RISK MANAGEMENT OVERVIEW 2014

Louise E. Swensen, JD, MS, CPHRMAssociate Director

Role of Risk Management in the HospitalWhen to call Risk ManagementMedical Malpractice & Disclosure Informed ConsentCommunication & Documentation

Review all serious patient events (incident reporting system)

Patient complaints and grievances – work with Customer Service

Handle all visits from UDOH, CMS, DOPL, FBI, etc. EMTALA investigations Work with Quality to do mandatory State reporting Review patient legal documents – custody,

guardianship, etc. in conjunction with the OGC Involved with device & product recalls

Unanticipated, negative outcomes

Neurological injury Medication errors Falls Maternal/fetal injury or

death

Implant device failures

Patient injury Patient or family

threaten to sue

Is professional negligence by ACT or OMISSION by a Health Care Provider which deviates from accepted standards of practice in the medical community and causes injury to the patient.

Is not the absence of a “perfect result.”

Is not the occurrence of known complications.

Failure to diagnose Failure to refer Procedure complications Failure to obtain informed consent Inadequate communication Inadequate history and physical Patient dissatisfaction with outcome/unrealistic

expectations

Interns and residents are named in about 30% of the 40-50 Notices of Intent/Notices of Claim filed against the University each year.

The Hospital and SOM have established self-insured trust funds for malpractice coverage

Excess coverage is purchased above the trust fund amounts through a commercial carrier

Coverage applies when you are working within the course and scope of your employment at the University

1. Duty2. Breach of the Duty (Standard of Care)

3. Injury (breach is the proximate cause)

4. Damages

1. Take care of the patient2. Contact Risk Management for help with

disclosing to the patient/family3. Document thoroughly and carefully including

the physical assessment of the patient.4.“Privileged” conversations - QI, M&M, RCA5. Don’t make copies of Patient Safety Net (PSN)

(incident) Reports or refer to them in the medical record

When asked if anything could have been done to avert legal action, 37% said an explanation and apology would have made a difference.

In another study, 24% said they filed when “they realized the physician had failed to be completely honest with them about what happened, allowed them to believe things that were not true, or intentionally misled them.”

Treatments performed Medications ordered & given Procedures performed Evidence of patient’s overall condition &

response to treatment Lapses in care Inappropriate care Inconsistencies/discrepancies

Notice of Claim/Notice of IntentPre-litigation PanelComplaintDiscoveryTrial

In Writing Nature and Purpose of the proposed Procedure Discussion of Risks, Benefits, potential

Complications & Alternatives Who will perform the procedure Opportunity to ask & have all questions

answered Emergency Exception

The medical record is meant to be: A complete, accurate, up-to-date

documentation of the medical history, condition, and treatment of each patient.

The primary means of communication for the healthcare delivery team.

Follow organizational and departmental policies

Maintain continuity of care As soon after the event as possible Timely entries:

◦Are more believable ◦Enhance communication and improved

quality of care

◦Never obliterate, alter, or destroy original note

◦Never use correction fluid or tape◦Single line through incorrect entry◦Sign & date (& time) the change

Don’t ever destroy evidenceDon’t ever change the medical recordDo label any addition to the medical

record as a ‘correction’ or ‘late entry’ or ‘addendum’

Do time and date your entries in the medical record

Do chart objectively

Don’t criticize or question care by others in the medical record

Do chart patient non-complianceDo chart complications objectively

without assessing faultDo chart notification & involvement of

other physicians or other health care providers

Don’t editorialize about the patient

Don’t use the medical record as a battleground to settle grudges with other members of the treatment team.

The professionalism of the treatment team should be reflected throughout the medical record documentation.

“11/23/83 [pt’s name removed] states that there is some discomfort over the tip of the ulnar styloid of her right wrist and she complains of some vague pain over the dorsum of her right hand. I think she may just be a chronic complainer. She does not have exactly the same pain as before but she is just full of one problem after another and I am unable to ascertain exactly what her bitch is at this time, but I think its mostly a vague discomfort so therefore we’ve removed the cast, placed her in a protective splint. We’ll start active PT on Monday.”

M.D.

Any questions, any time . . .Contact Risk Management

581-2031