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Risk Management and the Advanced Practice

Professional

Diane Moat, Director, Clinical Risk Management

Chery Salmon, Clinical Risk Manager

Christie Schenk, Asst. Director, Risk Management

Risk and Insurance Management

Vanderbilt University Medical Center

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Objectives• Identify primary Risk Management Office

functions/roles• Identify common reasons people hire an

attorney• Identify and discuss documentation practices-

VERITAS and Medical record• What to do when something happens• When to notify Risk Management of an event

– What happens next?.

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Risk Management Office Functions

• Workers’ compensation• Professional liability investigations• Occurrence reports• Trending events and issues to

proactively initiate change• Staff and physician education

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VUMC Med Mal Coverage

• Self insured trust; occurrence-based$ 5.5M per occurrence

• Add’l (Excess) thru various insurers• Provided for staff/physicians acting within the

course and scope of their duties as VU employees

• Excluded: criminal acts; acts during any suspension of medical privileges

.

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Anatomy of a Malpractice Claim

• Duty

• Breach of the standard of care

• Injury/damages

• Causation – the breach caused the injury

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Medical Malpractice Notice and Certificate of Good Faith Statute

• Plaintiff must provide Notice 60 days prior to filing a Complaint (lawsuit)

• A Certificate of Good Faith must now be filed with the Complaint

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Why do patients hire an attorney?

• Communication problems

• Problems regarding the bill/finances

• Hearing criticism from other healthcare providers

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Communication Problems

• When an event occurs, it helps to have a coordinated response.

• Patients/families hire an attorney when they feel they have unanswered questions and/or conflicting information.

• Use your resources if patients/families have unanswered questions.

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Billing questions/issues• When an unexpected event occurs,

patients/families often ask if they will be billed for that care.

• Do not make promises regarding bills, but contact the Office of Patient Relations or Risk Management for guidance.

• You may also directly refer patients or families to OPR if they are dissatisfied.

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Criticism from other Healthcare Workers, aka “Jousting”

• Frequently these are “non-verbals”

• May be statements that were not intended to be criticisms.

• Examples: Referring to tests that have not been performed “yet,” or physicians who have not been in to see the patient

• Referring to how busy or short staffed the service is

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What to do when an event occurs• First, care for the patient…• Report the event –

Management, MDs, AC, VERITAS• Record the event in the chart (VERITAS vs.

medical record-there is a difference)• Enlist support for help in dealing with patient,

family• Manager• Administrative Coordinator• Patient Relations• Risk Management

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Risks Specific to APNs

• Consults/referrals

• Scope of Practice “drift”

• Procedures

• Documentation

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What you document DOES matter!

Pt given a massive dose…10x more than needed…put [pt] at significant risk… additionally pt didn’t get [another treatment]…I plan on reporting this… this is inappropriate and exposes the patient to…a boatload of other risks…

• What should have been documented?

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Still more documentation…

We had a very long conversation, including my profuse apologizing for our gross negligence. I told her this is not our standard of care, nor the level of care she should expect from us.

What should have been documented?

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Documentation Examples• Patient fell out of bed, no c/o.

• Better: Patient found sitting next to the bed. Patient denies pain, states “I thought I could make it to the bathroom.” (Document assessment) DrX notified at 1430, will assess patient on rounds.

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Documentation Examples (Cont.)

• Patient requesting earlier appointment because it’s our fault she has to drive back here. Are you feeling better? The whole department has been out with the flu.

• Better: Patient requesting earlier appointment, has to drive a long distance.

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What to document when an event occurs

• In the medical record:– Objective facts. Document only what you know.– Do not document a VERITAS report or contact with

RM.– Use narratives as needed.– What information would future medical care givers

need to know to provide care?

• VERITAS– Confidential.– What do you want your manager or RM to know

about this event?

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Reminders about documentation:

• Do not keep your own notes or narratives on events

• Do not email event details or patient information to anyone, including your manager.

• Do not take photographs of patients with cell phones or personal cameras

• All documentation needs to be through the medical record (except VERITAS)

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A Few Words About Social Media

• Posting or messaging about patients puts you at risk.

• Not protected, completely discoverable.

• Potential HIPAA violations (which then have to be disclosed to patient/family)

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A recent example…

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And the reply…

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When to Notify Risk Management

• Unexpected event where there is potential or actual harm to the patient

• You have concerns about an event

• If you wonder if you should notify us

How to reach us:

• VERITAS or phone call

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What happens next?• Your VERITAS report will be reviewed by

RM, as well as the reviewer for a specific location or event type.

• Example: Trauma patient from ED with a medication event– RM– 10N reviewer– ED reviewer– Pharmacy

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Your questions and comments

Main Line: 936-0660

After-Hours Number: 878-0705