Chapter 24 Understanding the Risks for Litigation

more of the standards are not followed, it is possible to argue that the professional’s care was negligent or that failure to follow a particular standard contributed to the harm of a patient. Documentation is therefore critical. Demonstrating that all these standards were followed, however, is often difficult two to three years after care was given, when the chart is cold.

DOCUMENTING ELECTRONICALLY The electronic health record (EHR) has changed the method by which practitioners document. EHRs time- stamp all entries, so going back to “fix” a chart is not pos- sible. Electronic documentation systems also collect metadata, which is essentially an audit trail (16). Work patterns, such as how long is spent on each pattern, are easily discerned from an electronic system. However, it is important to note that some systems may allow the use of the copy/paste function, which may potentially introduce errors in the chart. For example, imagine that a history and physical are copied from a prior admission when the patient had a broken leg. The leg will likely heal in two months, but if the copy/paste function is used, it may appear that the broken leg is a current problem. In other instances where previous records were simply copied into a new chart, the timeline that was created did not pass the logic test and opened many questions of competency for the RDNs. Box 24.2 gives examples of documentation. A facility should not overlook the RDN’s leader- ship responsibility as part of the management team to ensure the general health and welfare of its residents. For example, staff and residents frequently use emer- gency exits because they are near the parking lot. If an intruder enters through an unsecured door, all staff may become liable for harm to a resident if a formal com- plaint is not made.

RDNs should know the facility’s policy on how to report adverse events and other data-sharing requests, such as a request for a copy of a grandmother’s chart by a granddaughter who is in nursing school. RDNs should have copies of the current state leg- islation related to legal authorization to perform nutri- tion services so they can share this with reviewers and auditors should they ask. They also should have copies of their state license, dietetic registration, and creden- tials readily accessible. Some states require that these are posted in a public area.

SUMMARY

Many lawsuits are avoidable. RDNs must know all state and federal rules and regulations and the needs of

BOX 24.2 Solutions to Common Documentation Problems

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Revise data collection forms. Whether handwritten or electronic, forms should aid in data collection and reflect current policies.

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Review policies to eliminate unnecessary orders, such as intakes and outputs for every admittance for the first week. Unless the reason for obtaining such data is clear, the policy is perhaps unnecessary.

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Document interaction and education of residents and family members.

Systematically and consistently conduct chart audits to determine potential problems. Peer reviews and consultants can help with this.

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Understand that it is necessary to keep a complete and accurate medical record.

those residents who are at risk. Adherence to RDN referral policies is a must. It is necessary to make immediate assessment on high-risk admissions either in person, by fax, or by teleconference. RDNs should serve as aggressive team members to support the total medical care of all patients.

Unhappy families are more likely to sue. Excellent food service, customer care, and communi- cation with the family are premium antilawsuit tech- niques. Treat others as you would like others to treat you or your family members if you were residents. Associating with facilities that have excellent survey records and positive customer/resident satisfaction rates minimizes the risk of nutritional litigation for RDNs. Inadequate hours and coverage, poor survey records, and inadequate facility nutritional monitoring systems for weights, laboratory tests, hydration, and pressure ulcers increase the risk that the RDN might become a potential codefendant.

RDNs must know about the professional obliga- tion to protect themselves and the dietetics profession. They should follow the Code of Ethics for the Profession of Dietetics and Process for Consideration of Ethics Issues to protect clients, the public, and the profession (17). RDNs need to stay current on profes- sional information and research, use and expand their available resources, and seek continuing education related to their duties. They should actively supervise and establish their own standards of practice and moral code. They should never tolerate illegal behaviors or acts or mistreatment of residents. By understanding the RDN’s role in resident care, one can minimize the potential for legal action.

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