In a Gallup Poll, nursing has again been voted as the most trusted profession for the 18^th year in a row.

One of the reasons it has been so long acclaimed is because of nursing ethics.  However, anything that nurses do that may not put our profession in the most favorable light, can be detrimental.

In an MTV reality TV show “Scrubbing In”, they portrayed nurses going to bars in their scrubs.  This negatively portrayed the nursing profession.  We are held to high standards, just like a physician.  Because we are a nurse 24/7, If we go out and drink, we should not wear our hospital attire, nor should we get behind the wheel of a car.

Be careful of any behavior which could be negatively interpreted by the public.  As stewards of health, let’s do our part to put our best foot forward in all situations whether or not we are at work.

Having a criminal matter can reflect negatively on the profession.  Because we are nurses 24/7, having a positive urine test even with a valid prescription, the Board cannot tell when you took that medication, even if you did take it after work.

Just remember, as a nurse, we are under the public spotlight. Ask yourself if you would have judgement toward a nurse engaging in certain behaviors.  If the answer is “Yes,” then don’t do it!  For example, if you take controlled substances off work, and the same medication you took comes up missing or a patient says they never received it, it will be difficult to defend yourself.

As nurses, we want to help.  But sometimes, helping can mean crossing the line.  One nurse went to the ATM for a patient across the street and the patient now claims she never received the money.

I am proud to be a member of the most trusted profession.  Hopefully it offsets the reputation of some attorneys!  Please join me in continuing to make nursing the most trusted profession and being professional even when you’re not at work.

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.