Hot risk management tips: What you need to know

By Sue Dill Calloway, RN, MSN, JD

Nurse Attorney

Mount Carmel College of Nursing

Columbus, OH

Most health care facilities have a designated person to perform risk management. However, every nurse also should practice good risk management skills.

This issue is so important that we were recently requested by our state’s board of nursing to put together some educational material on this topic that could assist nurses in this area. We ended up making a videotape that listed 40 tips in risk management that every nurse should know. (For videotape ordering information, see source box, p. 107.)

Knowledge of legal and risk management issues can help minimize legal liability and can help keep nurses and their employees out of the courtroom.

Here are four of the recommendations discussed in the video:

1. Documentation.

Whenever I’m asked to speak to a group of nurses and physicians on liability issues, I’m often asked what is the best way to keep out of the courtroom. There are two issues that immediately come to mind; the first is optimal documentation.

When patients are upset about the care rendered, they will often seek the services of an attorney. The attorney will request a copy of the medical records and send them to an expert to review. That expert sitting in his or her office or home reading the medical records is where the decision is made to sue or not to sue.

2. Good public relations (PR).

The other recommendation that comes to mind is the importance of good PR and communication. The literature has consistently held that patient lawsuits result from bad PR. Patients get upset if billing mistakes are not corrected, call lights are not answered in a timely manner, and patients are not treated with dignity and respect.

3. Policies and procedures.

Many plaintiffs’ attorneys subpoena the facility’s policies and procedures. Every nurse should be familiar with them. The plaintiff’s attorney will seek to use a policy to diminish the nurse’s credibility if the plaintiff can establish that the nurse was not aware of a policy and did not follow his or her own institution’s policy.

The policies should reflect the current standard of care. They should be reviewed periodically to make sure they are current. Policies should be clearly written and organized so they can be located easily if a nurse needs to review them. New policies should be posted along with policies that are changed.

4. Departmental communications.

Nurses should communicate optimally with other departments to avoid injuries. For example, consider that the nurse gives the patient morphine 5 mg IV and sends the patient to X-ray for an intravenous pyelography. The nurse needs to alert the radiology department of the medication so the staff can take appropriate precautions to avoid patient injuries such as falls. Critical lab values should be called to the nurse, who should communicate the results to the doctor.

Any canceled procedures also should be communicated to the physician. For example, a lawsuit was filed when a computed tomography’s (CT) scanner was broken and the part was not going to be available for 24 hours. The patient had an order for a CT scan of the head. The next morning, the patient died from a cerebral bleed. The doctor would have sent the patient to another facility for the CT scan if he had known the machine was down.

Knowledge of legal and risk management issues can help reduce liability exposure for the nurse and his or her employer. Every nurse should practice effective risk management strategies to make the facility a safer place.