Health Care

19Apr 2017

Because of age or incapacitation due to illness or injury, patients in health care settings often need help performing normal daily tasks like sitting up or walking. Helping patients with these tasks requires significant physical demands, putting employees in danger of musculoskeletal disorders (MSDs).

MSDs—such as muscle strains, lower back injuries, rotator cuff injuries and tendinitis—are the most common workplace injuries suffered by nurses and other health care workers. Risk factors include repeated and forceful movements associated with patient care like lifting, transferring and repositioning.

All together, MSDs account for almost half of the injuries and illnesses reported for nurses and nursing support staff, and rates of MSDs for nursing assistants are almost four times higher than the average for all workers.

The good news is that MSDs, especially back injuries, can be prevented by implementing a safe patient handling program and using mechanical lift equipment. The use of lifting equipment is essential for a successful safe patient handling program and has been shown to reduce exposure to manual lifting injuries by up to 95 percent.

Benefits of a Safe Patient Handling Program

Safe patient handling programs reduce the risk of injury for both health care workers and patients while improving the quality of patient care. Other benefits of safe patient handling programs include the following:

  • More satisfying work environment and professional status 
  • Improved nursing recruitment and retention
  • Increased patient satisfaction and comfort
  • Fewer patient falls and pressure ulcers
  • Reduced costs associated with injuries

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10Apr 2017

Failure to perform or communicate test results is a preventable error that can lead to unnecessary harm to patients and costly medical malpractice claims. In a recent Harvard Risk Management Foundation review of claims arising out of physicians’ offices, the top cause was failure or delay in ordering tests. Although many times this is a result of cognitive factors such as judgment, vigilance, memory or lack of knowledge, failure or delay in ordering tests can often be prevented by making simple changes to the system. To mitigate the risk of system errors that could lead testing errors and claims, reform and standardize practices across the facility.

Error-Proof Your Systems

Consider the following points to make your system less susceptible to medical malpractice claims as a result of testing errors:

  • Document the conversation with the patient in which the doctor explains tests to be performed.
  • Create checklists or prompts in assessment and order forms, reminding physicians to order tests.
  • Ensure that referral forms are comprehensive and that they include the following information:

o   Patient history 

o   Physical examination findings

o   Test results

o   Differential diagnosis

o   Expectations of the consultation

o   Urgency level

  • Allow access to test results by consultants.
  • Establish a test result management system to ensure all tests are completed. Standardized order forms combined with either an electronic or paper database should document the following:

o   Complete list of ordered tests 

o   Results

o   Review by physicians

o   Follow-up with the patient

o   Additional studies

o   Space to mark when completed

  • Require physicians to sign and date all of these forms with each step.
  • Establish a dissemination policy for critical test results.

o   Define which results require expedited, reliable communication, and develop critical test values.

o   Define appropriate time parameters for action on critical test results.

o   Flag critical results so they are acted on quickly.

o   Establish criteria for escalating critical results to a back-up physician in the absence of the referring physician.

Successful Implementation

To effectively mitigate the risk of claims arising out of testing errors, the cooperation of all staff is critical. Work with staff to identify best practices and integrate them into new programs. When staff members are engaged and participate in the process, they are more likely to support and effectively implement changes to your system, reducing the risk of testing errors.

10Apr 2017

Many medical devices contain configurable embedded computer systems that can be vulnerable to cyber-security breaches. In addition, as medical devices are increasingly interconnected via the Internet, hospital networks, other medical devices or smartphones, there is an increased risk of cyber-security breaches, which could affect how a medical device operates.

The Food and Drug Administration (FDA) has recently become aware of cyber-security vulnerabilities and incidents that could directly impact medical devices or hospital network operations, such as the following:

  • Network-connected/configured medical devices infected or disabled by malware
  • The presence of malware on hospital computers, smartphones and tablets, targeting mobile devices using wireless technology to access patient data, monitoring systems and implanted patient devices
  • Uncontrolled distribution of passwords, disabled passwords, hard-coded passwords for software intended for privileged device access (e.g., to administrative, technical and maintenance personnel)
  • Failure to provide timely security software updates and patches to medical devices and networks and to address related vulnerabilities in older medical device models (legacy devices)
  • Security vulnerabilities in off-the-shelf software designed to prevent unauthorized device or network access, such as plain-text or no authentication, hard-coded passwords, documented service accounts in service manuals and poor coding/SQL injection.

The FDA has been working closely with other federal agencies and manufacturers to identify, communicate and mitigate vulnerabilities and incidents as they are identified.

FDA Recommendations/Actions 

The FDA has a number of recommendations to mitigate the risks that technology may pose to health care organizations.

For all device manufacturers:

Manufacturers are responsible for remaining vigilant about identifying risks and hazards associated with their medical devices, including risks related to cyber security, and are responsible for putting appropriate mitigations in place to address patient safety and ensure proper device performance.

The FDA expects medical device manufacturers to take appropriate steps to limit the opportunities for unauthorized access to medical devices. Specifically, it is recommended that manufacturers review their cyber-security practices and policies to ensure that appropriate safeguards are in place to prevent unauthorized access or modification to their medical devices or compromise the security of the hospital network that may be connected to the device. The extent to which security controls are needed will depend on the medical device, its environment of use, the type and probability of the risks to which it is exposed, and the probable risks to patients from a security breach.

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10Apr 2017

The recent changes to the U.S. health care system have caused shifts in liability trends and the general litigation environment in the medical world. Now that the Affordable Care Act (ACA) is in effect, risk managers in medical facilities can better understand the results of reform on their exposures.

Potential Increase in Malpractice Claims

According to a study conducted by the RAND Corporation, a nonprofit global policy think tank, medical malpractice claims could rise 5 percent due to the increased number of newly insured patients after the implementation of the ACA.

The potential rise in malpractice claims is not estimated to come from doctor error, but from an increased number of insured patients, which means a higher number of interactions and procedures and more opportunities for patients to sue.

However, some insurance experts do not agree with this hypothesis. Some believe that the newly insured patients’ gratitude for their previously absent care could make them reluctant to sue their doctors.

Impact on Non-physician Practitioners  

The influx of new patients increases the need for non-physician practitioners, such as physician assistants and nurse practitioners, and expands those practitioners’ responsibilities.

These expanded responsibilities could extend legal and regulatory accountability for these employees. Malpractice litigation involving nurse practitioners often focuses on their regulatory authority to practice certain types of patient care, and whether they are qualified to make medical decisions.

The issue of vicarious liability, which imposes responsibility on one person for the actions of another, is also a risk associated with non-physician practitioners. Doctors and hospitals will be more vulnerable to vicarious liability claims based on the actions or diagnoses of nurse practitioners who work under their supervision. The management structure at a hospital or private practice may need to shift to accommodate closer supervision or extended training to reduce these risks.

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10Apr 2017

Often attributed as a partial cause of the ever-increasing cost of health care, medical malpractice claims are a common, and costly, risk faced by health care providers. However, according to recent research, technological developments in the health care industry may be able to lower some of the risk of medical malpractice claims.

Studies have begun to track the effect that the use of electronic health record (EHR) systems has on preventing medical malpractice claims. EHRs allow doctors to quickly scan patients’ medical histories, giving them more background information, which leads to a more accurate diagnosis. It also means avoiding duplication of tests and negative reactions between medications. When all of this information is readily available, doctors and nurses can make better decisions about patient health. Better care means fewer mistakes, which in turn means fewer malpractice claims. The clear record they provide of a patient’s treatment history also makes EHRs useful in defending against a medical malpractice claim if one is filed.

Additional Benefits 

EHRs may be able to do more than just help prevent claims, they may also get you a lower rate from your insurer. If study results continue to confirm the connection between EHRs and lowered occurrences of medical malpractice claims, insurers may start offering discounts to facilities that implement such systems.

Going beyond the realm of malpractice claims, EHRs also offer a number of other benefits to both your staff and patients. Once implemented, EHRs can streamline many of your existing processes. Charts no longer need to be physically moved from one location to another. With a few clicks, patient information can be brought up anywhere in your facility instantly. This kind of quick access to patient information means information stays up to date and is always on hand. This not only makes life easier on staff members, it also means that patients get high-quality, efficient care.

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10Apr 2017

Telemedicine Defined

Telemedicine, which the American Telemedicine Association defines as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status,” promises to transform the landscape of health care. Due to the growing population of the elderly, the increasing demand for health care services and the rapid advances in telecommunications technology, a roaring market demand for telemedicine has been created along with the means of satisfying it.

Telemedicine promises to become even more widespread in the coming years—erasing geographic barriers to place general practitioners and world-class specialists in the same virtual room. However, new opportunities present new risks, and some are less obvious than others.

Protecting Patient Privacy

Patient privacy is of paramount concern for all health care providers, and telemedicine only makes that concern more important. Telemedicine is contingent upon the quick and reliable transmission of electronic health records (EHR), which creates an inherent risk of a patient privacy breach.

Patient privacy needs to be secured at every point of access. Consider the following individuals who may have access to your network:

  • Doctors, nurses and other employees who use telecommunications equipment
  • Employees responsible for moving, storing and servicing telecommunications equipment
  • IT personnel—either in-house or contracted out—who perform service or maintenance on networks, systems and equipment
  • Guests and patients who are provided with Wi-Fi access

Administrators should work with in-house personnel to ensure every precaution has been taken to secure sensitive patient information. It’s also important to remember that these points of access exist at both the originating and distant site, and that both sites will have to work in conjunction to ensure that every effort has been made to protect patient privacy.

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10Apr 2017

Treating patients successfully and without error requires seamless communication–lacking or incomplete information can result in missed or delayed diagnoses, patient injuries and subsequent malpractice claims. To mitigate this risk, establish a system that ensures that requests for consults, studies and other referrals include sufficient, comprehensive information and that critical results are acted upon in a timely manner. A lack of clearly defined roles and responsibilities throughout the process can impede a facility’s ability to provide and promote safe patient care.

Ways of Mitigating Risk

To minimize the risk of error relating to patient referrals, consider the following guidelines:

  • Encourage face-to-face or telephone conversations between referring and consulting physicians to clarify contents of a report if necessary.
  • Clearly establish the responsibilities of both parties when communicating results.
  • Document each exchange thoroughly.
  • Require a provider to initial and date (or electronically sign) all consultation reports before filing them in a patient’s medical record.

Referring Physicians

Referring physicians should be encouraged to follow up on all cases they refer. When referring patients, the referring physician should remind the consultant of respective roles and responsibilities. To ensure that every patient is accounted for, take the following steps:

  • Develop a method for alerting the referring physician when a consultation has been completed and whether a written report has been received.
  • Require referring physicians to contact consultants when a written report is missing.
  • Require information regarding the patient to be included with the letter of referral, including: 

o   The reason for the referral

o   Patient history and diagnostic studies performed

o   Specific definition of expectations

o   Contact information and request for follow-up

Consulting Physicians

Consulting physicians should send timely written reports to referring physicians. Reports containing critical results should be clearly marked and should include the following:

  • Findings
  • Recommendations, including interventions and the delineation of provider responsibility for treatment
  • Follow-up of abnormal test results, including incidental findings

Consultants should also contact referring physicians when patients fail to keep appointments, and document the notification.

Contact Us

For more information on managing risk and securing coverage in health care facilities, contact Jimmy Porrello, Chief Operations Officer at Kaercher Insurance.