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Category Archives: Healthcare Risk Management
By Pat Iyer: Failure to rescue
Imagine this scene: You are visiting your elderly father in the hospital when you notice his speech is becoming slurred and he is less awake than usual. Concerned, you call his nurse into the room. She assesses your father, then … Continue reading
Why don’t healthcare providers follow the rules? Part 2 by Pat Iyer
Normalization of deviance occurs when a provider, such as a nurse, knowingly disregards a safety practice, like using two patient identifiers to verify patient identity. Repeated deviation from the safe practices tends to “normalize” the risky behavior in the nurse’s … Continue reading
Why don’t healthcare providers follow the rules? Part 1 by Pat Iyer
I’ve been updating a chapter on the roots of patient injury for the fourth edition of Nursing Malpractice. I’ve been thinking about the reasons people don’t follow policies and procedures. Back in the 1980s when I ran a nursing hospital’s … Continue reading
Pat Iyer’s 9 tips on detecting altered medical records Part 5
• Examine logs or communication books kept at the nursing station of some nursing homes. I found a note in a nursing home communication book that stated, “When you recopy the nurses’ notes, leave enough room for the night shift … Continue reading
Posted in Healthcare Risk Management, Legal nurse consulting, Medical errors, Medical malpractice, Medical records, Nursing malpractice, Tampering with evidence, Trial lawyer skills
Tagged altered medical records, altered records, spoliation of evidence, spoliation of medical records, tampering with medical records
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Pat Iyer’s 7 tips on detecting altered medical records part 4
• Look for the “too good to be true” pattern of documentation. For example, the patient was steadily losing weight but supposedly consuming 100 percent of his 2000 calories per day diet. • Note entries that are self-serving and needlessly … Continue reading
Posted in Healthcare Risk Management, Legal nurse consulting, Medical errors, Medical malpractice, Medical records, Nursing malpractice, Tampering with evidence, Trial lawyer skills
Tagged altered medical records, altered records, spoliation of medical records, tampering with medical records
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Pat Iyer’s Dirty Dozen Tips for Detecting Altered Medical Records Part 3
• Examine handwriting to see if there are obvious changes in the appearance of the writing within an entry. Another thing to look for is a change in style. If notes are sloppily written and suddenly a page of neatly … Continue reading
Pat Iyer’s Dirty Dozen Tips for Detecting Altered Medical Records Part 2
• 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. • … Continue reading
Pat Iyer’s Dirty Dozen Tips for Detecting Altered Records Part 1
• 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 … Continue reading
Why inexperienced people make mistakes
A group of residents eagerly perform complex surgery in the middle of the night while the attending surgeons who are supposed to supervise them are happily sleeping at home. Why is this very real scenario a bad idea? Why do … Continue reading
Why risk tampering with medical records? By Pat Iyer
A physician gets a notice that he is being sued. He gives into the temptation to review his office records. He decides to change an entry to 1. More completely describe events 2. Make it look as if he did … Continue reading
