Reduce your risks with policies, procedures
Nurses should also be aware of the facility’s policies and procedures as these have been used in the court room to show the standard of care, notes Sue Dill Calloway, RN, MSN, JD, a nurse attorney at Mount Carmel College of Nursing in Columbus, OH.
The plaintiff may use a policy a nurse has not followed to show a breach of the institution’s own standard of care, Dill explains. Here are risk management issues to consider pertaining to your ED’s policies and procedures:
• Orders.
Proper orders should be initiated promptly, Dill advises. "However, improper orders should be deferred," she says.
The ordering practitioner should be informed when the nurse believes the order is improper, and why the nurse thinks the order is improper, Dill says.
If the order is not changed and the nurse believes the patient would be injured by the order, the nurse should use the appropriate chain of command. "Every facility should have a policy outlining the chain of command that should be used to prevent patient injury," Dill cautions.
What makes up a sentinel event?
• Sentinel events.
Every nurse should know what constitutes a sentinel event, Dill urges. A sentinel event is a term that has been coined by the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, as an unexpected event that results in patient injury or death or the risk thereof.
It could include serious physical harm or emotional harm, Dill says. "An example would be a nurse who accidentally injects potassium chloride IV push instead of a drip, and the patient dies," she says. Inpatient suicide is another example, Dill adds.
The staff should know what to do and whom to report to when a sentinel event occurs, advises Dill. "This is important because the facility has only 45 days to write an extensive report known as root cause analysis and action plan," she says.
Staff should be familiar with the 10 most common sentinel events. They are as follows: inpatient suicide, medication errors, operative/post operative complications, wrong-site surgery, delay in treatment, death in restraint, elopement death, assault/rape/homicide, transfusion death, and infant abduction or wrong discharge.
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