Lessons From the Other Side; Case Studies from Maternal/Child Lawsuits

Transcription

1 Lessons From the Other Side; Case Studies from Maternal/Child Lawsuits 1 CAPWHN Conference October 28 th, 2011 Chris Rokosh RN, PNC(C) Legal Actions by Type of Practice

2 CMPA Stats 2006 to 2010 The Legal Nurse Consultant Brings nursing expertise to lawyers involved in medical or nursing malpractice litigation Reviews medical records, policies, literature, and relevant nursing standards of care Identifies breaches in the standard of care and how/if they are related to injuries Provides verbal or written opinions on whether or nursing not standards of care were met Act as an expert witness at inquests, hearings or trial

3 Nursing Negligence Issues A 1997 study by Smith-Pittman identified 5 nursing negligence issues as the basis of malpractice settlements of verdicts in favor of the plaintiffs. Similar nursing negligence issues were identified in studies by Campazzi (1980),Smith (1989), Mayberry and Croke (1996) Smith-Pittman M. Nurses and litigation: Journal of Nursing Law 1998; 5(2):7-19 Nursing Negligence Issues 1. Failure to Communicate Adequate Information to the Physician Smith-Pittman M. Nurses and litigation: Journal of Nursing Law 1998; 5(2):7-19

4 Frequent Documentation Documentation of change in patient condition without physician communication Documentation of change in patient condition with resident communication Doctor Aware or Charge Nurse Aware Documentation of abnormal findings and Doctor aware. No new orders Better Documentation Document who, why, when, where and what. Use SBAR or a similar tool. Document interventions, response and repeated physician communication and communicate to those who can intervene Key Point! Continue performing and documenting all interventions until the problem resolves or adequate intervention occurs

5 Nursing Negligence Issues 2. Inadequate Patient Assessment, Nursing Intervention or Nursing care Smith-Pittman M. Nurses and litigation: Journal of Nursing Law 1998; 5(2):7-19 Frequent Documentation Failure to document assessments according to facility policy, doctors orders, or based on patient assessment Abnormal findings, without an increase in the frequency or detail of assessments Repeated analgesia without re-assessment of pain or effectiveness of medication

6 More documentation Doctor Aware Charge Nurse Aware Patient Reassured, Doctor Paged or Resident Aware No follow up on critical findings such as hypotension, fever, abnormal labs, signs of wound infection, patient falls Busy Unit, Short Staffed Task oriented documentation Better Documentation Document according to policy, doctors orders and/or patient assessment. Add narrative documentation to flow sheets Document using the Nursing Process with evidence of critical thinking SOAP(IE) Key point! A change in condition equals change in action equals a change in nursing documentation

7 Nursing Negligence Issues 3. Medication Errors Smith-Pittman M. Nurses and litigation: Journal of Nursing Law 1998; 5(2):7-19 Frequent Documentation Illegible Doctors Orders - If you are uncertain of illegible writing and act anyway it is considered inexcuseable by the courts Wrong drug, wrong patient, wrong dose Ignoring patient complaints Drugs given too frequently

8 More documentation Lack of assessment for known side effects Documentation of allergy ignored/missed Lack of nurse/nurse communication about frequency of administration or reactions Failure to access information from EMR Better Documentation Document clarification of medication orders The 5 R s of medication administration Document specific site of parenteral meds Clear documentation of Allergies/reactions Pay close attention to drugs and patient Key point! Document evidence post administration monitoring

9 Nursing Negligence Issues 4. Inadequate Infection Control Smith-Pittman M. Nurses and litigation: Journal of Nursing Law 1998; 5(2):7-19 Frequent Documentation No evidence of infection control No documentation of patient or family teaching A single written entry identifying signs of infection without appropriate follow up No documentation of appropriate referrals or protocols

10 Better Documentation Document basic infection control measures such as aseptic technique, patient in reverse isolation or as per protocol Include protocol in the medical record Document consultation with Infection Control Key point! Investigate, document and report signs of infection Nursing Negligence Issues 5. Unsafe and Improper Use of Equipment Smith-Pittman M. Nurses and litigation: Journal of Nursing Law 1998; 5(2):7-19

11 Frequent Documentation No documentation of use of equipment, type of equipment, settings, changes to settings or safety precautions used Lack of ongoing patient assessment No documentation of who administered or changed medication in pump No follow up or QA of equipment Documented use of wrong equipment Better Documentation Documentation the use, type of equipment, settings, changes to settings and safety precautions and who administered all medications. Follow up with QA Stay knowledgeable about equipment and don t ignore alarms or early signs of trouble Key point! Documentation ongoing assessment of the patient (including IV sites! and assessment for known side effects)

12 The Challenge for all of us To provide safe, competent and ethical care at all times and in all situations. In the Event of Litigation Key point! Your best and maybe only defence in a nursing negligence lawsuit is documentation confirming that you provided care in keeping with current standards and policies; that you acted as another reasonably competent nurse would have acted in the same situation

13 For more on this subject.. www. cnps.ca (infolaw) (Canadian Health Info Institute) (RCA, teamwork, communication, stats, presentations, economics) (Legal Issues for Registered Nurses) (Canadian Legal Info Institute) (Ethics, Scope, Best Practices) (2010 Annual Report) (Canadian Adverse Events Study) 2010