patients Archives - Brown Law Office

Malpractice Claims are on the Rise with Electronic Health Records

January 9, 2020 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

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.

Keeping Your Nurse Practitioner License Safe

November 27, 2019 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

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.

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.
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!”
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.
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.
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.

Is The Handwriting On The Wall?

October 10, 2019 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

I frequently have nurses come to me because they have been fired from their jobs and are afraid that they will be reported to the Board. What’s interesting about these nurses is that almost all have said, “I knew I should have been looking for another job.” If you feel the handwriting is on the wall, it is better to resign than get terminated. On every job application, you will have to include that job on the application and include that you were terminated. You cannot simply omit a job because you were terminated. And you must tell the truth. If you do not put these jobs on an application or do not tell the truth about being terminated, its considered fraud and material misrepresentation in obtaining a position.

I always say you can get another job, but you can’t get another license. Many nurses stay in the job because they feel a loyalty to their patients. I can assure you, when there is a problem or complaint, your employer will have not have loyalty to you.

Many nurses stay in a position rather than leave because it is comfortable for them. It is so much more difficult to go out and find another job.

I’ve represented 2 nurses around the same proximity in time. One nurse worked at Hospital A and got terminated and went to Hospital B and said, “If I knew Hospital B was so much better, I would have left a long time ago.” The other nurse said, who worked at Hospital B, got terminated from Hospital B and went to Hospital A, said the exact same thing. “If I had known Hospital A was better, I would have left a long time ago.” It’s so interesting that 2 nurses each had very different experiences at the hospitals.

There is a place out that there which you love, you will fit, you will say “I wish I had come here a long time ago.” If you’re struggling and see the handwriting on the wall, I am not telling you to quit your job but just think about it and make a decision. Are you staying out of loyalty or comfort? Could there be a better fit out there? You won’t know until you try.

I would love to hear your comments below about how you handle difficult situations at work and what you would do if the handwriting is one the wall.

Office of the Inspector General Exclusion List (OIG List)

September 26, 2019 by LORIE A BROWN, R.N., M.N., J.D. 1 Comment

Lorie Brown, Nurse Attorney, discusses the Office of the Inspector General Exclusion List. She explains what it is, how it affects your nursing license and your ability to practice with Medicare/Medicaid patients. She also discusses what will get you on the List, tips to stay off the List, and the difference between mandatory and permissive exclusions. For more information read Lorie’s article at: https://yournurseattorney.com/medicaremedicaid-exclusion-list/

He Said, She Said … Who Do You Believe?

May 23, 2019 by LORIE A BROWN, R.N., M.N., J.D. 5 Comments

Shows a nurse and a doctor disagreeing and another nurse watching

One of the hardest things about representing a nurse before the Board is that anyone can make an allegation against the nurse and report it. Many times, these can be a “he said … she said” situation.

“The nurse gave me only 1 type of codone instead of 2!” “The nurse held my arms so tight; I got a bruise!” “The nurse took money from my wallet!” And the list goes on and on.

It is so sad that these allegations are made and the ones in the previous paragraph are just from patients. But coworkers can make allegations too. “I saw her drop a medication on the floor then administer it to a patient.” “My coworker was rude to a patient.” When a hospital hears about allegations from patients and staff about nurses, they are going to be concerned. In my experience, the facility usually takes the patient’s side and even if the complaint is unsubstantiated, frequently the nurse will lose their job.

How can you protect yourself from these allegations? Well, to be honest, I don’t have a magic answer.

I think part of the problem is the culture of nursing. The Board’s job is to protect the public and not the nurse. The hospital thinks the nurse’s job is to promote good customer service.

About the only advice I can give would be that if you have any concerns about taking care of particular patients, voice those concerns and see if you can have your assignment changed. It is not worth it to put yourself in a situation where a complaint can be made against you.

I frequently hear from nurse clients that a particular coworker or manager, “had it out for me.” Should you ever feel like you are in one of situations, it is better to leave the facility and find another job rather than to face an allegation.

I think it would be great if the criminal standard of being “beyond a reasonable doubt” would be applied to a complaint. However, it’s not. The Board can listen to hearsay and if there’s any concern about safety to the public, they will take action. It doesn’t seem quite right but that is what happens.

I think the best way to prevent circumstances is to avoid them. If you feel that you should have a witness while caring for a particular patient or when you are with a coworker, bring someone with you. Then, if you are ever called on the matter, you have some protection. Your license is too important.

How would you protect yourself in these types of situations? Have you ever found yourself at the center of such matter? What did YOU do? Let us hear your comments in the space below.

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