Showing posts with label Geriatric Healthcare. Show all posts
Showing posts with label Geriatric Healthcare. Show all posts

Saturday, December 10, 2011

Geriatric Nurses, Eldercare Nursing, #NurseFriendly #eldercare #caregivers #nursing #nurses #geriatrics #seniorcare

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Tuesday, December 6, 2011

Elderly Patient Repeatedly Injured In Nursing Home "Accidents." Negligence, Coincidence or Abuse? #nursefriendly #nursecasestudy #elderly #geriatrics

See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety:

Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Attorneys, Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material.

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Summary:  As the elderly population continues to increase, more and more families are faced with the decision to place loved ones in nursing homes.  When a family member is placed in a facility, a certain standard of care is expected.  In this case, a resident was injured repeatedly while under their care.  When the patient died a few days after being "dropped" the family sued.

The patient was a 95 year old woman who was placed in a Missouri nursing home when the family was no longer able to care for her needs.

"Approximately 1.5 million people live in the nation's 17,000 nursing care facilities. . .The typical nursing home resident is a woman in her 80s displaying a mild form of memory loss and dementia. Although physically healthy for a woman her age, she needs help with approximately 4 of 5 activities of daily living (eating, transferring, toiletting, dressing, and bathing)."2

During her admission the patient would sustain  multiple injuries over the course of her stay.  In 1993, on two occasions, the patient's legs were broken with fractures diagnosed.  Each time the patient was transferred to the hospital for treatment and then returned to the nursing home.

Each time the documentation would show that the family had been "made aware."  This was reflected in incident reports that had been filed.  The incident reports did not specify which family members had been notified.

A third injury took place in 1995 when the patient was being transferred from her bed.  Documentation of the incident stated that the patient had been "dropped" during a transfer.  The charted notes documented that a head injury was sustained and that family members were notified.

The patient was again transferred to the hospital and was evaluated in the Emergency Department.  Interestingly, when examined by a physician, the day after the incident, the physician stated that there was no evidence of head injury.  Five days following this examination, the patient died.

The family would sue the nursing home.  They would allege that standards of care had not been met.  They would accuse the nursing home of rendering negligent care.

It is no secret that nursing home abuse occurs.  It can take many different forms and have devastating consequences on residents and their families.

"The United States Department of Health and Human Services researchers identified seven categories of abuse. Ninety-five percent of those surveyed said they felt that all seven are problems for nursing home residents:

Physical abuse --infliction of physical pain or injury.

Misuse of restraints --chemical or physical control of a resident beyond physician's order or outside accepted medical practice.

Verbal/emotional abuse --infliction of mental or emotional suffering.

Physical neglect --disregard for the necessities of daily living.

Medical neglect --lack of care for existing medical problems.

Verbal/emotional neglect --creating situations harmful to the resident's self-esteem.

Personal property abuse --illegal or improper use of a resident's property for personal gain."3

The basis of the family's lawsuit centered on the assumption that a certain standard of care, and a "duty" is owed to nursing home residents.   This duty it was assumed, included safe living conditions, freedom from harm and timely medical treatment.  They alleged that these standards had not been observed by the nursing home.

In the initial trial, a review of the charting and documentation showed that in each "incident," facility protocols had been followed.  Upon discovery of the injuries, medical treatment and family notification had been provided.

The Defense moved to have the charges dismissed.  The court agreed.

The family appealed.

Questions to be answered.

1. Was there clear evidence of either neglect or abuse on the part of the nursing home staff in either of the three documented incidents of injury?

2. Had standards of care been met in regard to treating an injured patient and providing safe and reasonable care.

Chiefly due to the timely documentation of the incidents, the records were used to demonstrate adequate care being given.

The family's lawsuit chiefly targeted the "handling" of the incidents rather than the "cause" of injury.  The documented interventions and notifications on the part of the nursing staff provided sufficient proof that standards were upheld.

It is common knowledge that documented nurses' notes and the medical chart are legal records.  They should be written and treated at all times as if a jury will later examine them.

Had the incident not been documented as thoroughly or had incident reports not been filled out, it might have been a different story.  It was the clear and concise charting of the nursing homes staff's handling of the incidents that saved the facility from a potentially costly lawsuit and trial.

This was particularly evident when the family accused the nursing home staff of "failure to notify" the family members.  As long as efforts were documented in the notes to notify the family, the facility was covered.

It is a bit strange that the specifics as to "who" was notified was not included in the chart.  Under a different set of opinions, this could easily be interpreted as a "red flag."  In this case it was not.

This documentation of  "notification" could have been seen as the nursing home staff charting to cover themselves regardless of whether a family member had been contacted.

To minimize suspicions of impropriety it is suggested that when a family member is contacted, the name and phone number also be documented.  All evidence is subject to interpretation.  This can be applied to physician notification as well.

When a patient has an attending, consulting physicians and residents responsible for their care, "MD made aware" leaves much room for debate as to who was notified.  If the name of the physician is noted, the guesswork is removed and accountability easier to establish.

What was not addressed in this case was the nature of the "accidental" injuries.  It is not difficult to imagine a 95-year-old patient falling as she tries to get out of bed.  It is common for patients to fall on their way to or from the bathroom.  The pertinent question is "could the injuries have been avoided."

It is clear from published studies that indeed many can be.

""We found that neither complaint investigations nor enforcement practices are being used effectively to assure adequate care for Nursing Homes residents and the prevention of nursing home abuse and neglect. As a result, allegations or incidents of serious problems, such as inadequate prevention of pressure sores, failure to prevent accidents, and failure to assess residents' needs and provide appropriate care, often go uninvestigated and uncorrected."4

Lawsuits against nursing homes are common and on the rise.  If you are working in a nursing home, you need to be aware that you are responsible for documenting adequate care.  You are equally responsible for prevention.  If a dangerous condition or "accident waiting to happen" is identified, steps must be taken and documented to correct it.

If a patient is at risk for falling they may refuse to call for assistance.  If they try to get out of bed anyway, it should be documented that the patient was instructed to "call for assistance," and did not.

If a patient is clearly a danger to himself or herself and others, restraints may be indicated.  The family or the physician may refuse to allow or write an order for them.  The nurse must document that the need for them was communicated, to whom and the response.

Even with adequate care being given accidents can happen with legal consequences.  Nursing homes are currently the focus of intense governmental supervision and regulation.  The effectiveness of the regulation is debatable.  There are many that feel that the only "solution" to correcting problems are legal actions against nursing homes.

If this approach is to be paralleled to eliminating medical malpractice, a solution may be a long way off.  What can be anticipated is increased pressure from the government, from consumers and the courts.  This will result in increased litigation and increased pressure on nursing home staff and facilities.  Each member of the nursing staff would be wise to document carefully daily care and especially incidents that result in injury.

Related Case Studies:

June 13, 1999: Felony Child Abuse Conviction, Made Possible Thanks to Nurse's Documentation.
State v. Gillard, 936 S.W. 2d 194 - MO (1999).
http://www.nursefriendly.com/nursing/clinical.cases/061399.htm

June 6, 1999: Emergency Department Nurse Verbally Abused, Physician History Well Documented
Gordon v. Lewiston Hospital, 714 A.2d 539 - PA (1998)
http://www.nursefriendly.com/nursing/clinical.cases/060699.htm

May 30, 1999: Patient Left Unrestrained, Patient Injured. Nurses Judgement Call
Gerard v. Sacred Heart Medical Center - 937 P. 2d 1104 (1997)
http://www.nursefriendly.com/nursing/clinical.cases/053099.htm

Related Link Sections:

Abuse:
http://www.nursefriendly.com/nursing/directpatientcare/abuse.htm

Clinical Charting and Documentation, Nurses Notes:
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Emergency Department Nurses on the Nurse Friendly:
http://www.nursefriendly.com/nursing/directory/spec/ed.html

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Head Injuries:
http://www.nursefriendly.com/nursing/directpatientcare/head.injuries.htm

Mechanical & Physical Restraints:
http://www.nursefriendly.com/nursing/directpatientcare/mechanical.physical.re...

Medical Legal Consulting Nurse Entrepreneurs:
http://www.nursefriendly.com/nursing/ymedlegal.htm

Nursing Homes, Long Term Care Links:
http://www.nursefriendly.com/nursing/nursing.homes.long.term.care.htm
 

Sources:

1. 40 RRNL 1 (June 1999)

2. American Health Care Association.  September 1998. Profile: Nursing Facility Resident: Retrieved June 27, 1999 from the World Wide Web:  http://www.ahca.org/secure/nfres.htm

3. Seniors-Site.  No date given.  Nursing Home Abuses to Senior Citizens.   Retrieved June 27, 1999 from the World Wide Web: http://seniors-site.com/nursing/abuses.html

4. United States Senate.  March '99. Excerpts from Committee On Aging Hearings.  Retrieved June 27, 1999 from the World Wide Web: http://www.jeffdanger.com/

The Uniform Resource Locator (URL) or Internet Street Address of this page is
http://www.nursefriendly.com/nursing/clinical.cases/062799.htm

Send comments and mail to Andrew Lopez, RN

Created on Saturday May 23, 1999

Last updated by Andrew Lopez, RN on Saturday, September 17, 2011

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Saturday, June 4, 2011

Are senior citizens being overmedicated? – The Chart - CNN.com Blogs

Strong, antipsychotic drugs are being prescribed more often to senior citizens in U.S. nursing homes, setting off a debate about whether it's the right treatment for the elderly suffering from dementia.

Daniel Levinson, inspector general for the Department of Health and Human Services, believes this increase - detailed in a recent study by his office - is a cause for alarm.  "The report found that too often, elderly residents are prescribed antipsychotic drugs in ways that violate government standards for unnecessary drug use," he wrote in a commentary for CNN.com.

Psychiatrist Daniel Carlat disagrees, saying the study Levinson cites is a "blizzard of statistics" that doesn't tell the entire story.  "When these drugs are successful, they soothe the inner turmoil that makes life intolerable for these patients, improving their quality of life dramatically," Carlat wrote in his commentary for CNN.com.

via thechart.blogs.cnn.com

Click on the "Via" link for the full article.

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Nursefriendly, Inc. A New Jersey Corporation.
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Sunday, May 15, 2011

Geriatric Nurses on: The Nurse Friendly

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Carol J. Rhodes RN, LNC, Medical-Legal Remedies Inc (MLR):"Medical-Legal Remedies Inc (MLR) provides medical-legal Litigation Support Services for Legal Professionals that include Legal Nurse Consulting, Paralegal Litigation Support, a Medical Information Service called Virtual Legal Nurse and Medical Expert Referral Service for Attorneys, Insurance Companies, Hospital Risk Managers, Government, and Claims Management. MLR MLR's Paralegal Staff and Legal Nurse work together as a team to assist our legal clients with comprehensive medical-legal litigation issues and are committed to serve clients by offering our extensive experience and expertise to provide specialized high quality medical-legal litigation support services. By utilizing Medical-Legal Remedies Inc Paralegal/Legal Nurse Team allows the litigator to control costs and increase revenues while securing the competitive advantage with superior work products. So whether your firm or company needs a Paralegal, a Legal Nurse, or both - MLR will assist your firm or company with any medical-legal litigation case project."
Carol J. Rhodes RN, LNC
14286-19 Beach Blvd. #248
Jacksonville, FL 32250
(904) 223-3969
Carol@JaxLegalNurse.com or Carol@VirtualLegalNurse.com
LinkedIn: http://www.linkedin.com/pub/carol-j-rhodes/30/81b/685
http://www.jaxparalegal.com/

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National Gerontological Nursing Association (NGNA):"We are the first and only nursing specialty organization dedicated to helping you realize your full potential as a gerontological nurse. We are a growing, dynamic and dedicated group of professionals who share ideas and information that improve the quality of nursing care for our elderly.
National Gerontological Nursing Association (NGNA)
7794 Grow Drive
Pensacola, FL 32514
Tel:(850) 473-1174 or (800) 723-0560
Fax:(850) 484-8762
email: ngna@puetzamc.com
http://www.ngna.org/

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Mark Ballinger RN BSN Partners In Care, Nebraska, Temporary Staffing, Medical-Surgical & Geriatrics
http://www.nursingentrepreneurs.com/ballinger/

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Dominique Ann Bernard, RN, BSN, Virginia Nurse Entrepreneurs:"My goal is to work from home. Currently I am employed in a psychiatric facility and I work part time in a geriatric setting. My interests are varied."
http://www.4nursing.com/bernard

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Tina Berkofsky, RN, CLNC, Florida Legal Nurse Consultants, Nursing Entrepreneurs
http://www.nursingentrepreneurs.com/berkofsky/

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Folts, Mark, MSN, CNS, Michigan

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Tracy McClelland, RN, MSN, Ycarte Health Career Center, Georgia Nursing Entrepreneurs:"Opening doors to the Nursing Profession is our primary concern. We are a nursing tutorial facility designed to assist our community by training healthcare professions with the most updated nursing information and training equipment. We focus on assisting individuals who want to advance in the healthcare profession, or begin with an entry level into healthcare. Our goal is to bring education to you in a comfortable non-threatening environment that allows for learning. Whether you are new to healthcare or desire to advance in this profession, we can provide you with the training you need."
Tracy McClelland, RN, MSN, Ycarte Health Career Center
North Pointe Plaza
1214 North Peterson Ave. Suite P
Douglas, GA 31533
Phone: (912) 384-8680
Fax: (912) 384-4390
info@ycartehealth.org
http://www.nursingentrepreneurs.com/mcclelland

Categories: ACLS (Advanced Cardiac Life Support)
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Mary Rosabell Higgins, BSN, Registered Nurse, M. R. Higgins & Associates Legal Nurse Consultants:"M. R. Higgins & Associates-Legal Nurse Consultants, a professional service company specializing in litigation review. Established in 1997, the company is headquartered in San Francisco, California.

Services include: comprehensive medical research; investigation of medical records to determine accuracy and or tampering; translation of medical terminology and deposition reports; and, interpretation of health science literature and documents. Consultation also comprises developing chronological summary reports from medical records.

Specialty Areas:

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rWayneWDyer
The more you work at just being yourself, the more likely you'll feel purposeful and significant in your life
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For Health Information you can use, Follow, Connect, Like us on (Most Invites Accepted):
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What's New:
http://www.nursefriendly.com/new/

Blogger:
http://4nursing.blogspot.com/

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Nursing Entrepreneurs, Nurses In Business
http://nursingentrepreneurs.ning.com/

StumbleUpon,
http://www.nursefriendly.com/stumbleupon
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Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

150,000 + Nurse-Reviewed & Approved Nursing Links

http://www.4nursing.com
http://www.inspirationalnursing.com
http://www.legalnursingconsultant.com
http://www.nursefriendly.com
http://www.nursingcasestudy.com
http://www.nursingentrepreneurs.com
http://www.nursingexperts.com
http://www.nursinghumor.com

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