Malpractice Prevention. Health, Medicine and Nursing Essay.

Malpractice Prevention

 
Medical malpractice is the failure of a healthcare professional to exercise such care as would a reasonably prudent healthcare professional under the same or similar circumstances. Malpractice is determined by standards of care, expert witness, national guidelines, and consensus opinions.
In today's medicine, nurse practitioners are facing increasing demands to interact with more patients, return more calls, review more charts, and perform more duties. In a study conducted at a major teaching hospital, over a nine-month period, an error was made on 50% of patients. Out of these errors, 18% of the practitioners suffered a serious consequence and 1% were sued for malpractice
Why Do People File Malpractice Claims?
There are multiple reasons as to why people file malpractice claims. They include:
Expectation: plaintiff expects a better outcome.
Investigation: plaintiff wants to see if anyone is at fault.
Blame: plaintiff wants to place fault on someone else.
Retribution: plaintiff wishes to punish the nurse.
Remuneration: plaintiff wants money.
Institutionalization: plaintiff wishes to punish the system.
The Nurse Practitioner's Liability
Today, more and more cases are being filed against nurses. Nurse practitioners are increasingly being named in malpractice suits even when at first appearance the nurse practitioner does not seem negligent or even involved. Malpractice attorneys often name anyone and everyone remotely connected with the case. For them, it is easier to let defendants fall out of a case than it is to bring them in later. As quoted in the CLE Program for Attorneys, "Midwives, Nurse Practitioners [...] are not always employees of hospitals or attendings and may actually be independent medical practitioners. Even when they are employees, you may consider naming them as defendants since they may have their own insurance policies.
Some statistics:
Approximately 50% of all claims are unfounded and have no basis.
Approximately 20% have some merit but will not reach a settlement or trial.
30% will be resolved either out of court or in trial.
1.4 per 1,000 nurse practitioners have claims filed against them, compared with 2.4 per 1,000 physician assistants and 19 per 1,000 physicians.
Many states, about 50%, have imposed caps on damages as a means to reduce amounts paid to plaintiffs. This, in turn, reduces premiums. Some states have shared fault in which the award is reduced by the percentage the plaintiff was found to contribute to the outcome.
National Practitioner Data Bank
The National Practitioner Data Bank is administered by the U.S. Department of Health and Human Services and is designed to prevent negligent health care professionals from moving across state lines for practice. It contains information on licensure, malpractice payments, professional memberships, clinical privileges, and drug enforcement action.
How does it work?
When you apply for a job, the prospective employer queries the data bank. You can query your own record at The National Practitioner DataBank (NPDB) (Links to an external site.)Links to an external site.to make sure it is accurate.
Hospitals are required to query the data bank every two years for any health care professional employed or on staff. The JCAHO 2003 mandates the same for long-term care facilities and sub-acute facilities.
A malpractice payer must report any payment made on your behalf to the data bank. He or she will incur a $10,000 fine if this is not done.
Protecting Yourself from Malpractice
Remain Within Your Scope of Practice
The Nurse Practice Act is a state law that regulates the practice of nursing. Each state has a different scope of practice. The Nurse Practice Act provides general guidelines regarding those duties which can be performed by the nurse or nurse practitioner. Your employer has the right to restrict you to a narrower scope of practice, but cannot expand your scope beyond the Nurse Practice Act.
To be sure you are remaining in your scope of practice, ask yourself the following when you are performing a job or function:
Am I qualified educationally and experientially to be performing this task?
Could I defend my education and this task/job in court and would the jury believe I am qualified?
Documentation
Documentation is crucial at a malpractice trial. It provides a record of the quality of care provided. A lack of documentation can make you vulnerable to a malpractice claim. All notes and prescriptions within your documents must be legible.
Document all items including patient no shows, canceled appointments, and telephone calls made to patients. Letters that are sent as reminders to patients of particular testing that needs to be done should also be documented. Keep copies of these in the patient's chart.
Always document discussions trying to get the patient to improve adherence. Be sure to document the patient's verbal responses. Also document a patient's refusal of care. Take note that you have explained the risks, benefits, and alternatives of treatment. Also discuss and document the risks of refusing treatment.
Other Ways to Protect Yourself from Malpractice
Keep up with the latest treatment options.
Be sure to review textbooks and journals. Discuss cases you read about with colleagues. Participate in continuing education programs and use online resources, such as the Agency for Health Care Policy and Research (AHCPR) Guidelines, to stay informed.
Follow up on "high ticket" items.
It is the nurse practitioner and physician's responsibility to follow up on potentially serious problems. This is true even if the patient does not complain of continued symptoms. The duty to follow up with the patient is yours until the issue has been resolved.
Be sure to always maintain confidentiality.
Any breaches in confidentiality can result in a malpractice claim. Examples of confidentiality breaches include discussing a patient where others can hear, releasing information without permission, leaving a message on an answering machine, discussing a patient's condition with family members, leaving a record in view of others, and not shredding documents.
Avoid the risk of negligent nondisclosure.
If you examine a patient and find an abnormality, you must inform the patient of it. All facts to assist the patient with making decisions regarding the problem need to be provided.
Always obtain informed consent.
Informed consent is a document that establishes proof that the procedure was discussed with the patient, including its risks and benefits. Informed consent allows patients or proxy to ask and have all questions answered. No coercion should be involved and the person performing the procedure must be involved in the informed consent process.
Warn patient of side effects.
Make patients aware of side effects of medication. In one instance, a psychiatrist prescribed a medication which called for a warning to avoid driving or operating heavy machinery. The psychiatrist failed to provide the warning to the patient. The patient took the medication, drove, and caused an accident that injured a third party. The third party sued the psychiatrist for malpractice and won (Buppert, C. Nurse Practitioner’s Business Practice and Legal Guide, 1999).
Use the 4C's to remember how to protect yourself: Caring, Communication, Competence, and Charting.
Malpractice Insurance Policies
Any nurse who works in more than one job should have their own malpractice insurance policy. Nurses who perform volunteer work should also have their own policy. However, most experts now recommend that even if your employer has a malpractice policy for you, you should consider investing in your own policy.
Benefits of an Individual Policy
Covers defense costs not normally covered by an employer.
Covers you as a volunteer.
If you have more than one job, it travels with you.
You will be appointed your own lawyer.
Pays up to $500 per day while you are unable to work.
Covers any amount exceeding an employer's plan.
Drawbacks of an Individual Policy
Some experts propose that you may be more likely to be sued if you have your own policy, however there is a lot of controversy regarding that premise.
Ethics and Advanced Practice Nursing
At the core of the profession, nurses deal with issues and situations that have elements of ethical or moral uncertainty. Ethics and morals are often used interchangeably, but are always contextual.
Nursing is an ethical enterprise because it involves choosing alternative actions in the treatment of human beings in a world where resources are limited. Nurses have a unique relationship to the patient that requires the APN to extend beyond the technical demands of practice and into the patient's world.
Ethics Principles
The 1979 Belmont Report outlines three ethical principles for any research involving human subjects. These ethical principles can also be applied to the nursing profession. An additional principle of fidelity is included in nursing.
Autonomy: respect for all persons or "self rule." This gives patients the right to decide what happens to their bodies. Autonomy guides informed consent, confidentiality, and the right to the truth.
Beneficence: doing no harm. This principle includes maximizing benefits for the patient; minimizing risks and using an "I know what is best for you" point of view.
Justice: fairness to everyone. Justice includes also treating everyone equally, including vulnerable populations. The issue that arises, however, is defining what is fair. Consider if treatment for all is the same or if preference is given to the disadvantaged? How does fairness affect decisions made in ER triage situations?
Fidelity: faithfulness. This added principle for nurses includes commitment to one's professional obligations, adherence to the terms of an agreement, and faithfulness to one's autonomy.
Ethical Decision Making
Ethical dilemmas occur when two or more morally acceptable courses of action are present and to choose one, prevents selecting another. Dilemmas exist when difficult problems have no satisfactory solutions or all appear equally favorable.
Making ethical decisions is a process of value awareness and clarification. Nurses must also understand basic human rights and identify any culture, interprofessional, and organizational barriers involved and address them as needed.
Steps in Ethical Decision Making
Identify the health problem.
Identify the ethical problem.
Identify your role.
State what principles are involved.
Consider alternatives and consequences.
Make the decision.
Consider how the decision fits with your philosophy and beliefs, the Nursing Code of Ethics, and the mission of the institution.
Implement.
Evaluate consequences and use this information in the future.
After reviewing this week’s required readings on malpractice insurance, what questions or concerns do you have about the process?