Communication can reduce risks in a crowded ED
There is no question that ED overcrowding increases legal risks. "In a busy ED, communication is key to avoiding a lawsuit," says Debra A. Gray, RN, MSN, LNC, principal of Gray's Analysis, a Beaverton, OR, legal nurse consulting company. She gives these five tips to reduce risks:
• Acknowledge and address particularly critical information from the triage nurse or pre-hospital providers, other ED providers, patients, and their family members.
• Although written documentation of critical information, including your own assessment and findings, might be available to the ED physician, bring particularly important information to the physician's attention verbally.
"Otherwise, it may be alleged that you were negligent in failing to timely inform the ED physician of this information," says Gray. "Of course, the physician is also liable for failing to read and take this information into account."
• Remember that it is your responsibility to independently assess the patient's medical status.
"Question any physician order that is unclear or appears inappropriate, especially when there has been a significant change in the patient's condition," says Gray.
• Be honest with your nursing supervisor, and only accept clinical assignments that you are competent to perform.
"If you lack the training to use a certain piece of equipment or to perform a certain procedure, say so," says Gray. "Then follow up and obtain the needed advanced skills or training."
• Be honest concerning your "fitness for duty.'"
"Minimize fatigue and stress, which can be exacerbated during times of ED crowding, by scheduling yourself to work no more than 12 hours per day and a maximum of 60 hours in seven days," says Gray. "Medication and other errors are more likely to occur when you are tired."
Is there a 'suit waiting to happen' in waiting room? Take these steps when your waiting room is crowded, advises Mariann Cosby, MPA, MSN, RN, PHN, CEN, NE-BC, LNCC, CLCP, CCM, MSCC, principal of Sacramento, CA-based MFC Consulting, a legal nurse consulting company. Cosby is also a practicing emergency nurse.
"This will expedite the care and provide the physician with data needed for disposition and reduce delays," says Cosby.
Chris DeMeo, JD, a health care attorney at McGlinchey Stafford in Houston, says, "With wait times in the ED increasing, nurses should be cognizant of the necessity of continuing documentation showing the progression/stability of any condition." |
Which patients are yours? Make it crystal clear You don't want any "grey area" when it comes to which patients you are responsible for. This responsibility must be clear while you're caring for them, and later on. "Sometimes, patients 'crash' or a code situation arises, necessitating a lengthy stay at that patient's bedside," says Debra A. Gray, RN, MSN, LNC, principal of Gray's Analysis, a Beaverton, OR, legal nurse consulting company. "In such instances, you may need to hand over your other assigned patients to the charge nurse or someone else to cover." To clearly establish which nurse has a duty to which patient at particular points in time, you should chart the time you reported off to that particular nurse," she says. "You should also chart the time you later receive report back from a particular nurse who has been covering for you." Documentation of such report times also can be helpful when patients are placed in your zone and assigned to your care without your knowledge, says Gray. "However, you should also address and rectify this situation with all parties involved, so that this dangerous practice does not continue." |
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