RISK MANAGEMENT OVERVIEW 2014 Louise E. Swensen, JD, MS, CPHRM Associate Director

 Role of Risk Management in the Hospital  When to call Risk Management  Medical Malpractice & Disclosure  Informed Consent  Communication & Documentation

 Review all serious patient events (incident reporting system)  Patient complaints and grievances – work with Customer Service  Handle all visits from UDOH, CMS, DOPL, FBI, etc.  EMTALA investigations  Work with Quality to do mandatory State reporting  Review patient legal documents – custody, guardianship, etc. in conjunction with the OGC  Involved with device & product recalls

 Unanticipated, negative outcomes  Neurological injury  Medication errors  Falls  Maternal/fetal injury or death  Implant device failures  Patient injury  Patient or family threaten to sue

 Is professional negligence by ACT or OMISSION by a Health Care Provider which deviates from accepted standards of practice in the medical community and causes injury to the patient.  Is not the absence of a “perfect result.”  Is not the occurrence of known complications.

 Failure to diagnose  Failure to refer  Procedure complications  Failure to obtain informed consent  Inadequate communication  Inadequate history and physical  Patient dissatisfaction with outcome/unrealistic expectations

Interns and residents are named in about 30% of the Notices of Intent/Notices of Claim filed against the University each year.

 The Hospital and SOM have established self- insured trust funds for malpractice coverage  Excess coverage is purchased above the trust fund amounts through a commercial carrier  Coverage applies when you are working within the course and scope of your employment at the University

1. Duty 2. Breach of the Duty ( Standard of Care) 3. Injury (breach is the proximate cause) 4. Damages

1. Take care of the patient 2. Contact Risk Management for help with disclosing to the patient/family 3. Document thoroughly and carefully including the physical assessment of the patient. 4.“Privileged” conversations - QI, M&M, RCA 5. Don’t make copies of Patient Safety Net (PSN) (incident) Reports or refer to them in the medical record

When asked if anything could have been done to avert legal action, 37% said an explanation and apology would have made a difference. In another study, 24% said they filed when “they realized the physician had failed to be completely honest with them about what happened, allowed them to believe things that were not true, or intentionally misled them.”

 Treatments performed  Medications ordered & given  Procedures performed  Evidence of patient’s overall condition & response to treatment  Lapses in care  Inappropriate care  Inconsistencies/discrepancies

 Notice of Claim/Notice of Intent  Pre-litigation Panel  Complaint  Discovery  Trial

 In Writing  Nature and Purpose of the proposed Procedure  Discussion of Risks, Benefits, potential Complications & Alternatives  Who will perform the procedure  Opportunity to ask & have all questions answered  Emergency Exception

The medical record is meant to be :  A complete, accurate, up-to-date documentation of the medical history, condition, and treatment of each patient.  The primary means of communication for the healthcare delivery team.

 Follow organizational and departmental policies  Maintain continuity of care  As soon after the event as possible  Timely entries: ◦ Are more believable ◦ Enhance communication and improved quality of care

◦ Never obliterate, alter, or destroy original note ◦ Never use correction fluid or tape ◦ Single line through incorrect entry ◦ Sign & date (& time) the change

 Don’t ever destroy evidence  Don’t ever change the medical record  Do label any addition to the medical record as a ‘correction’ or ‘late entry’ or ‘addendum’  Do time and date your entries in the medical record  Do chart objectively

 Don’t criticize or question care by others in the medical record  Do chart patient non-compliance  Do chart complications objectively without assessing fault  Do chart notification & involvement of other physicians or other health care providers  Don’t editorialize about the patient

 Don’t use the medical record as a battleground to settle grudges with other members of the treatment team.  The professionalism of the treatment team should be reflected throughout the medical record documentation.

“11/23/83 [pt’s name removed] states that there is some discomfort over the tip of the ulnar styloid of her right wrist and she complains of some vague pain over the dorsum of her right hand. I think she may just be a chronic complainer. She does not have exactly the same pain as before but she is just full of one problem after another and I am unable to ascertain exactly what her bitch is at this time, but I think its mostly a vague discomfort so therefore we’ve removed the cast, placed her in a protective splint. We’ll start active PT on Monday.” M.D.

Any questions, any time... Contact Risk Management