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The Fine Line Between Supervision and Accountability

In an earlier blog, we discussed the Swiss cheese model as it relates to risk management in healthcare. Today’s article takes a deeper dive into the element of supervision in that model, especially as it relates to Advanced Practice Providers (APPs). These APPs are generally defined(1) as professionals with advanced training, such as Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs). A practice itself might employ APPs or managing physicians may simply have supervisory responsibilities due to contractual arrangements directly with APPs or with facilities that use APPs. In either case, APPs are able to practice independently of physicians(2).

As this video explains, APPs are essential to professional practices in that they assist with provider workload and help keep costs down. Any office that is inundated enough to outsource some of its workload to APPs runs the risk of miscommunication, inadequate care, adverse events, and subsequent litigation. This resulting litigation could potentially involve both the supervising physician and the APP. That is why it is immensely important to outline the scope of the APP’s responsibilities, taking in to account their experience and ability to make judgement calls in the absence of the supervising provider.

The RiskFit helpline, managed by OmniSure, serves as a vital resource to CARE Professional Liability Association members. The professionals that operate this helpline can answer questions about the following:

  • Developing a collaborative provider/APP agreement
  • State-specific laws regarding APP scope of responsibilities
  • Hiring protocols
  • Proper risk reduction audit procedures
  • Capturing patient satisfaction metrics

All of these aspects of APP employment need to be carefully planned and documented to avoid potential litigation issues. The partnership between CARE and OmniSure puts a wealth of expertise at your fingertips to help you fill the holes in your risk management plan so that it does not turn into a block of Swiss cheese.

Contact us today if you have questions about whether your plan provides coverage for the APPs in your practice. Laws vary based on the state where you practice(2), and are constantly changing. Put our expertise to work for you in designing a coverage plan that perfectly suits your business.

Footnotes

  1. https://www.forbes.com/sites/realspin/2017/03/16/advanced-practice-providers-are-key-to-americas-healthcare-future/#2c8596759985
  2. https://www.studergroup.com/resources/articles-and-industry-updates/insights/august-2016/optimizing-the-value-of-advanced-practice-provider
  3. https://www.healthleadersmedia.com/clinical-care/aprn-and-pa-scope-practice-rules-draw-fire

Signed Consent: Does it Prevent Litigation?

Many healthcare professionals believe that a signed document equals informed consent, and that no further documentation is necessary. While that theory is basically true, there is definitely a difference between theory and practice. The obligation (in both the ethical and legal sense) to fully inform patients of the risks, benefits, and alternatives to treatment falls to the treating provider. Informed consent is best described as a process, not a single document. Patients must demonstrate their understanding of the treatment being pursued, as well as an explanation of both the provider’s and the patient’s roles in the treatment, as well as the risk of addiction to the medications prescribed.

Consider our recent case study(1) involving a patient who allegedly died of a prescription overdose because the plaintiff contends that the multiple providers he sought treatment from were negligent in monitoring his conditions and medications. Reading through the documentation, it seems that no single provider was aware of the patient’s entire medical history, nor his current medication intake. And while the patient provided informed consent about the possibility of drug interactions to multiple providers, the seriousness of the situation did not appear evident to all involved parties, including the providers and the patient.

CARE Professional Liability Association and OmniSure Consulting Group(2) suggest the following steps to reduce your professional risk(3):

  • Customize consent forms to be as procedure-specific as possible; generic forms are too generalized to communicate proper information
  • Document the entire consent process in the patient’s medical record, including the conversation with the patient and specific questions they asked and how they were answered
  • Create policies and procedures outlining who specifically can obtain informed consent
  • Audit medical records periodically to validate that documentation and informed consent processes are being followed correctly

Patients might be too embarrassed to ask questions about the procedure, or might not even know what to ask if they don’t understand the consent form. Or they might feel rushed, or simply downplay the consent form’s importance. It’s our job as healthcare providers to make sure patients are comfortable enough to ask pertinent questions so that their consent is not simply a signature, but a complete understanding of the treatment they receive.

Contact us today. We can help you develop an informed consent documentation plan that works for both you and your patients.

Footnotes

  • https://care-ins.com/case-studies/
  • https://www.omnisure.com/
  • https://www.riskfitness.com/informed-consent-recommendations

Adverse Anesthesia Events: Are They Inevitable?

Statistically speaking, anesthesia-related deaths are very rare: only one death is reported per every 200,000 – 300,000 events. But as with any medical procedure, there is room for improvement, including more stringent monitoring techniques and widespread adoption of best practices. Both of these suggestions can pave the way for standardized procedures to make that statistic even smaller.

The leading causes of anesthesia-related issues include:

While not all adverse events result in death, serious issues can arise, such as brain injury, brain death, increased cardiac and respiratory complications, prolonged hospital stays, and necessary mechanical ventilator support.

Patient knowledge, consent, and comfort are important factors in anesthesia care. Thoroughly discussing techniques, risks, and outcomes with patients encourages candid dialogue about patient history, current physical constraints, or even mental illness that may affect certain modes of anesthesia. Setting the proper expectations for patients creates an environment of trust and confidence in their providers.

In the unlikely event that issues arise, immediately document every aspect of the incident. While this includes a thorough description of technical events, don’t overlook the importance of engaging relevant consultants, such as neurologists and radiologists. Professionals from other disciplines can provide valuable third-party insight in determining cause and effect.

CARE members also have valuable resources at their disposal, such as the RiskFit helpline (available compliments of CARE’s partnership with OmniSure). This helpline can answer questions and provide guidance on how to best mitigate the risk arising from adverse events. The RiskFit helpline garners best practices from the volume of information it collects on similar events. Coupled with the experience level of the associates that provide consultations, this information helps members decide on the best course of action specific to their situation.

Contact us today if you would like more information about the benefits of joining CARE, or would like to see how the CARE/OmniSure partnership can benefit you too.

CARE and OmniSure: A Solid Partnership

CARE Professional Liability Association has partnered with OmniSure Consulting Group, a risk management and loss-control firm, to provide you with complimentary access to Risk Fitness®, which is an online tool that helps reduce your professional risk. This includes the RiskFit® library, email tips, and the RiskFit® helpline.

As the program name implies, it’s designed to ensure your firm’s well-being. The experts that manage the helpline could be considered your trainers. The health of your risk management plan is dependent on more than a single site visit for a cursory assessment. It is not a static event. A healthy risk management plan requires curating over time, introducing best practices as they are learned and new policies as they are developed.

The RiskFit helpline can help you with questions about your professional practice, risk mitigation, and regulatory-related issues. In addition to calling, you can also send an email to helpline@omnisure.com. You might know your business best and have great relationships with your patients, but you shouldn’t be expected to know every nuance of every change in laws and regulations. You need a resource you can depend on. That’s what the RiskFit helpline is to you … a lifeline.

Every company has its own risk management challenges. It’s important to partner with an organization that can provide insight about gaps, concerns, and challenges from an outside party’s perspective. Many claims and lawsuits can be traced to poor risk management and inattention to detail. In the daily barrage of work, these elements are easy to overlook. Some areas that usually end up lacking are documentation, follow up, and patient communication. It’s easy to become complacent.  

Contact us today. We can help you maximize your RiskFitness tools through our partnership with OmniSure. The collective knowledge and experience we all bring to the proverbial table makes us better-informed resources for each other.