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Sharing Care Safely: the medico-legal risks Liz Price Training, Consultancy and Business Services Manager Medical and Dental Defence Union of Scotland.

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Presentation on theme: "Sharing Care Safely: the medico-legal risks Liz Price Training, Consultancy and Business Services Manager Medical and Dental Defence Union of Scotland."— Presentation transcript:

1 Sharing Care Safely: the medico-legal risks Liz Price Training, Consultancy and Business Services Manager Medical and Dental Defence Union of Scotland


3 Risk Alert 1: Quarterly Review of Claims 1. Recording of Negative Results Family of a deceased patient disputed that a BP test had been carried out by our member. As there was no supporting record, we were unable to substantiate the members claim that the BP test had been carried out and was normal. EXPERT OPINION “It is becoming less and less acceptable to record only positive responses, partly for the obvious medico-legal reason but also because of fragmentation of medical care… : it’s helpful to any doctor seeing the patient later to have negative as well as positive findings recorded”

4 Risk Alert 2: Quarterly Review of Claims 2. Retention of Digital Records Three cases reviewed highlighted another records management issue. In each case records were lost when an existing computer system was upgraded. In each case our ability to defend the member was adversely affected by the lack of records. EXPERT OPINION “It is important that care is taken by members to ensure that existing records are archived so that they can be accessed and, where necessary, recovered.”



7 Risk Alert 3: Advice Calls 3. Practices failing to implement an effective date stamp/action system On several occasions, practices have failed to act timeously on hospital or lab correspondence due to failures within the workflow system in place. LEARNING POINT Before implementing electronic systems of dealing with correspondence, practices should: √ review the current system √ create a flowchart for the new system √ risk assess the proposed system √ train, implement, monitor and review

8 “Mother died shortly after visit to doctors” The Verdict Giving a narrative verdict that Mrs. X died of heart failure caused by renal failure, the coroner said: "In my opinion three mistakes were made by the surgery. First they failed to contact Mrs. X the day before her death and this was not passed on to the doctor who requested to see her. Second the doctor who had made the request forgot about it and there was no system in place to remind him Finally the system was not effective so Dr A was not made aware of Mrs. X test results before he saw her on the morning of her death." “THE family of a 45 year old woman who died of kidney failure say they were let down by a basic lack of communication at one of the town's doctors' surgeries…. The mother-of-two died just over an hour after visiting the Medical Centre on March 23 last year” “ As…(the coroner)…said, this could happen in any surgery in the country and we are very concerned that another family may have to go through what we have “

9 Risk Alert 4: Complaints 4. Alleged alteration of computerised records after a patient death The son of a deceased patient alleged that a GP had altered his fathers records after hearing that the patient had passed away. The complainant approached EMIS directly for access to the audit trail and EMIS refused as GP permission was required. This unfortunately resulted in the complainant perceiving there was something to hide. LEARNING POINT Practices should: √ be proactive in dealing with complaints √ have rules in place for deleting information from patient records √ have rules in place for deleting information from patient records √ highlight awareness of these issues in the practice

10 Risk Alert 5: Advice Calls 5. Erasure of patient records from hardware This applies to recycling and destruction of computer hardware but also to data no longer required to be kept on current systems. Often, for example, significant events and reports are removed from surgery computers but are still traceable and thus not really destroyed. LEARNING POINT Practices should: √ investigate methods of securely erasing data from old hardware √ ensure they are aware of the risks above and therefore who has access to hardware when it is recycled √ raise awareness of these risks within the team

11 Risk Alert 6: Advice Calls 6. Destruction of paper records Patient records have turned up in inappropriate places when practices thought they had a system in place to destroy them. LEARNING POINT Practices should: √ purchase their own high security in-house shredder √ investigate properly external providers of paper destruction services √ ensure they have in writing a description of the destruction process and have reassured themselves of confidentiality

12 Risk Alert 7: Advice Calls/ Coroners Inquest 7. Lack of team training, competence and awareness of systems involving electronic records Examination findings tend to be briefer and hard to justify in hindsight if dealing with a complaint or claim. Some users have been found to be unfamiliar with aspects of the IT system itself – or the practice policies/systems surrounding it. Users have failed to enter information properly and/or failed to access existing information. LEARNING POINT Practices should: √ check all team members are fully trained and competent √ ensure all team members are involved in creating and implementing practice systems/ electronic workflow etc √ raise awareness of these risks within the team

13 The debate clear benefits of electronic records vs regulatory requirements common law duty data protection act security issues

14 “Patients fear safety risk from electronic notes” “In findings from a poll of 200 organisations worldwide (50 in the UK) by a network of patient groups, 62% of groups believed patients should be able to decide who can access their own electronic record” “Concern that medical records will fall into the wrong hands is greatest among groups representing people with disabilities, HIV or mental health problems, who already face stigmatisation. They fear that if confidential information is intercepted electronically that their members could face greater discrimination” “A poll of almost 2,000 patients by the BMA found that 75% had concerns about the security of information on the care records system” Society Guardian, Nov 2005

15 GMC Confidentiality: Protecting and Providing Information Patients have a right to expect that information about them will be held in confidence by their doctors. Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality, patients may be reluctant to give doctors the information they need in order to provide good care *** If you are asked to provide information about patients you must: inform patients about the disclosure, or check that they have already received information about it *** anonymise data where unidentifiable data will serve the purpose be satisfied that patients know about disclosures necessary to provide their care, or for local clinical audit of that care, that they can object to these disclosures but have not done so seek patients' express consent to disclosure of information *** keep disclosures to the minimum necessary *** keep up to date with and observe the requirements of statute and common law, including data protection legislation *** Sharing information in the health care team or with others providing care Most people understand and accept that information must be shared within the health care team in order to provide their care. You should make sure that patients are aware that personal information about them will be shared within the health care team, unless they object, and of the reasons for this. It is particularly important to check that patients understand what will be disclosed if you need to share identifiable information with anyone employed by another organisation or agency who is contributing to their care. You must respect the wishes of any patient who objects to particular information being shared with others providing care, except where this would put others at risk of death or serious harm

16 Q & A

17 Risk Management Good

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