Home Health & Hospice

Insider’s Scoop: Adverse events: When bad things happen to good nurses

Homecare Insider, August 31, 2015

Editor’s note: This week’s Insider’s Scoop was adapted from one of HCPro’s popular home health titles, Clinical Documentation Strategies for Home Health, reviewed by Elizabeth I. Gonzalez, RN, BSN. The complete volume equips nurses and other home health clinicians with the tools they need to produce documentation that reflects quality care, withstands regulatory scrutiny, and lays the groundwork for receiving earned reimbursement. For more information or to order, call customer service at 800-650-6787 or visit www.hcmarketplace.com

People expect safe and responsible care whenever they enter the healthcare system. They hold everyone in it accountable for the outcomes they experience—both the good and the bad.
If an organization has a systematic, well-coordinated quality and risk-management program, it demonstrates to the public a commitment to upstanding care. In addition, if an organization builds its policies, practices, and guidelines on evidence-based standards, it reduces its risk of liability.
The most common problems that occur during the course of providing patient care include adverse drug events, infections, suicide, falls, burns, and pressure ulcers. Incidents with serious consequences are most likely to occur in the hospital; however, patient care errors can occur in any nursing care setting—including home health.
In addition to the legal ramifications, medical errors cost nurses and agencies at large in the form of lost confidence, fear, and anxiety about not being able to provide the best care possible. Loss of public trust, in turn, places the home health nurse in a vulnerable position, charging the individual—not the system—with the lapse.
We have not yet cultivated a blameless approach to medical errors. Until we regain the trust of the public by creating safe, foolproof patient care systems, medical errors will continue to spawn claims of malpractice or negligence. Supervisors of clinical services or nurse managers will be held accountable for ensuring safe patient care processes, and nurses will be held accountable for actually providing that care.
Therefore, when an adverse event occurs, it is important to follow your organization’s policy regarding responding, reporting, and recording—a quality and risk-management responsibility that extends to all employees. If you are in a nursing management role, you will be culpable for an event if you do not follow the policy as stated. The following are a few examples of the types of events that should be reported:
  • During ambulation of a patient, the individual hits the bedside table with his arm
  • Your home health aide reports that a patient was found on the floor
  • Shortly after administering a medication to your patient, you note a mild reaction of a rash, itching, and skin warm to touch
  • During a procedure, the equipment involved does not function properly
Whenever there has been an adverse event, your organization’s policies will be reviewed by the department of public health, the board of nurse examiners, and—if the given case suggests negligence—agency attorneys. You can protect yourself against culpability during these activities by demonstrating:
  • Accurate documentation in the clinical record
  • Accurate, timely incident reporting
  • Compliance with established policies
  • Cooperativeness in the follow-up investigation
Risk-Reduction Strategies
To prevent adverse events from occurring in the first place—or to mitigate fallout in their aftermath—work with agency leadership to incorporate the following safeguards into the daily workflow:
  • Be sure that everyone is clear as to who is managing the patient. This is especially critical in complicated cases with numerous consults. One of the major factors in adverse events is fragmentation or lack of clear communication between providers. Therefore, use the clinical record as a communication tool for all providers. Be sure and read notes from other providers and disciplines.
  • Be sure staff understand and utilize the chain of command when necessary. All care team members are considered patient advocates and must speak on behalf of these individuals to ensure the delivery of quality services. Documentation surrounding the chain of command process should be factual and blameless.
  • If an adverse event occurs, attend to the affected patient’s needs before taking any other action. If the patient is injured, nursing and medical interventions take precedence over everything else.
  • Follow the organization’s policy on medical-event disclosure. Staff should be aware of who is responsible for informing the affected patient and his or her family after the occurrence of an adverse event. Documentation of this relation should include who was present during the discussion, what information was shared, and the responses of all those involved.
  • Ensure that the affected patient and his or her family receive compassionate care following an adverse event and that everyone involved maintains a professional relationship.
  • If an adverse event occurs, contact the risk manager or designated point person for your agency. Discuss the case discreetly because conversations are not protected under a quality statute or attorney-client privilege, and may therefore be discoverable.