Getting Back On Track: Risk Reduction Strategies To Re-Engage A Noncompliant Patient

Despite sound practices of patient engagement, healthcare practitioners will continue to encounter what has been termed “noncompliant” patients. A patient who is noncompliant is not necessarily defiant. Discussing with the patient the reasons why they are not following a recommended care plan will help to identify — and potentially eliminate — barriers that are getting in the way of the patient following the agreed upon course of care and true engagement.

When a patient is getting off-track, they are:

• not taking medications as prescribed
• not obtaining diagnostic testing as ordered
• not following care instructions
• repeatedly missing or canceling appointments

What risk reduction strategies can a healthcare provider engage in to reduce the potential for harm to the patient and possibly a claim of negligence?

Discuss and Document!

The patient record should reflect all details related to the issue and how you have communicated with the patient regarding the issue of noncompliance, the potential harm that may result, and what they need to do to get their care back on track. Having face-to-face dialog with the patient is best, but if a patient is repeatedly missing or cancelling appointments, you may not have that opportunity.

Robust documentation, including the “At-Risk” letter, helps to reduce the patient’s capacity to claim he/she didn’t know or wasn’t advised of the potential risk of noncompliance

The “At-Risk” Letter

If you do not have the opportunity for a discussion or follow-up discussion, prudent use of an “at-risk letter” is a sound patient engagement and risk reduction strategy. The facts and details of the letter are patient-specific and depend upon the situation. The key purpose of the letter is to remind the patient of the active role they need to take in their healthcare, potential risks if they do not, and what they need to do to get back on track.

The letter should:

1. Acknowledge patient engagement and responsibility by including the patient as part of their own healthcare team
2. Identify how the patient has not been compliant with their healthcare
3. Describe why it is important to follow healthcare provider recommendations and the potential implications for failing to do so
4. Provide a plan to encourage the patient to get back on track

Delivering this information as a formal communication to the patient demonstrates the healthcare provider’s commitment to the patient and can be effective in enlisting the patient be more engaged. In the event that patient chooses not to follow the recommendation and disrupts their care, robust documentation, including the “At-Risk” letter, helps to reduce the patient’s capacity to claim he/she didn’t know or wasn’t advised of the potential risk of noncompliance.

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About Author

Judi Olnick

Judi is a Certified Professional in Healthcare Quality (CPHQ) with more than 30 years of experience working in the areas of healthcare quality, patient safety, and risk mitigation. Judi works as the Senior Risk and Safety Consultant for Saxton & Stump, LLC and SE Healthcare Quality Consulting. In this position, Judi educates and assists with matters including risk assessment and recommendations, safety programs, quality plans, and related performance improvement measures. Judi is a member of numerous organizations including the American Society for Healthcare Risk Management and Central Pennsylvania Association for Healthcare Quality. She currently serves as the Quality Improvement Advisor for Fame Emergency Medical Services.