CHAPTER 25 | Understanding the Risks for Litigation 395 Box 25.2 Industry Standards of Care
Screen, assess, and evaluate nutritional status, including pertinent anthropometric data, laboratory data, clinical data, and diet history. Make appropriate recommendations that follow standards of practice. Follow order-writing protocols if clinical privileges are granted.
Address hydration status (needs, input and output, laboratory test results, risks).
Make appropriate nutrition recommendations based on current medical nutrition therapy protocols specifically related to unintended weight loss, enteral feedings, pressure injuries, hydration, and any other factors that put the resident at nutritional risk.
Individualize recommendations for each resident.
Record clear, concise statements that identify whether the resident is meeting nutrition, energy, protein, vitamin, mineral, and fluid needs.
Document issues in quality assurance monthly reports or consultant reports. Quality assurance reports oſten are not discoverable (ie, cannot be subpoenaed for use).
Chart in a nonaccusatory manner that does not implicate the facility in any wrongdoing or negligence.
Address all care plans with nutritionally related information.
Check that care plans match nutrition needs and status as reflected in the assessment, orders, and progress notes.
Ensure that the physician’s orders for diet prescriptions match the registered dietitian nutritionist’s documentation and are adequate and appropriate to meet the resident’s needs and wishes.
Liberalize diets with the physician’s consent. Avoid unnecessarily restricted diets.
Ensure that recommendations comply with local, state, Centers for Medicare and Medicaid Services, and federal regulations and facility process procedures (ie, enteral feedings or dehydration, complete assessments).
Do not just “sign off” on medical records. One’s license, finances, and reputation are at risk. Read the medical record, visit the resident, and make any changes necessary before signing.
Document regularly, per the facility’s policy, for each high- risk resident. Keep a facility tracking list of all high-risk residents and include dates of documentation.
Keep a detailed list of residents documented on each visit.
Document education provided to families and residents, as well as explanation of risks and negative outcomes. Include time spent with the resident, family, or both on controversial topics.
Record resident or family refusal or noncompliance. Include waivers or consider education sheets for residents making choices contrary to medical advice.
Special Circumstances of the Public Health
Emergency On January 27, 2020, US Secretary of Health and Human Services Alex M. Azar declared novel severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), which results in COVID-19, as a public health emergency under section 319 of the Public Health Service Act.14
The COVID-19 pandemic
greatly affected health care operations, particularly at long-term care facilities. Many residents and staff acquired SARS-CoV-2 infection, leading to increased deaths in an already medically fragile population experiencing staffing shortages and closer scrutiny of infection control procedures. Many health care facilities have been accused of negligence and have been threatened or served with
negligence claims. At the time of this writing, the fate of these claims is still to be determined. Some facil- ities have cited the Public Readiness and Emergency Preparedness Act, a longstanding federal law meant to shield companies fighting public health emergen- cies. The statute was expanded in 2020 to limit health care practitioner exposure to COVID-19–related law- suits. In January 2021, the US Department of Health and Human Services clarified that nursing homes and other facilities are immune from liability, except for cases in which virus mitigation measures were totally disregarded. However, in October 2021, in a setback to nursing home operators, a federal appeals court in New Jersey ruled against two facilities and determined that the claims should proceed in state courts.15
In addition, there were claims unrelated to
COVID-19, and claimants argue that those should be allowed to proceed. It will take many years for these
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