable. Explain that no verbal abuse means no use of profanity, escalation of voice, insulting or demeaning, confrontational, accusatory or threatening. We cannot have constructive conversation with the patient or family if those interactions are verbally abusive; 3) Remind them that this is the work environment for our staff and care team and that UCSF is committed to maintaining a safe and positive work environment for all patients, staff and visitors. 4) Lastly, document the verbal conduct advisement in Apex. Be objective in how you describe and document the behavior and avoid using judgmental or triggering language (e.g., ranting, cussing, rude, difficult, unpleasant). Use quotations to document specific words or phrases used by the patient or family member. Also document if the patient failed to re-direct during the course of the verbal advisement.

Verbal Advisement for Dictating or Interfering with Care: Patients and family may not dictate care or interfere or disrupt care. This type of behavior might range from tampering with equipment, preventing an RN from doing specific bedside checks or vital signs. They may try to bring in food for a patient who is on aspiration precautions or NPO for surgery or simply disagree with one or more aspects of the POC. Families may try to move the patient themselves or give them medications or adjust their oxygen level. In the outpatient setting, patients may demand specific medications or generally reject a multitude of treatment or management recommendations.

Always start with empathic listening and the expressed desire to help understand their concerns. For inpatients, explain to them that the POC and orders are determined by the care team and that the RN staff must strictly follow all orders, nursing protocols and safety protocols.  If a family member is causing disruption of care, then explain that the patient is our legal responsibility in terms of providing therapeutic care and interventions. While we are always grateful for the family’s supportive presence and advocacy at the bedside, the patient/family cannot interfere with or disrupt the RN’s ability to follow all orders, nursing protocols and safety procedures.

If the family or patient disagrees with a POC or physicians orders, they can arrange to speak to that physician. We will always do our best to ensure that the patient and family understand the reasons and purpose for all treatment decisions and physician orders. The RN can also ask that the patient or family not interact with him/her when care is being rendered in the room to avoid distraction. These disrupting behaviors can create an unsafe care environment for the RN trying to deliver care.

For outpatients, make sure the patient understands the therapeutic basis for our care recommendations and why the care they are demanding is not indicated, safe, advisable or appropriate for us to accommodate. Patients cannot dictate care or threaten or demand care that is not felt to be clinically indicated by their specific condition or is of uncertain benefit or ineffective or has the potential to result in harm.

Make sure this verbal advisement is documented objectively in Apex and that it covers all topic addressed.

If a family member continues to interfere with or dictate care even after a verbal advisement is given, then they need to be cautioned that they can be temporarily restricted off the floor.

Verbal Advisement for Sexual Harassment and Inappropriate Touching: The key element of sexual harassment is that the conduct is unwelcome and uninvited. Unwelcome sexual advances, flirtations and personal comments, uninvited and inappropriate touching and other verbal and physical conduct of a sexual nature constitutes sexual harassment.  When this happens in this workplace it can create an intimidating, hostile or stressful work environment.

Below is some exemplar language and responses that staff can use in real time if a patient or visitor makes any sexually charged, flirtatious or personal comments or inappropriate unwelcome sexual advances or any type of unwanted physical touching or contact or even just invades the provider’s personal space by trying to get physically close. Make it clear that the conduct is unwelcome and that you asked for it to stop. Please document these instances in the chart and that you asked the offender to cease the inappropriate behavior. If it continues after the verbal warning, then a written warning letter can be provided.]

“Your comment(s) [or unwanted touching or sexual gestures] make me feel uncomfortable and are unwanted and I would like to ask you to refrain from making any personal remarks like that (e.g., sexual advances, flirtations etc.) and to respect my professional boundaries as this is my workplace.” [Unwanted touching includes touch, pinching, patting, brushing up against the body or even cornering or impeding another person’s movement.]

“That kind of conversation or personal comment is inappropriate in this workplace. It makes me feel very uncomfortable and is offensive. Please stop making any further personal comments of this nature.”

“Please stop making flirtatious (or personal or inappropriate) comments or compliments to me. It makes me feel uncomfortable. I am at work and am asking you to respect my professional boundaries.”

• Sterilization Informed Consent
• Advance Healthcare Directive Form
• Tip Sheet - Guidelines for Physicians when Disclosing an Adverse Event
• Child Custody and Consent

Please remember that UCSF policies are NOT to be shared with non-UCSF personnel (family, visitors, etc).

Commonly Used Policies and Procedures:

• Advance Health Care Directives/POLST 6.04.01
• Prohibited Substance Usage or Possession by Patients / Visitors 1.01.03
• Discontinuation of Care 6.03.03
• Withdrawal or Foregoing of Life Prolonging Treatment 6.05.05
• Informed Consent 6.02.02
• AMA/Elopement 6.03.17
• Management of Disruptive Behavior 6.07.19
• Medical Incapacity Hold 6.03.18

How to find UCSF policies online, please click on the link - PowerDMS How to Guide

1. UCSF Patient Relations, responds to patient and family concerns and grievances surrounding patient care.
2. UCSF Case Management and Social Work, our social workers act as patient advocates by serving as counselors, helping to find resources and solving problems. When it's medically necessary, social workers also help arrange alternate types of care when patients leave the hospital, which may include rehabilitation facilities, skilled nursing facilities, hospice, or board and care homes.
3. UCSF Regulatory Affairs, oversees UCSF Medical Center's compliance with The Joint Commission accreditation standards and regulatory requirements, which includes assessment, measurement, and reporting of ongoing compliance.
4. UCSF Health Office of Medical Affairs and Governance (OMAG)
5. UCSF Risk Advisory and Insurance Services (Campus Risk Management), Risk Advisory and Insurance Services (RAIS) strives to protect the assets and interests of UCSF through assessment of loss exposures, focused prevention efforts, and efficient management of insurance and self-insurance policies.
6. UCOP Risk Services, the Office of Risk Services is responsible for developing and implementing UC Enterprise Risk Management systemwide.
7. UCSF Police, contact UCSF Police for emergencies call 9+911 from any campus telephone. For non-emergencies call (415) 476-1414. For emergency assistance, to file a UCSF police report, to report suspicious behavior/event.
8. UCSF Health Security, contact UCSF Health Security Services at 415.885.7890.