Education for nurses from legal nurse consultants..

[Erin RN]

I know there are several legal nurse consultants and I thought it might be beneficial to others if we posted what types of cases (in general) we receive against nurses.

I know that since I started doing this about 4 yrs ago now my own charting has probably gotten better in certain areas to CYA better....

The biggest thing and of course we have all heard this..if it wasn't charted it wasn't done period. I see a lot of files that have no documentation or scant documentation surrounding an incident. When it is me, the insurance adjustor, the atty and the risk manager reviewing a claim..we have to assume if it isn't written down it wasn't done..even though many times I suspect policies were followed..if you don't leave a paper trail supporting it..that's it.

The top three types of cases I receive that involve nurses directly are:

IV infiltration:

Document your start (size site patentcy etc)

Document you checked the IV per your protocol and if it looked okay, patent etc

If you DC a bad IV..document it

If the pt has two IVs, document which site you pushed the med through.

* I recently had 3 of these cases 1 was easy to defend because the documentation was there but the other two, the hospt ended up paying on (One was very serious and quite extensive damage was done), this was due to limited documentation and with the latter NO documentation that the pt even had an IV except in the MD's dictation. The nurse did document the administration of several nasty drugs which could only be given IV but it site, route and time were not included..just the drug name and dose.

Pt falls which result in fractures

These are "usually" post op pts seems like.

Upon admisssion to the floor DO the fall risk score then if applicable place the pt on fall precautions..document that the precautions are being followed.

Over the last yr, I have had several elderly pts on diueretics on narcs with a hx of falls that the fall risk assessment score was either not done or they scored 0..don't think so. If you have a pt that is confused or combative or trying to get up without calling document it and what you are doing about it..many times the nurse is interviewed and this is what we are told but there is no evidence of it in the chart at all..makes it difficult to defend.

Allergic reactions:

Upon admission if the pt is allergic to a med make sure the allergy band is on, look at the band or ask the pt about allergies before giving something that has a high incidence of allergic reactions..and for goodness sake IF the pt has an allergic reaction..DC the med and put an allergy band on pronto before the next RN gives it again.

I do get others that are more complex or that I look at the medicals and recommend which type of MD look at etc but these three are definately the top three as far as nurses go..

I know paperwork takes us away from pt care but we need to CYA especially when there are so many lawsuits...protect that license you worked so hard to get..:) Erin

[ERNurse752, RN]

That's awesome! Thanks! :kiss

[Moho]

I totally agree as a RN, BSN. And I especially agree as a patient who just experienced an IV infiltration immediatly after recieving a rapid bolus of Dilantin, following a tonic-clonic seizure, brought on by recieving Demerol (ALLERGY BAND), not checked, given twice in a 30 minute period, and whaloa!!!!! CHECK, CHECK, AND RECHECK. CHART, CHART, AND CHECK CHART??????????

Always remember patient safety.

Moho:specs:

[Erin RN]

Yep..had one where a nurse administered calcium chloride through an infiltrated IV site documented that the site seemed "positional" since it was difficult to get in. Then after that documentation nurse number 1 who discovered that the IV was infiltrated but did not dc it put in a late entry about it being infiltrated prior to the drug administration and that she started a new one.. The pt ended up with necrosis..multiple surgeries and will having lasting nerve damage mobility problems..it was a very difficult file to review based on limtied and late documentation..in the very least pull the bad IV..not a good outcome for the nurse, hospital or the pt...

[CCU NRS]

I was working with a Nurse last weekend that is an attorney and we were discussing this very issue. I am always astounded when I take over a Pt that nobody except doctors have written progress notes on, or sometimes when I return and recieve my same Pts back I see that no one has charted on progress notes since my last entry the day before.

I had a bit of a scare recently which has made me much more aware of the need to chart diligently. Forunately I had charted very responsibly D/T the situation that was occurring but I admit prior to this incident my charting was sub-standard but even then it was miles above some of the nurses I work with that never chart anything other than flow sheets.

[Erin RN]

Things like PCA Pumps can cause probs also..esp Demerol PCA (hate Demerol)..MD stops one and swiches to IM..the order is signed off there is no documentation the PCA was actually turned off..3 doses were signed out of Pyxis with a 2 hour period , only two were documented as being given (one IM and one IV??)..the pt has a seizure then one dose is lined through with an error. The error dose was wasted in the Pyxis 18 hours later..where is the 3rd one? Did the other dose really get wasted since it was not documented until the following day following the seizure?? Messy messy messy.

Now the pt continues to have seizures..1 yr later..is it related? Maybe not (probably not) but definately a mess and lots of ammo for the plantiff atty... Erin