Physicians
are continually reminded about the significance of patient safety. Malpractice defense attorneys such as myself
often speak on the importance of preventing medical errors, effectively
communicating with nursing staff and patients, and ensuring proper charting –
all with the goal of helping physicians decrease the chances of being named in
a medical malpractice lawsuit. However,
safety does not stop at the hospital doors.
The basics of patient safety must be carried back to your clinic office
or you risk exposing both you and your clinic to potential litigation.
Of particular importance to patient
safety in the office setting is the ability to effectively and rapidly respond
to a medical emergency. While
life-threatening emergencies in the office setting are rare, they can and do
arise, and the ramifications of being caught unprepared can be severe. Some of the more common office-based
situations which can lead to a lawsuit include: (1) the lack of functioning
equipment and up-to-date supplies; (2) the failure to document maintenance
checks on equipment; and (3) the failure to properly train staff on how to
respond in an urgent situation.
Take for instance an elderly patient
who comes to your office for a routine check up. While in the examination room, you notice the
patient is having difficulty breathing.
She tells you that she left her oxygen tank at home and cannot seem to
catch her breath. Concerned, you
instruct your nurse to retrieve the clinic’s oxygen tank. The tank is brought into the room, hooked up,
turned on, and….nothing. As your patient
struggles for breath, you realize the tank is empty. Now consider how that situation will appear
to a jury in the hands of a skilled plaintiff’s attorney:
Deposition
Examination of Defendant Doctor by Plaintiff’s Attorney
Attorney: Doctor,
what did you do when Ms. Patient began experiencing breathing difficulties in
your office?
Doctor: I had my nurse get our oxygen tank and bring
it to the examination room where Ms. Patient was located. I then hooked up the cannula, placed it on
Ms. Patient, and turned on the oxygen.
Attorney: Those
actions did not relieve Ms. Patient’s breathing difficulties, did they?
Doctor: No, unfortunately they did not.
Attorney: And
the reason the oxygen tank did not help Ms. Patient with her breathing
difficulties is because there was no oxygen in the tank, correct?
Doctor: I don’t know if there was no oxygen at all,
but yes the tank was low.
Attorney: It was
so low, in fact, that it was not providing oxygen to Ms. Patient at her time of
distress, correct?
Doctor: She
was not getting oxygen from the tank, correct.
Attorney: When
was the last time you checked the oxygen levels in that tank?
Doctor: I am not sure of the exact date.
Attorney: When
was the last time someone on your staff checked the tank’s oxygen levels?
Doctor: I do
not know.
Attorney: Well,
did you have a checklist on the tank which would indicate when it was last
checked?
Doctor: No, not that I am aware of.
Attorney: Was
there a checklist anywhere in your clinic which would show when the oxygen tank
was checked last?
Doctor: I do not believe so.
Attorney: Now
you’re aware that the oxygen in the tank gets depleted over time with use,
aren’t you?
Doctor: Yes.
Attorney: And
you’ve used that oxygen tank in the past on other patients, haven’t you?
Doctor: Yes, we’ve used it on other patients before.
Attorney: So
you’re telling me that you knew the tank had been used before, you knew the
oxygen levels went down with use, and yet you had no plan in place to
periodically check the tank to ensure that it was ready to assist the next
patient who might need it. Doctor,
wouldn’t you consider it good medicine to make sure your oxygen tanks actually
have oxygen in them?
This deposition excerpt is something no physician or
malpractice attorney wants to encounter.
With an investment of time and effort, however, this scenario can often
be avoided. Below are some suggestions
that are aimed at not only reducing the likelihood of litigation but, more
importantly, optimizing patient safety in the office setting.
Develop
an action plan. Having a predetermined plan of action with personnel
trained to carry out the plan in a rapid and efficient manner is essential for
managing any emergent situation.
Generally, it is best to have a plan that delineates the specific
responsibilities unique to each staff member.
In other words, make sure that
your staff knows who is supposed to
be doing what when an emergency
arises – i.e., the receptionist will be responsible for calling 911, nurse # 1
will retrieve the crash cart, nurse # 2 will meet the EMS personnel at the
entrance and direct them to the patient, etc.
Train
your staff. Staff education is paramount to implementing
an effective response to an urgent clinical situation. Train your employees, both clinical and
non-clinical staff members, on where the emergency equipment is located and how
to use it properly. Update your training
as your equipment changes or is upgraded.
In addition, make sure to document any training sessions your staff
undergoes in case questions arise as to when and whether a certain employee was
aware of the action plan or equipment procedures. It may also be advantageous to conduct mock
emergency drills to allow your staff to practice all the steps in the action
plan and become comfortable with the protocol.
Take an
inventory of the medications and supplies on your crash cart. Pay special
attention to the expiration dates on medications. If a medication is outdated, dispose of it
and replace it. Make sure that the seals
are unbroken and that the equipment is clean.
Also check to see if your supplies have all the proper parts and
attachments. Does your AMBU bag have a
mask? Does your intubation box have the
appropriate stylets? The worst time to
find out that your equipment is missing connectors or the right attachments is
during the midst of an emergency.
Check to
ensure that equipment is functioning properly. Like the
oxygen tank scenario posed above, there is nothing worse that having the right
equipment, but failing to make sure it is in good working order. Routine tests and checks should be performed
on all equipment to ensure batteries are fully charged, suction devices work,
and pressure gauges show an adequate volume of oxygen.
Stock an
adequate variety of equipment. The selection of emergency supplies that will
be kept on-site at a clinic will vary depending on your particular type of
practice and your clinic’s patient population.
For example, a clinic that sees children and adolescents in addition to
adults should generally keep a wider array of equipment sizes on hand than an
adult-only clinic setting.
Document
regular maintenance checks.
The supplies and equipment you keep on hand
for emergencies should be inspected regularly and all maintenance checks should
be documented. I recommend keeping a
checklist of when each item was inspected, who performed the check, and any
findings or actions taken. Monitor your
staff to ensure that these maintenance checks are done routinely, legibly, and
correctly. In addition, it is easy to
overlook the restocking of a crash cart in the aftermath of an emergency, so
make sure that someone performs a re-check of the equipment and
supplies after each use. Replace any
used, opened, or soiled supplies.
The above-referenced suggestions are not a
one-size-fits-all solution to office safety.
Each physician must make his or her own determination as to what types
of equipment to keep on hand and which policies to implement. These decisions should be guided by several
factors including, but not limited to, the volume of patients seen at the
office, the demographics and medical profile of your patients, the complexity
and types of procedures performed in-office, and the proximity of your office
to a hospital. In sum, tailoring your
emergency plan to your individual clinic needs, devoting the time and effort
into ensuring that your clinic is properly stocked with functioning equipment,
and adequately training your staff will undoubtedly pay dividends if you are
ever faced with an in-office emergency.
Starnes
Davis Florie LLP
100
Brookwood Place, 7th Floor
Birmingham,
Alabama 35209
Phone: (205) 868-6075
Fax: (205) 868-6099
E-Mail: aadams@starneslaw.com
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