According to The Doctor’s Company, a medical malpractice insurance company, more and more claims are being filed as a result of Electronic Health Records (EHR).  Because of drop down menus and lack of alerts, patients are getting harmed.

In one example, a physician intended to order 15mg of Morphine.  The drop-down menu gave him the choice of 15mg or 200mg.  The physician mistakenly ordered the 200mg.  The patient took the 200mg Morphine with Xanax and became somnolent and spent the night in the hospital.

There are numerous problems with copy and paste.  In one case, a 38-year-old man presented to his PCP with symptoms of shortness of breath and dizziness.  The man died 5 days later of pulmonary embolus, the Plaintiff’s Attorney was able to show that the physician copied and pasted his previous note into the visit just prior to his death.  Not only is this information available in the audit trials to show everything which was done to the EHR, but the same exact vital signs were copied, and numerous spelling errors were noted in the previous note and copied with the same errors.  The allegation was failure to properly assess this man.  Had he been properly assessed; the physician would have been able to identify signs and symptoms of a pulmonary embolus.

Risk management strategies include:

1. Do not copy and paste anything except patient’s past medical history if you are sure it is accurate.
2. If your EHR auto populates information, ask that that feature be removed.
3. Be extra careful in selecting items from a drop-down menu and make sure it is correct.
4. Make sure you read and review prior medical records, so you have an accurate history.
5. If you use a scribe, you are responsible for the entry so double check to make sure it is accurate.
6. It is easy to save your charting for later and even do it at home but how do you remember the information? Remember attorneys can find out what time the patient’s visit was scheduled and what time the entry was made.

What do you do to avoid malpractice with EHR?  I would love to hear your comments below.

Recently I attended the Nursing Service Organization Annual Summit where they discussed the results of their annual statistical analysis of claims against nurse practitioners.  They look at things such as area of practice, resultant injuries, alleged breaches in the standard of care and on their license protection claims.

Here are some of the risk management strategies that they recommended.

1. Professionalism is the key. Nurse practitioners have an amazing way of developing a great rapport with their patients.  Establishing the rapport and complying with your employer’s standards, policies and procedures is a great step in reducing your risk as a nurse practitioner.
2. You will “live and die” by your documentation. Therefore, document, document, document!  It is important to note in your chart your reasons for your clinical decision making process and rationale.  If your reasoning is supported in the chart, that goes a long way to protect you.  There has never an attorney who has said, “I wish they didn’t document so much.”  It has always been: “I wish they would have documented more!”
3. Additionally, it is important to document all discussions, consultations, clinical information along with the risk benefits and alternatives to treatment options. If you hand out any educational materials, that also should be noted.
4. If the patient it is not compliant, it is important to note that fact in the medical record. You should also document any efforts you have made to encourage compliance.  Simply stating that the patient was noncompliant is not enough.  As a health care professional, you have a duty to warn the patient of the risks of their noncompliance and the benefits of their being compliant.
5. You do not have to provide care to patients who are not compliant. If you have concerns about continuing to provide care to a noncompliant patient, bring that concern to your employer’s attention and consider terminating the care for that patient.  Unlike nursing, as a nurse practitioner, we can somewhat choose our patients.  If you have a concern that a patient may sue you or is not compliant, you can discontinue services by giving them 30 days notice and send the letter by certified mail.  You are required to provide emergency care for the 30 days, and it is helpful to refer them for other care.

Do you have any suggestions for other risk management strategies?  I’d like to read them in the comments below.

Year after year, nursing is voted as the most trusted profession.

And there’s good reason for that because we help people at their most vulnerable times.  We are entrusted with their health, their healing and their mental, physical and psychosocial well-being.

Historically, nurses were nuns which adds to our trustworthiness and credibility.

Anything that you do that could be unbecoming as a nurse, the Board can take action.  If you have a criminal matter against you, you must notify the Board.  Each state varies so I strongly recommended that if you are arrested, know your Nurse Practice Act and reporting requirements so you can report an arrest or conviction in a timely manner.

Remember, anyone can report you to the Board.  I’ve had ex-spouses report nurses to the Board.  Given this, it is important that you remember that you are a nurse 24/7 so no one will report you.

One of my biggest complaints about TV shows with nurses is when they are portrayed going to a bar in their scrubs and drink alcohol.  This is conduct unbecoming of nurse and is unprofessional.  I have no problem with anyone drinking responsibly but I would recommend changing out of your scrubs first!

Remember, it is your license and your livelihood and so protect it.