With the hundreds of thousands of unexpected deaths and injuries arising out of hospital mistakes each year, there is no shortage of people who contact attorneys with a complaint of a treatment or hospital stay gone awry.

However, as everyone knows, case screening is a costly process and unless one has a track record of settling most of the cases with more wins than losses at trial, the screening methodology needs some overhaul.

Thus, we shall look at some of the lesser known ways of determining whether a potential client’s complaint about hospital or nursing facility services has any merit. Hence, we need to know that in all hospitals and long term care institutions there is a twenty-four hour responsibility for everything, i.e. medication, nutrition, hydration, electrolyte balance, safety, civil rights, mental well-being, circulation, elimination, hygiene, mobility, infection prevention and the environment, to name a few.

It all boils down to the nursing process because the nursing department is involved as the patients advocate in all aspects of care. Therefore, one must know what duties the nurses owe their clients. The key to understanding the nurses’ obligations in any given scenario is in the nursing process. This entails assessment, action and follow-up.

First, the assessment component requires identifying needs and evaluating risks. The methodologies for needs analysis, aside from the patient or family member stating a request, are observation, auscultation and palpation; look, listen and feel.

The admission assessment is the first document that identifies to what depth the nurse went in identifying needs. Following the needs assessment there is the subcomponent of evaluating the risks of complications that may arise just from being in the health care facility such as falling, bed sores, pneumonia, pulmonary embolism or disuse arthritis.

Second, the action module involves notification and intervention. Nurses by legal definition are required to diagnose the patients responses to treatment and any changes in condition. This also includes making sure that all tests and diagnostic procedure results are in the chart and reported to the attending physician.

The nurses must also note and report all clinical changes and take whatever action is necessary in a timely manner. In many instances a nurse is required to act without waiting for a doctors order, but in all cases the physician must be told as soon as possible.

Third, the nurses have an obligation to evaluate and record the patients response and outcome of the prior interventions. For instance, the nursing care plan sets forth a goal with respect to a potential complication.

The nurses must then provide the follow-up to determine whether the patient reached his or her goal and if not, they must state the reason and enter a new goal with a target date.In summary, effective hospital or nursing facility case screening requires reviewing the following documents:

  1. The discharge summary
  2. Admission nursing assessment
  3. Nursing care plans
  4. Fall risk assessment
  5. Risk for bed sores (Braden Scale)
  6. Nurses notes that identify the incident and/or injury

It is important to keep in mind that the presence of an unexpected condition and/or complication requires further investigation into the records. The discharge summary will often identify and describe in detail the events leading up to the injury, surprise complication or unexpected death.

Be wary of narratives that seem to be self serving by blaming others or describing the problem in some way as “unavoidable”. Finally, narratives that describe the end result like “patient found on floor” with out pertinent details should also be suspect. At this point you have enough pieces of the puzzle to know whether it would be a good investment to engage a nurse consultant to investigate further.


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