Risk management and nursing: Educating for a better tomorrow
Kansas Risk Management law (KSA. 65-4921 et. seq) began in 1986 with the intended purpose of decreasing the number of lawsuits within the health care system. KSA. 65-4921 (-f) defines a reportable incident as “An act by a health care provider which ( 1 ) is or may be below the applicable standard of care and has a reasonable probability of causing injury to a patient; or (2) may be grounds for disciplinary action by the appropriate licensing agency.” This law requires all licensed nurses to report incidents which they believe may have resulted in substandard care. [Once reported in hospitals, it becomes the facilities responsibility to investigate and analyze whether licensed nurses met the standard of care (SOC) expected for the institution’s patients and, if not, whether failure to meet those standards might reasonably have caused patient injury.]
Investigations and analysis of incidents with a resultant documented SOC are the mechanisms whereby hospitals provide reasonable assurance that their practitioners are meeting the SOC in every case. While hospital risk management committees have some flexibility in making SOC determinations, licensed nurses must follow SOC’s generally accepted by other ordinary, reasonably prudent practitioners in the sante or similar circumstances. This implies that all health care professionals know their duties, must meet those duties, and thereby avoid patient injury. This is why it is extremely important that a peer committee review the case on an individual basis.
The Kansas risk management law permits hospitals, through designated committees, to identify and correct their own patient care problems through the process of making and documenting objective findings arrived at through reporting, investigating and analyzing cases. Any professional whose practices cause concern among his/her peers should appreciate the opportunity of knowing that fact before a lawsuit or regulatory action is taken.
In order to assure program integrity the SOC determinations must be clearly stated and supported by documented rationale and all risk management information should be clearly labeled as confidential peer review. Following the Adams vs St. Francis case it becomes even more important that the documentation be clearly labeled as peer review and that standard of care determinations, conclusions/rationale and discussions be separated from the facts of the case.
Historically, data has been collected by KDHE and their presented hospitals with the number of risk management incidents confirmed to meet standard of SOC determinations level 3 or 4, the agency in which the incident was reported and the number of reports generated by facility size.
Licensure/Risk Management Survey Activity
Between December 1, 1996 and December 31, 1998, 92 on-site surveys and revisits were conducted in non-JCAHO accredited facilities. One hundred and eighty-two (182) survey codes are most frequently utilized in the survey process, with 158 related to licensure and 24 are risk management statutes or regulations. Eighteen different survey codes represented the most frequently cited with 10 or more deficiencies cited for each one.
Several nursing standards appear in the list of the most commonly cited survey code deficiencies for licensing surveys conducted by KDHE in conjunction with their routine inspections for non-JCAHO accredited facilities. Two codes cited frequently that directly applies to nurses and nursing are the following:
Survey Code 033(Second most commonly cited, and cited in 63% of facilities) KAR 28-34-7(g) Nursing care policies and procedures shall be in writing and consistent with generally accepted practice and shall be reviewed and revised as necessary.
Nursing or interdisciplinary care planning not done or not individualized. Failure to assess patients at risk for falls or skin breakdowns.
Survey Code 0061 (Ninth on the list of most common citations, with 37% of facilities being cited) KAR 28-34-lOa. (b)
Organization and staffing. The pharmaceutical service shall be directed by a licensed pharmacist If the hospital has a pharmacy, it shall be directed by a licensed pharmacist If the hospital does not have a pharmacy or a full-time staff pharmacist, a pharmacist employed on apart-time or consultant basis shall be responsible for control and dispensing of drugs and for operation of the pharmacy or the pharmaceutical functions of nursing stations. In addition to meeting the standards in this regulation, services shall be provided in accordance with KAR 68-7-II and amendments thereto.
Control and dispensing of medications not addressed by policies. Designation of staff granted access to pharmacy not followed: all nursing staff, ancillary staff with unlimited access. Nursing staff dispensing medications.
Copyright Kansas State Nurses Association Apr 1999
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