Risk Management Tips 2000-2001 | Health Resources Unlimited

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Risk Management Tips 2000-2001

Your experience / Your questions - 05/06/01
In efforts to meet your needs, I would love to hear from you regarding issues of interest related to this weekly posting. Do you have legal experiences / tips to share? What would you like to hear about? Please forward your feedback via email to EDUCATE@hru.net All replies will be responded to. Thank you very much!

If you're thinking about becoming an attorney - 05/01/01
Consider networking with this group, or, contacting a member. The American Association of Nurse Attorneys: http://www.taana.org

Nursing Standards - 03/12/01
The following website gives you a source to review the available (and purchase) national nursing standards from the American Nurses Association. http://www.nursesbooks.org by American Nurses Publishing

Patient Bills/Charges - 03/05/01
Did you know that sometimes a patient bill/charge sheet is "requested for production" (RFP) by patient attorneys? Often times nurses express "it's the care that counts" and may not pay due attention to appropriate/accurate charging. Believe it or not, our care is also reflected in the charges we apply to a patient's bill during their hospital/outpatient stay.

Forensic Nursing II - 02/25/01
This is not only a great read for any true crime fan, it is a valuable reference tool that you will go back to time and time again. How long does it take for rigor mortis to set in and how long do the effects last? How can time of death be determined by examining a victim's stomach contents? How can an infant death by suffocation be distinguish from SIDS? You will know all this and much, much more by the time you get to page 215. Check it out (only $6.29!): Unnatural death: confessions of a medical examiner. http://www.amazon.com/exec/obidos/search-handle-form/105-4473782-8196724

Forensic Nursing - 02/19/01
If you're interested in the medicolegal concerns following injury, trauma, violence or complications of therapeutic procedures, you may wish to visit these websites:

http://www.aafs.org American Academy of Forensic Sciences

http://acfe.com American College of Forensic Examiners

http://amrn.com American Forensic Nurses

Nurse Attorney - 02/12/01
If you're considering being a nurse attorney or are a nurse attorney, check out this organization for lots of info: http://www.taana.org

Online Nurse Practice Acts - 02/05/01
Unfamiliar with the latest update of your state nurse practice act? Check the following sites for online state nurse practice act information. Some states even have online CEU programs available!

http://www.medi-smart.com/practice.htm

http://www.ncsbn.org/files/npa.asp

Legal Dictionary - 01/30/01
An inexpensive (approx.$7)resource filled with legal terms that I've found to be an extremely helpful resource is a pocket-sized "Legal Dictionary" by Random House. ISBN # 0679764356.

Patient Rights - 1-22-01
There was a lot of discussion last year in Congress about a Patient Bill of Rights. This will be back up for discussion this year so it is important to remember some issues related to the topic. Several organizations have documented "patient rights" and some individual hospitals and physician offices have done so as well. You are responsible to know what your facility informs patients of. For example, your state may have a bill that defines patient rights as does the American Hospital Association, ACLU (American Civil Liberties Union), Hospice Association, and many others. Use the Internet to search the topic and become familiar with what applies at your job.

Patients/Families who threaten you - 1-14-01
Do not take any verbal threats lightly-that may seem innocent initially, but can easily become your worst nightmare. As soon as possible after the incident document the specifics. Note the exact words in quotes of the person who verbalized the threat, anyone who witnessed it, the date/time it occurred. Do not document what you assumed to be the problem just note facts. For example; 2-2-01 1700 Patient Janice Smith was in exam room 5 being sutured when her husband approached me and stated, "You have not heard the end of this from me-you better have yourself a good attorney and a gun at your bedside." Event witnessed by Dr. Jordan, and nursing assistant Sandra White. Also- you have every right to report this type of threat to the local police/sheriff department.

The USA legal system - 01/08/01
The United states does not have a unified legal system, but instead has more than fifty separate systems of state and federal law. To find out more about your state law visit the following website: http://www.morelaw.com/states/

A new year - thoughts of legal action - 01/01/01
It is common that after the holidays and family get-togethers, the contemplation of a lawsuit and search for an attorney begins. If you are in search of an attorney and am not sure who to turn to, you may want to consider the following sites:

http://www.attorneyfind.com

http://www.ettourneys.com

http://www.lawyers.com

http://www.healthlawyers.org

http://www.nhla.org

Legal Book Resources - 12/14/00
Sometimes, you just want the book . . . Here are a couple of sources if you're looking for legal book references:

The Law Bookstore: http://www.thelawbookstore.com

Nolo Press: http://www.nolo.com

Law Journals: http://www.ljx.com

Happy Surfing!

Statute of Limitations - 12/03/00
Did you know that the statute of limitations (the length of time after an event within which a civil or criminal action arising from the event must be brought forward) varies state by state? It is also different for a minor vs. adult. To find out more about state-to-state laws visit http://www.morelaw.com

Scientific evidence reference manual - 11/19/00
The second edition of Reference Manual on Scientific Evidence has been published and distributed to federal judges. The manual can be downloaded in Adobe Acrobat format from the list below. Follow this link for a downloadable version of the first edition:

C:\Documents and Settings\Administrator\My Documents\Research\RefmanualScEv.htm

If you do not have the free Adobe Acrobat Reader, go to www.adobe.com.

More about evidence. . . - 11/05/00
Direct evidence = evidence purportedly showing the existence or nonexistence of a fact that must be decided in a case without the need for any application of reasoning or linking of related facts. Most often, the testimony of an eyewitness.

Documentary evidence = Real evidence in the form of a document.

Extrinsic evidence = evidence pertaining to a written instrument such as a deed, contract or will.

Hearsay evidence = testimony or document offered in court that contains hearsay (ie. she told me she saw . . .)

Opinion evidence = testimony as to what a witness believes or concludes about a situation as distinguished from what the witness personally observed.

Real evidence = any demonstrative evidence (document or object)

Legal-Speak: Let's talk evidence - 10/29/00
1. Evidence = information or things pertaining to the events that are subject to the case.

2. Character Evidence = evidence pertaining to the character of a party or witness.

3. Circumstantial Evidence = evidence of a fact that makes the evidence of another fact-one that actually must be decided in the case-more or less likely.

4. Competent Evidence = evidence that is admissible.

5. Cumulative Evidence = additional evidence that is introduced to prove a fact for which there has been considerable evidence, adding little to what has already been admitted.

6. Demonstrative Evidence = evidence that the jury can perceive directly instead of just being told about it by a witness (documents, objects).

Stay tuned next week for 6 more definitions of evidence!

What are compensatory damages? - 10/23/00
Compensatory damages are awarded to the plaintiff to compensate for the harm resulting from the defendant's wrong, including actual financial loss and intangible harm such as pain and suffering. These are the damages to which a plaintiff is normally entitled upon proving his/her case. Compensatory damages may be divided into general damages, special or consequential damages, liquidated damages, stipulated damages, nominal damages, punitive damages, exemplary damages, speculative damages and treble damages.

What makes you an expert? - 10/15/00
Your skills, education and experience of course! To be a credible "expert" and a "professional" we must keep ourselves up-to-date with techniques, research and current developments. Consulting current professional journal(s) is one way to keep up-to-date. Ongoing continuing education and experience will continually qualify ourselves as professionals. Even if your state doesn't require CEU's it will greatly benefit you to accumulate CEU hours. As a general rule shared by librarians: any text older than 10 years is out-of-date and shouldn't be kept on the shelves. Does this surprise you?

What is an affidavit? - 10/08/00
An affidavit is a formal written statement affirming or swearing to the truth of the facts stated, signed before a notary public or similar officer. Dishonesty in an affidavit is false swearing or perjury.

Do it yourself legal tips / resources - 09/28/00
Working on a contract or want a resource for simple legal forms / advice? Try this resource / companied created by an attorney to provide resources for the layman. The array of resources is phenomenal! http://www.nolo.com

Comprehensive Online Legal Resource - 09/17/00
If you're looking for an attorney, law firm in your state, case law, or want to define a legal term or research a legal subject, try this comprehensive website: http://www.cdlaw.com

Tips for your Deposition - 09/08/00
You are scheduled to give a deposition. Don't fret, consider these tips:

1. Maintain self-confidence (remember you are the expert!)

2. Read a couple of depositions on your own to get an idea of the ways attorneys phrase questions. (samples: http://www.malpracticedepositions.com)

3. Don't answer a question until you are sure what you are being asked.

4. Maintain your composure.

5. Always tell the truth.

6. Dress and act professionally.

7. Never guess at an answer. If you are unsure say you aren't sure.

8. Know the facts.

9. If you are being paid - remember that payment is for your TIME, not your testimony!

Does the licensed professional nurse (RN) have a role in litigation? - 08/28/00
Professional negligence claims are growing in civil litigation. Why? Because the average juror lacks working knowledge of the professional requirements and duties, the court allow for testimony from those deemed expert in the field. Expert qualifications vary, but for the most part, most agree that the expert must be educated and experienced in the topic at hand. A current, valid un-restricted license is required. Certification by a recognized specialty board and/or history of published articles on the topic at hand is considered a well-qualified professional. As an independent licensed professional involved in litigation (either by choice or if requested) you have a role and responsiblity to provide informed and objective testimony.

Jewelry and the Surgical Patient - 08/21/00
Ever wonder why jewelry is taped to a patient having surgery? Surprisingly, it is not related to the cautery at all! The reason jewelry is taped is so that patient valuables can be properly accounted for (document this action!) If a patient is having surgery on an extremity, it is best to remove all jewelry on that extremity to avoid having to cut these items off later. And, remember to ask about belly and tongue rings (best to remove these).

Searching patient's belongings? - 08/14/01
Have you ever been placed in a position when someone has asked you to search the patient's belongings? Before you quickly respond and begin playing detective, remember: Always ask the patient for permission. If the patient refuses, seek further advice from administration before proceeding unless you have policies to direct you. For example, some behavioral health departments have policies and procedures that are part of the admission screening process to protect the patient from self harm. If an officer of the law asks you to search you must be in compliance with the patient's rights and some state laws vary in this regard. Use common sense, seek advice, and document your rationale and actions.

Neighborly Advice - 07/31/00
Your neighbor has a two year old little boy and she calls you because he will not move his right arm today. She wants to bring him by for you to check his arm. What should you do? You may give the advice as long as you do so in a reasonable and prudent fashion. For example, if you have no pediatric experience, you may not be qualified for this advice. Learn to become comfortable with responses such as; "You sound concerned about Timmy's arm; however, I have no experience with children. The best advice I can give you is to call his doctor or take him to a clinic or emergency room." Principles that apply to you when you work as a nurse, are the same principles you may be judged by when giving advice to a neighbor.

Angry Patients May Push Your Buttons! - 07/24/00
We are all faced at some time with patients that are angry for a variety of reasons. It is most important that the patient know you have heard their concerns. This does not mean you agree with their behavior, it simply implies you did not ignore them. Verbalize to the patient by repeating what they have said to you that you heard their concerns and if appropriate for your organization document the conversation on an incident form. "I hear that you are angry because you feel your call light was not answered soon enough" "What can I help you with now?"

Are You At Risk? - 07/17/00
Some decisions we make related to aspects of care we do or decide not to do, increase our risk to be named in a lawsuit. For example, failing to respond to a patient's complaint or failing to meet a physical need such as bathroom access, may increase your risk. Deciding to delegate a nursing function to someone not qualified or performing a skill yourself that is out of your scope of practice, puts you at risk.

Legal Resources - 07/10/00
I would like to recommend a resource for nurses looking for a handy reference related to legal concerns: Nurse's Legal Handbook Fourth Edition, Springhouse Publishers.

Hiding errors - 07/03/00
As soon as possible, notify the patient's physician. Be honest with the patient and his or her family as well. Trying to cover up a mistake or incident makes you look guilty even when you're not, and destroys any trust the patient may have for you as well as your colleagues.

Saying Too Much In The Medical Record - 06/19/00
While you need to chart completely regarding any incident that jeopardizes a patient's well being, it is not necessary to put everything that goes in the incident report in the medical record. For example, names and phone numbers of staff members and witnesses to events would be included in the incident report but not usually in the medical record.

Saying Too Much In The Incident Report - 06/12/00
Don't draw conclusions about what actually happened , or why, or who's to blame in an incident report. This goes double if you are the one who made a mistake. Be factual and honest, but objective as well.

Incident Reports and Attorneys Who Love Them - 06/01/00
Referring to an incident report in the medical record. Believe it or not, there are still nurses out there doing this, so it bears repeating. If you mention the existence of an incident report in the medical record you are basically giving the other side's attorney permission to see it when they might not have access otherwise.

Sloppy Charting-failure to document completely - 05/22/00
Sloppy writing may be used by the plaintiff's attorney to suggest that your care is just as sloppy. If the thought of a page or two of your charting displayed on a large screen makes YOU cringe, you'd better clean up your act. Otherwise, be prepared to have to decipher your own charting in front of a less than impressed jury.

Writing several entries at one sitting-with more than one time written - 05/15/00
This is dangerous because of the reasons discussed above. In addition, trying to appear as if you are charting contemporaneously with events when you're not makes it look like you are being insincere or self-serving. Both of these impressions can really hurt you.

Looking Guilty-Part 2 - 05/05/00
Writing late entries: Most of us have done it at least once-sat down at the end of a particularly busy shift or after a code and charted the events. This practice should be avoided when possible, but can usually be explained as long as:

*You don't make a habit of late charting

*Your charting is clear, complete, accurate If you do have to make a late entry do it as soon as possible and in the next available space in the chart. Refer to the previous place in the chart where the note belongs and include the exact date and time the events occurred.

Are you looking guilty? - 02/27/00
There are some things that a plaintiff's attorney will always look for in a medical record. Most of us have done at least one of these things, but if your care comes under suspicion and these things are in the chart, YOU'RE going to have some explaining to do! This legal beagle wants you to think when you re-write a nurses note. Keep your eyes on this web page, as re-writing nurses notes will be the first Legal Beagle discussion coming soon!!