“Lorie Brown put together the video series to provide tips for nurses on the front line of the coronavirus fight. It features 18 experts who provide advice such as keeping up immunity, getting better sleep, practicing mindfulness and understanding nurses’ rights.” [Read Full Article]
“Lorie Brown is both a nurse and attorney. She’s fighting for nurses who are currently suspended or on probation to return and aid in the fight against the novel coronavirus pandemic.” [Read Full Article]
Have you ever worked somewhere and your supervisor says, “Just write an order for that. We always do that to help out the physicians.”
In that situation, you feel like you’ve been put between a rock and a hard place. Your supervisor is telling you one thing and your gut is saying, “Hey! Wait a minute! I don’t have an order. I don’t have a policy and procedure and the physician is not available for me to ask.” Your gut tells you that this is something you should not do yet your Supervisor is ordering you to do exactly that.
This is a dilemma in which nurses frequently find themselves.
If you are asked to do something outside of the scope of your practice … trust your gut … don’t do it! The physician just might not cover you for what you did.
In addition, know your facility’s standing orders which are those that you can adjust medications based on labs and things like that. But they must be in the actual order or in the policies and procedures.
Taking it upon yourself to adjust or order medications or order labs is improper without the protection of a standing order or a policy and procedure. This would be called practicing medicine without a license and exceeding your scope of practice.
In addition, as nurses, we know too much. Sometimes when we have a pain, we are inclined to take a pain medication that we had around for a long time that was prescribed for another purpose or a previous episode of the same event. This also is considered practicing medicine without a license and exceeding your scope of practice.
It is really important that as nurses, we set the example. We cannot borrow a pain medication from someone else because we hurt our back. We have to go through the proper procedures as we are held to a higher standard than the general public and need to go through the same channels that the general public goes through. When we are sick, we go to the doctor, emergency room or urgent care to get a prescription.
If you are asked to take a drug test and have a positive urine for a medication for which you don’t have a prescription or a medication that has expired or prescribed for another reason, it is very difficult to protect and defend yourself.
When you take an expired medication or one borrowed from someone else, you are self-prescribing and practicing medicine without a license and exceeding the scope of your practice. It also is considered diversion because the medicine was not prescribed specifically for you or for that reason. Diversion simply means taking something from where it was supposed to go and moving it to another place.
This is such a big issue in healthcare.
Although you may not feel well, go to the doctor who knows the best way to help you. In this way, it is documented that everything was properly prescribed.
When you are faced with these difficult ethical dilemmas and you don’t have policies and procedures to support you, stand in your power and tell your supervisor that you do not feel comfortable doing something which is outside the scope of your practice.
Although you may fear you might lose your job, as I often say, you can always get another job but not another license.
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:
- Do not copy and paste anything except patient’s past medical history if you are sure it is accurate.
- If your EHR auto populates information, ask that that feature be removed.
- Be extra careful in selecting items from a drop-down menu and make sure it is correct.
- Make sure you read and review prior medical records, so you have an accurate history.
- If you use a scribe, you are responsible for the entry so double check to make sure it is accurate.
- 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.
Lorie Brown, R.N., M.N., J.D. interviews Yolene Lofton, former nurse and entrepreneur, about her problems when she had to appear before the Board of Nursing and advice to Nurses that may be going through similar problems. Also, the devastation that losing her nursing license caused and how she was able to find her way back and is now thriving with her businesses, Nurse’s Court and Nursing Events Management Production, LLC.
Nurse’s Court provides support and counseling for Nurses who have to appear before the Nursing Board. The website, www.NursesCourt.com, should be operational shortly.
Nursing Events Management Production, LLC which plans events for health care organizations such as job fairs, is currently planning a big event for 2020. 2020 Year of the Nurse and Midwife Worldwide Celebration with take place on April 30, 2020 in Miami, Florida. Tickets will go on sale in January, 2020 through TicketMaster or you can get information by emailing NursingEventsManagementPro@gmail.com.