Mock trials show staff legal fallout from errors

Nurse Leader Insider, July 1, 2005

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The last thing you want is your staff member sitting in a courtroom defending medical errors using spotty documentation.

At Saint Francis Hospital in Charleston, WV, Director of Risk Management Patricia Skaff thought getting nurses and other medical staff into a courtroom might give them better perspective on the fallout from a medical error and the importance of thorough documentation, so she developed a mock trial to be held during a patient safety fair.

The hospital's patient safety team devised a fictional case in which a patient with multiple ailments was admitted to the hospital. The patient suffered a fall and became trapped in the bed equipment. The patient then developed a decubitis ulcer and died. Documentation of the case was intentionally kept vague and incomplete, says Skaff.

Staff were divided into jury members, witnesses, and an audience. The witnesses were given the record to review before they were questioned by the lawyers. The hospital's legal counsels played the part of both the defense attorney and prosecutor. The trial was staged four times during the day. Each time, the jury found in favor of the plaintiff, says Skaff.

"They could not justify anything but a plaintiff's verdict," she adds. "They were devastated but had no choice if they followed the law."

The plaintiff's attorney ruthlessly highlighted errors in the reporting and in the care of the fictional patient. The defense attorney was equally pointed in defending the hospital's actions. "The audience was kind of in shock when they saw how aggressive the attorneys could be with what they thought was an honest mistake in the documentation," says Skaff.

Staff now look at even minor problems in a new light, she said. A patient slipping on the floor can lead to serious consequences unless everyone follows the hospital's policies and procedures. The trial showed how small, seemingly isolated incidents can come together and lead to a terrible outcome for a patient and, ultimately, the hospital.

Source: Adapted from Briefings on Patient Safety (July 2005), published by HCPro, Inc.

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