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Archive for June, 2010

Generations and Medical Malpractice Part Two

Wednesday, June 30th, 2010

There are four generations of people employed in health care. Consider how each reacts to situations that put patients at risk for medical errors and medical malpractice. These guidelines are generalities and may not apply to a particular person.

3. Gen X
Gen Xers were born between 1965 and 1978. The Watergate debacle, which revealed the extent of dirty politics, was an influence on this generation. Women’s liberation affected traditional household roles and saw the rise of strong feminists. The gas crisis in 1973 resulted in a sudden feeling of vulnerability. The Gen Xers were the first generation of children affected by both parents working. They were exposed to massive corporate layoff, leading them to value self reliance. Quality of life and balancing work and home life affects this generation. They may be less likely to accept working long hours and schedule changes as they are driven by a need for life and work balances. They saw an increase in divorce rates. This is the impatient generation. They are in a hurry, and want quick promotions and for work to be fun and informal. The Gen Xer tends to be more productive, producing more work in less time. They often prefer to work alone and may distrust and challenge authorities. This may influence their ability to work as part of a team and affect the need to communicate with others.

4. Gen Y or Millennials
The Gen Y population was born between 1981 and 2000. This is the generation that is drawn towards the family for safety and security. They are a global generation who accept multiculturalism and multitasking as a way of life. The Gen Ys are savvy about technology and instant communication. They are highly creative and well educated, confident, hopeful and goal-oriented. They enjoy teamwork. They are a digital generation that is globally concerned. They expect 24-hour a day information. They have difficulty dealing with complex problems and are inexperienced within the medical world. They benefit from mentoring and structure. This is a group who has a high need for feedback and structure. Data shows that 30 percent of Gen Y nurses turnover in the first year of practice and 57 percent by the second year. They have been taught to question each situation to find meaning in every task.

The Veterans may be reluctant to challenge authority, which may be necessary when the healthcare provider needs to be a patient advocate. The Baby Boomers, Gen Xers and Gen Yers have been taught to speak up. Gen X and Gen Y healthcare providers get frustrated with older people who resist technology. All generations want to be respected, valued, and rewarded for their efforts. Healthcare workers do best when they recognize there may be generational differences, and welcome the diversity.

What are these?

Tags: Gen X, Gen Y, generations of workers, Medical malpractice, Millennials
Posted in Communication skills, Medical malpractice, Nursing malpractice, medical errors | No Comments »

Generations and Medical Malpractice Part One

Monday, June 28th, 2010

1. Veterans or Traditionalists
This generation has born between 1927 and 1946. They have specific values such as “remember the lessons of history”. They have loyalty to the organization. The Veterans worked to get their retirement. They have a nose to the grindstone work ethic. They are the keepers of the institutional memory. They tend to be patriotic, polite, and fiscally conservative. They have a high work ethic and are the senior employees and physicians, eyeing retirement and considering slowing down trial practice. Many of them are influenced by a military model as they grew up in World War II. They understand and follow a chain of command.

2. Baby boomers
Born between 1946 and 1964, Baby Boomers are the largest group. They were influenced by several events in the tumultuous world of the 60s including the civil rights movement. The Baby Boomers have a strong work ethic. They are workaholics and loyal to the organization. They will stay until the work is done. They are highly competitive, question authority, and invented the type A personality. They have an overwhelming need to succeed. The Baby Boomer believes in team work and consensus building. They are optimistic. Baby Boomers are often found in management positions. The Baby Boomer is uncomfortable with conflict and reluctant to go against peers. It is hard for them to ask for help; they have difficulty admitting something is wrong. This may influence their behavior when caught up in a situation that could lead to patient injury.

What are these?

Tags: baby boomers, generations of workers, Medical malpractice, traditionalists, Veterans
Posted in Communication skills, Medical malpractice, Nursing malpractice, medical errors | No Comments »

Pat Iyer’s Dirty Dozen Tips for Detecting Altered Medical Records Part 2

Wednesday, June 23rd, 2010

• Compare the nursery records generated at birth with those sent to the hospital to which the baby is transferred.
• Review the copies of hospital records found within a physician’s office records with those supplied by the hospital.
• In most hospitals, the mother’s labor and delivery record is normally copied and placed into the newborn’s chart. The copy from the mother’s chart must be closely compared with the copy from the newborn’s chart in order to see if there are any added additions to a set of records.
• Often, copies of a record are supplied to others in the ordinary course of treatment long before a problem or an attorney appears on the scene. The record examiner should not assume that the records supplied in discovery are identical to the ones supplied to others before a problem manifested itself. It is not unusual for a doctor referring a patient to a specialist to send a copy of the patient’s chart to the consulting doctor. Likewise, when a patient changes providers, a copy of the first doctor’s chart is sometimes sent to the subsequent treating doctor. These records need to be closely compared to see if there are any additions.
• Compare the letters and reports written by physicians when they are found in more than one set of records. Are the letters identical or does one set of records contain fewer or different reports?
• Compare the set of records obtained by the plaintiff prior to litigation with the set provided after the plaintiff’s attorney requested the records.
• Compare the set of records obtained early in litigation with those obtained shortly before resolution of a claim.
• Compare a set of records supplied to the plaintiff with those supplied to a regulatory agency.
• Observe for new entries added to later copies of the record, or pages that are missing from the first set of records. Look for additional pages that were not supplied with the first request for records.
• Look for a stamp or mark (usually on a face sheet) that indicates that the chart was kept under the control of the Risk Management Department or the Health Information Management Director’s office. This indicates that restricted access to the chart was in place. This has likely occurred because of an unexpected outcome or a suspicion of wrong doing.
• Note descriptions of the patient that may reveal antagonism between the patient and staff. A bad clinical outcome may lead to the temptation to alter records.
• Note finger pointing or blaming of other staff members or professionals after an incident occurred.

Modified from Roy Konray and Pat Iyer, “Tampering with medical Records, in Pat Iyer and Barbara Levin (Editors) Medical Legal Aspects of Medical Records, released in March 2010, for more tips at www.medleague.com.

What are these?

Tags: altered medical records, spoliation of evidence, tampering with medical records
Posted in Healthcare Risk Management, Legal nurse consulting, Medical records, Medication errors, Nursing malpractice, Tampering with evidence, Trial lawyer skills, medical errors | No Comments »

Pat Iyer’s Dirty Dozen Tips for Detecting Altered Records Part 1

Monday, June 21st, 2010

• Determine if the entries are in correct sequences and the date is within the correct time frame. For example, a physician recopying an office note may inadvertently use the year that the change is being made, rather than the right year for the chart entry.
• Search for discrepancies in dates. Entries may be inconsistently dated. Information may be added to a form out of sequence. For example, one medical record included a page listing the nursing home resident’s medical diagnoses, followed by the dates of the care planning sessions. The sheet contained the diagnosis of fractured hip, which occurred in June 2009. Yet the care planning sessions were documented as having occurred in May 2009. The form did not indicate that the hip fracture diagnosis was entered after the May 2009 session.
• Examine the chart for discrepancies in times or entries that are not in the correct chronological order.
• Look at the dates when treatments or medications were ordered versus the dates they were documented as having been given. For example, in one chart, the wound care sheet included an entry on 1/22/09 that antibiotics were started for a foul smelling pressure ulcer. In reality, the order for antibiotics was not written until 1/25/09.
• Create a chronology of care with the dates of admission and discharge. Look to see if care was charted after the patient left the facility.
• Look at the medication records to determine if medications were charted as being administered after the patient left the facility. Note if the patient’s medication administration record shows that oral medications were being administered when the patient was supposedly comatose and unable to swallow.
• Compare the condition of the patient on days of transfer from one facility to another. Look for discrepancies in the description of the condition of the patient. For example, a pressure ulcer’s presence may be ignored in a hospital chart but documented in detail when the patient arrives at a nursing home.
• Compare the observations of the physicians with those of the nurses. Are they consistent?
• Observe for any handwritten entry made by someone who significantly erred in treatment, particularly if the entry is at odds with the rest of the chart.
• Examine the typical way in which the healthcare professional documents. Are notes usually brief but become extensive on the day of an incident?
• Compare a set of original medical records with that supplied to the attorney. Use self-sticking tabs or notes to indicate when documents need to be copied or examined further. Always make a list of records that have been requested to verify that everything has been received.
• Whenever two sets of records are located, compare them. For example, compare the prenatal chart kept by the obstetrician with the prenatal records sent to the hospital prior to the labor and delivery.

Modified from Roy Konray and Pat Iyer, “Tampering with medical Records, in Pat Iyer and Barbara Levin (Editors) Medical Legal Aspects of Medical Records, released in March 2010, for more tips.

What are these?

Tags: altered records, spoliation of medical records, tampering with medical records
Posted in Healthcare Risk Management, Legal nurse consulting, Medical malpractice, Medical records, Nursing malpractice, Tampering with evidence, Trial lawyer skills, medical errors | No Comments »

Do You See What I See? by Pat Iyer

Monday, June 14th, 2010

From behind, the group of people walking in front of me through Newark Airport last week looked like a family. There was an older woman, a young couple, and a baby being pushed in the stroller. I filled in: grandmother, husband and wife and child. Then I took a closer look. The first detail I noticed was the older woman. She was in her early 50s. Her hair was cut in a punk style. The top half was dyed a deep purple. The next layer has dyed peacock blue. The bottom layer was a natural brown. She wore a black and white horizontal striped jacket over a white billowy dress. She had on black and white flower pattern leggings. Around her upper right arm was a wide tattoo.

The “husband” was Caucasian. The woman pushing the baby was Asian. The child looked to be full blooded Asian. After studying this unusual group, I realized how quickly I made assumptions. I assumed without thinking that they were a family. (And maybe they were – but maybe they weren’t.) Then I filled in other ideas, and speculated about their relationship, but all I was left with was questions.

How quickly do we jump to conclusions? In the medical legal arena, how often do we reach unfounded conclusions about the defendant? The plaintiff? The public may believe people who sue for medical malpractice are primarily interested in money. Read Sorrel King’s book, Josie’s Story, about the medical error that cost her 18-year-old daughter her life. In the book, Sorrel wrote that her attorney brought legal documents from Johns Hopkins, where the error occurred. “There it was: the settlement offer. It was a concept that was difficult to comprehend – money for the death of our daughter. The concept of us accepting it was almost as appalling as them offering it. We didn’t want their money and felt that by accepting it we would be letting them off the hook. We didn’t want it to be so easy for them.”

When their attorney asked them what they did want, Sorrel said, “I wanted them to remember Josie, to learn something from her and to never let this happen again. I want every hospital in the country to know her name and why she died. I want them all to learn something”’, I said angrily. Her attorney replied, “‘Then do that. Do that with the settlement money. If you leave this money, it will just get sucked up in a black hole. Take the money and do something good. Do something for Josie. You can make this more than a sad story for the media to cover. You can create something much more.” The King family took their settlement check and funded patient safety efforts in the hospital in which their daughter died, and has been instrumental in improving safety in other hospitals throughout the world.

Look at your conclusions. Are they founded on information or insufficient data? How often do we go through a situation assuming we understand it, only to realize a fact that changes all of our conclusions? I recently worked on a large case involving a girl who was in a motor vehicle accident. Her attending physician documented she was intoxicated at the time she came into the emergency department. I got three quarters of the way through 10 three binders before I saw a letter from her attending physician admitting he was given misinformation and the girl had a zero blood alcohol level.

Question your assumptions. Get more data. Ask questions.

What are these?

Tags: blood alcohol level, Josie's Story, Medical malpractice, medication error, Patient safety, Sorrel King
Posted in Damages, Medical malpractice, Nursing malpractice, Personal observations, medical errors | No Comments »

The aging population by Pat Iyer

Wednesday, June 9th, 2010

According to the American Association of Retired people (AARP), who collected information in 2009 about the growing older population, there are 10 key findings that affect provision of long term care services:
1. The population age 85 or old – the age group that is most likely to need long-term care services- is growing at a dramatic rate.
2. The older population is more racially and ethnically diverse than ever before.
3. The older population is financially and socially diverse.
4. Family caregivers are the main providers of long term care services in all states.
5. Older people with disabilities have a growing array of service options, but the services are costly and can deplete life savings of older households.
6. Nursing facility residents, beds, and occupancy rates have remained nearly constant over the last five years, despite an increase in older population.
7. The bulk of Medicaid long term care dollars go to nursing homes rather than home and community-based services.
8. The number of older people and adults with physical disabilities receiving Medicaid-funded home and community-based services has increased over the past five years.
9. Long term care spending is not the primary cause of Medicaid spending growth.
10. On average, Medicaid dollars can support nearly three older people and adults with physical disabilities in home and community-based settings for every person in a nursing facility.

Clearly, the nursing home care is expensive and the quality of care delivered in long-term care and subacute beds affects a large portion of the population either directly (as patients) or indirectly (as relatives of patients). With the aging of the baby boomers, it can be anticipated that this level of care will become a more important factor in health care.

Source: Houser, A., Fox-Grage, W., and Gibson, M. Across the States 2009: Profiles of Long Term Care and Independent Living, Washington, DC, AARP, 2009

What are these?

Tags: aging population, elder care, nursing home care
Posted in Nursing home | No Comments »

Prescription drug overdoses on the rise in U.S.

Monday, June 7th, 2010

by Megan Brooks
(Reuters Health) – More and more Americans are landing in the hospital due to poisoning by powerful prescription painkillers, sedatives and tranquilizers, according to a report released American Journal of Preventive Medicine, April 2010. City-living middle-aged women seem particularly vulnerable.
People have seen the headlines related to Heath Ledger, Michael Jackson, Anna Nicole Smith and they think that’s tragic but maybe contained to Hollywood,” Dr. Jeffrey H. Coben of West Virginia University School of Medicine in Morgantown told Reuters Health. “But the fact of the matter is we are seeing, across the country, very significant increases in serious overdoses associated with these prescription drugs,” Coben warned.

Between 1999 and 2006, US hospital admissions due to poisoning by prescription opioids, sedatives and tranquilizers rose from approximately 43,000 to about 71,000. That increase of 65 percent is about double the increase observed in hospitalizations for poisoning by other drugs and medicines, Coben and colleagues found.

Opioids — examples include morphine, methadone, OxyContin and the active ingredient in Percocet — are powerful narcotic painkillers that can be habit-forming. Some examples of sedatives or tranquilizers include Valium, Xanax, and Ativan.

What’s behind the rise in poisoning by prescription painkillers, sedatives and tranquilizers? “There is not any single cause,” Coben said. “There is increasing availability of powerful prescription drugs in the community and attitudes toward their use tend to be different than attitudes toward using other drugs, especially among young people, who report that prescription drugs are easy to obtain, and they think they are less addictive and less dangerous than street drugs like heroin and cocaine.”
Read more

What are these?

Tags: drug overdose, Medication errors, medication overdoses, narcotics, opioid overdose
Posted in Damages, Medication errors, Patient safety, medical errors | No Comments »

Common Errors of Pharmacy Technicians – Guest Post by Ashley Jones

Wednesday, June 2nd, 2010

Medications save lives, but they do so only when they’re taken correctly – by the right patient, who takes the right medicine, at the right time, in the right dosage, by the right route, and for the right amount of time. According to the National Patient Safety Foundation, of the 3 billion prescriptions that are filled, as many as 30 million dispensing errors occur. While some of them are not even noticed, others can have serious consequences, even resulting in death at times. The most common pharmacy errors occur when:

• Pharmacy technicians hand out the wrong prescriptions to patients – they get the names wrong, which means the entire set of medicines is wrong. (Pat was once given pills for another patient with the same last name. The technician did not ask for her first name.) And when patients fail to check the drugs they’ve been given and follow the prescription blindly without even looking at the name, it spells disaster in the making.
• Overworked and negligent pharmacy technicians give out the wrong drug because they don’t read the prescription carefully. This could cause serious consequences if the patient is allergic to the new drug or if it worsens their symptoms and causes them to become more ill.
• Pharmacists and technicians substitute one drug for another without checking with the doctor who prescribed the drug. This could lead to complications because the pharmacist is assuming that he/she is qualified to make the switch.
• They give out drugs that are past their expiration dates and which could either cause harm or not effect a cure since they are worthless past a certain date.
• Pat adds: They can misinterpret handwriting and fill the prescription with the wrong medication.

Errors can have profound consequences for the pharmacists who supervise technicians. A former Ohio pharmacist pled no contest to involuntary manslaughter of a 2-year-old child who died in 2006 as a result of a chemotherapy compounding error. The pharmacy board revoked the pharmacist’s license, and a grand jury indicted him on charges of reckless homicide and involuntary manslaughter. The pharmacist faced up to 5 years in prison. Prosecutors held the pharmacist responsible for the toddler’s death because he oversaw the preparation of her chemotherapy. The child had undergone surgeries and four rounds of chemotherapy to treat a curable malignant tumor at the base of her spine. She was supposed to receive her last dose of chemotherapy on the day of the error. A pharmacy technician mistakenly prepared the infusion using too much 23.4% sodium chloride. According to a news report, the technician mentioned to the pharmacist that the final preparation didn’t seem right, but the error went unnoticed. The infusion was administered to the child, who died 3 days later.

The Institute for Safe Medication Practices expressed the outrage of many in the patient safety world that this case resulted in criminal charges. Safety experts including ISMP advocate for a fair and just path for individuals involved in adverse events, arguing that punishment simply because the patient was harmed does not serve the public interest. Its potential impact on patient safety is enormous, sending the wrong message to healthcare professionals about the importance of reporting and analyzing errors.

Most of these errors occur when pharmacy technicians and pharmacists are too busy, distracted, and overworked. As patients, we can help minimize pharmacy errors by being vigilant, checking the name on the prescription, double checking the medicines against the prescription, ensuring that the drugs are not past their expiration date, and consulting the doctor before we switch to generic or branded equivalents. Don’t be in a rush because it could be a matter of life and death – take the time to check with your pharmacist if you’re not sure that you’ve been given the right medication or if it looks different from what you’ve been taking so far. It’s your health and your life, and unless you assume responsibility for both, you are equally to blame for the disasters that happen when pharmacy errors occur.

This article is contributed by Ashley M. Jones, who regularly writes on the subject of Pharmacy Technician Certification. She invites your questions, comments at her email address: ashleym.jones643@gmail.com.

What are these?

Tags: drug store errors, medication dispensing errors, Medication errors, pharmacy errors, pharmacy technician errors
Posted in Damages, Medication errors, Patient safety | 2 Comments »

Medical-Legal Topics

Archive for June, 2010

Generations and Medical Malpractice Part Two

Generations and Medical Malpractice Part One

Pat Iyer’s Dirty Dozen Tips for Detecting Altered Medical Records Part 2

Pat Iyer’s Dirty Dozen Tips for Detecting Altered Records Part 1

Do You See What I See? by Pat Iyer

The aging population by Pat Iyer

Prescription drug overdoses on the rise in U.S.

Common Errors of Pharmacy Technicians – Guest Post by Ashley Jones

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