Here's how to reduce your liability
Avoid these 15 legal pitfalls
Case managers working with elderly clients face unique liability risks, says Tonia D. Aiken, RN, BSN, JD, president of RN Develop ment in Metairie, LA. There are 15 areas of health care liability that commonly cause problems for health care professionals working with the elderly, she says. While several of these areas clearly apply to health care providers, many are relevant to case managers. Those 15 areas are:
1. Failure to adopt a care plan to the specific needs of the elderly. "When you prepare a care plan, be careful not to guarantee outcomes," Aiken cautions. "Always offer some deviation, or patients and their families may hold you responsible for failure to meet promised outcomes under a claim of breach of contract."
2. Failure to adequately assess and implement a care plan. "Be certain when you develop a care plan that you gather all the necessary records," she says. It's important to be thorough.
3. Failure to evaluate the patient's condition and modify care to prevent deterioration and maintain health. "Simply developing a care plan is not enough. Case managers must modify care plans over time, as necessary. If your patient's needs change, the plan must be modified to reflect that."
4. Failure to administer medications in a timely and proper manner. "Drug toxicity is a key problem in the elderly," she says. "Drug levels aren't drawn. The patient overmedicates and dies."
5. Failure to observe and detect multiple interactions of drug therapy. "Polypharmacy is another special concern with elderly patients."
6. Failure to document in a timely and proper manner the patient's condition, care and treatment rendered to the patient, and the patient's response to treatment. "In addition, to proper documentation, you must follow state laws regarding reporting of such issues as elder abuse," she notes.
7. Failure to follow facility or organization policies and procedures. "You must be aware of all the policies and procedures for your facility or organization. If a claim is filed, an attorney will look for evidence that you breached your own policies."
8. Failure to document appropriate teaching, including patients' responses and evidence of their understanding. "I recommend that you have a duplicate teaching form for the patient to sign and date indicating that they have been instructed on this date," Aiken says.
9. Failure to adequately protect the patient who is sedated, confused, or disoriented.
10. Failure to go through hierarchy to get appropriate and timely treatment. "Negligent referral is a big area of potential liability for case managers. If you know a patient needs treatment, you must not only advocate for treatment, but also check out the facility and the physician. You need to make sure that you continuously monitor these providers. Document your evaluation process." (For more on case management liability and patient advocacy, see stories, pp. 116 and 113.)
11. Improper use of restraints. "If restraints are used, you must show that the patient is a danger to himself or others. You must also show that you have unsuccessfully tried other methods to curb dangerous behaviors. There must be clear policies and procedures in place for the use of restraints. You must also monitor and document the patient's condition properly. Strangulation, skin breakdown, and death can result from improper monitoring of restrained patients."
12. Failure to provide timely and proper skin care to prevent decubitus ulcers, which can lead to amputation, sepsis, or death. "Many cases result from decubitus cases. There's improper skin care, poor documentation, and nurses fail to pick up on signs and symptoms," Aiken says.
13. Failure to properly assess, monitor, and take safety measures to prevent falls and injuries. "This is particularly an issue in home care. You must check out the home for potential safety issues. Document your findings in the home and the patient's functional capacity the day you visited," she adds. "Many elderly patients go in and out. They have good days. You may have visited on a good day and the patient seemed quite competent to care for themselves in the home."
14. Failure to prevent patients from burns. "Elderly patients are susceptible to burns from hot water bottles, heating pads. You often are dealing with people who have a lack of sensation in their extremities. There was even a case where a nurse allowed a patient who was paralyzed from the waist down to smoke a cigarette. He dropped it in his lap."
15. Abandonment of patients. "The unilateral definition of abandonment is discontinuation of care by a health care provider without the patient's consent," Aiken says. "However, it's not really clear in the law what constitutes a true sense of abandonment."
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