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Basic Training

Basic Training. Clinical Risk Management In the Long Term Care Setting Jo Ann Fisher, MSN, FNP-C. Basic Training. Objectives List clinical areas of risk and strategies for managing risk for these areas. Define Quality Indicators Describe the role of the care plan as a communication tool.

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Basic Training

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  1. Basic Training • Clinical Risk Management • In the Long Term Care Setting • Jo Ann Fisher, MSN, FNP-C

  2. Basic Training Objectives List clinical areas of risk and strategies for managing risk for these areas. Define Quality Indicators Describe the role of the care plan as a communication tool. Recognize the advantages and disadvantages of verbal and written communication. List specific techniques to improve communication.

  3. Basic Training Clinical Areas of Risk Quality Indicators Falls and Related Injury Chemical Restraints Pressure Sores

  4. Basic Training Quality Indicators CMD is responsible for participating in the monthly Quality measure/Indicator meeting Admin, DON, CMD, Risk manager, 3 other staff members must be present Thirteen domains, multiple measures! accidents, behaviors/emotional/cognitive patterns, > 9 meds, infection (UTI), pain, nutrition/eating, physical functioning, skin care psychotropics, & quality of life. Compare facility to state and national averages

  5. Basic Training Quality Measure and Indicator Meeting Review and comment on trends/outlyers (%) Review incidents and accidents for trends Review adverse incidents, facility must report in 1-5 days, investigate and report in 15 days: If it could have been prevented it is an Adverse Event If event was beyond the control of the nursing home, it is not an adverse event Review grievances and resolve

  6. Basic Training Falls and fall-related injury Prevalence of injury Trending of incident data Fall does not necessarily mean liability

  7. Basic Training • Chemical restraints • Definition • Regulatory use • Legal evaluation

  8. Basic Training Nutrition and hydration Malnutrition Dehydration Swallowing dysfunction Tube feeding and alternatives Potential areas of liability

  9. Basic Training Pressure ulcers Incidence much higher for high risk populations 80% rate of recurrence Preventable versus avoidable

  10. Basic Training Factors to avoid/defend against litigation: Supporting documentation Assessing, documenting underlying diseases, complications Aggressive, comprehensive prevention, treatment Demonstrating pre-existing debility These can be applied to any clinical risks

  11. Basic Training Wandering and elopement Tactile wandering Environmentally cued wandering Recreational wandering Agitated purposeful wandering

  12. Basic Training The Care Plan Use as an interdisciplinary communication tool Attending physicians are required to review and approve the POC Includes a resident-specific approach to care focused on identified goals Nursing staff must create a care plan within the first 7 days, identifying patient problems, interventions, goals

  13. Basic Training Care Plan (cont.) Describes services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being; and any services that would otherwise be required but are not provided due to the resident's exercise of right. This includes the right to refuse treatment.

  14. Basic Training CommunicationStrategiestoReduce Risk Document: Attempted family calls and all communication (expressed or potential conflict) Refusals of treatment (special forms) Review: Nurses notes & Consults Telephone orders Medications & Diagnostics Consider the Establishment of: Notification protocols Non-emergency protocols

  15. Basic Training Written Communication Advantages: Permanent Flexible Allows for broader explanation, context Disadvantages: Perceived as time-consuming Responses may be out of context Assumption of receipt

  16. Basic Training Verbal Communication Advantages: Allows for immediate response Allows for bi-directional information exchange Disadvantages: Understanding often is assumed Prone to distractions No “record” Significant filtering frequently occurs

  17. Basic Training Non-Verbal Communication Advantages: Powerful Can provide emotional link with listener Can enhance message, make it “real” Disadvantages: Powerful Can elicit strong defensive reaction Can override actual verbal message

  18. Basic Training Guidelines for Improved Communication In person Ensure attention/check for understanding watch non-verbal cues Telephone Ask and listen Have message repeated for accuracy Fax Establish your own policy w/facility Get clarifying information when needed Know HIPAA and state privacy regulations

  19. Basic Training Summary Communication is the key to risk management at all levels of care Attention to the Care Plan and QI process can help justify unavoidable outcomes All negative outcomes do not become part of the litigation process

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