Tips in risk management: What you need to know
By Sue Dill Calloway, RN, MSN, JD
Nurse Attorney
Mount Carmel College of Nursing
Columbus, OH
[Editor’s Note: This column is the first of a two-part series on the basics of risk management for nurses. This month, we discuss documentation, good public relations, policies and procedures, and departmental communications. Next month, we will discuss state laws, accreditation standards, the Nurse Practice Act, state laws, and the Standards of Emergency Nursing Practice.]
Most health care facilities have a designated person to perform risk management. However, every nurse should practice good risk management skills.
This issue is so important that we were recently requested by our state’s board of nursing to put together some educational material on this topic that could assist nurses in this area. We ended up making a videotape that listed 40 tips in risk management that every nurse should know. (For ordering information, see resource box, p. 142.)
Knowledge of legal and risk management issues can help minimize legal liability and can help keep nurses and their employees out of the courtroom. Some of the recommendations discussed include the following:
• Documentation.
Whenever I’m asked to speak to a group of nurses and physicians on liability issues, I’m often asked what is the best way to keep out of the courtroom. There are two issues that immediately come to mind. The first issue is optimal documentation.
When patients are upset about the care rendered, they will often seek the services of an attorney. The attorney will request a copy of the medical records and send them to an expert to review. That expert sitting in his or her office or home reading the medical records is where the decision is made to sue or not to sue.
• Good PR.
The other recommendation that comes to mind is the importance of good public relations and communication. The literature had consistently held that patients will file a lawsuit when there has been bad public relations. Patients get upset if billing mistakes are not corrected, call lights are not answered in a timely manner, and they are not treated with dignity and respect.
• Policies and procedures.
Many plaintiff attorneys will subpoena the facility’s policies and procedures. Every nurse should be familiar with them. The plaintiff’s attorney will seek to use a policy to diminish the nurse’s credibility if the plaintiff can establish that the nurse was not aware of a policy and did not follow his or her own institution’s policy.
The polices should reflect the current standard of care. They should be reviewed periodically to make sure they are current. Policies should be clearly written and organized in a manner they can be easily located if the nurse needs to review the policy. New policies should be posted along with policies that are changed.
• Departmental communications.
Nurses should communicate optimally with other departments to avoid injuries. For example, consider that the nurse gives the patient morphine 5 mg IV and sends the patient to X-ray for an intravenous pyelography . The nurse needs to alert the radiology department of the medication so the employees can take appropriate precautions to avoid patient injuries such as falls. Critical lab values should be called to the nurse, who should communicate the results to the doctor.
Tell physicians about cancellations
Any canceled procedures also should be communicated to the physician. For example, a lawsuit was filed involving a case in which the computed tomography’s (CT) scanner was broken and the part was not going to be available for 24 hours. The patient had an order for a CT scan of the head. The next morning, the patient died from a cerebral bleed. The doctor would have sent the patient to another facility for the CT scan if he had known the machine was down.
In summary, knowledge of legal and risk management issues can help reduce liability exposure for the nurse and his or her employee. Every nurse should practice effective risk management strategies to make the facility a safer place.
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