No one wants their agency sued or your business practices called into question. The reality is, we live in a very litigious society and healthcare is a target. No one wants to see a loved one decline even if the prognosis expects it. It is sometimes easier for those in the grieving process to blame the agency or clinicians providing care than to accept the decline or loss of a family member. So, your agency needs to protect itself by identifying potential vulnerabilities in policies and documentation. So, let’s take a look at how a nurse expert witness reviews your documentation.
3 Major Things The Nurse Expert Will Be Reviewing:
First of all, it’s a long list. Here is a narrowed down those items often seen as an issue when the nurse expert witness reads the chart:
1. Interrater Reliability: This may be the biggest landmine for agencies to deal with if a lawsuit comes into play. Seeing discrepancies in how something is categorized and how it is treated between clinicians is a big red flag. Your Oasis needs to look like the patient in front of the clinician. It doesn’t make sense that an end stage COPD patient has no notable shortness of breath. Better yet, wound care is huge here. In reviewing legal cases, we have seen where the same wound is categorized in 3 different ways: pressure, stasis, and surgical. However, in complete chart review, it should have been listed as pressure the entire time. This same chart has Braden assessments completed that do not match the rest of the documentation related to patient status. This leads to treatment regimens that do not match best practices for the type of wound listed. It also puts your clinician in the hot seat for his or her ability to properly assess and characterize the type of wound present. The physician is often making treatment decisions based upon the recommendations of the home care nurse’s assessment. This is a big problem when interrater reliability isn’t there.
2. Policy: The nurse expert witness is going to review your policies to see if your care followed your protocols. If your agency pivoted from policy, then you are at risk even if what you did for the patient was within the scope of appropriate patient care. The reviewer may identify a pattern of practice that doesn’t follow your policy. Let’s consider hospice this time. Your agency may have contracts with your DME providers to teach the patient equipment use when it is delivered to the home. It is ultimately the responsibility of the hospice to make sure the patient/ caregiver know how to safely use equipment. Should harm come to the patient because equipment wasn’t used correctly, your agency will be sued if you cannot prove that you verified the competence of the patient/ caregiver to utilize the DME. It is our experience that many times, the hospice nurse may not be reviewing the information with the patient as it is assumed the DME provider did it.
3. Best Practice: The nurse expert witness will look at the type of treatment provided to the patient to determine if best practices were used. For example, let’s consider wound care again to clarify this point. Let’s say you have a wound with a treatment that is considered outdated or cytotoxic. If you do not make the attempt to contact the doctor for a more appropriate treatment and the wound deteriorates requiring rehospitalization and subsequent surgery, then you are greatly at risk. Did you educate/coordinate additional nutritional supplementation and appropriate support surfaces? Are you accurately documenting when there is non-compliance? We have reviewed charts where a wound has declined and ultimately caused the demise of the patient. The clinical staff reported the patient and caregivers were monumentally non-compliant with the treatment regimen. However, it was documented one time in the chart even though the patient was seen over the course of 6 months. It doesn’t matter at that point if the patient was at fault, your agency will be encouraged by your insurance provider to settle the case.
Ok, So What Next:
Look at your charts with objective eyes. Consider that you are on the opposite side of the courtroom than your agency. Review your charts for interrater reliability, policy compliance, and best practices to see if you are vulnerable. If you find vulnerability, determine if it is clinician-specific, policy related, or related to your overall documentation protocols. This will help you decide if you need to provide individual coaching or if it needs to be for clinicians agency wide. If it is policy related, determine if your clinicians don’t follow policies or whether or not your policies are outdated. Outdated policies and procedure manuals can cause you problems at survey and most definitely in the courtroom. If it has been years since you updated yours, then it is time to consider purchasing an online manual you can edit specifically to your agency but includes all updated federal regulations.
Kenyon Homecare Consulting Can Help:
Ay Kenyon Homecare Consulting, we focus high-quality patient care and have nurse expert witnesses who work with agencies providing documentation education to clinicians while helping agencies determine vulnerability in legal action. Should you need individual consulting from one of our senior consultants or need and updated policy and procedure manual, give us a call today at 206-721-5091 or contact us online to see how we can help you stay out of the losing side of the courtroom.