MANAGING LEGAL RISK
TOP TEN LIST
presented to
2014 National Association of State Veterans Homes
July 31, 2014
presented by:
Janice Sumner, RN, CLNC
HMR Veterans Services, Inc.
Phone: (864) 622-2709
jsumner@hmrvsi.com
Sandra L.W. Miller, Esq.
Womble Carlyle Sandridge & Rice, LLP
Phone: (864) 255-5425
samiller@wcsr.com
IMPORTANT
The materials provided and information presented in this
seminar are intended to be informational only and do not
constitute legal advice regarding any specific situation.
ADMISSION RISKS
THE FIRST 72 HOURS DAYS ARE CRITICAL
 You don’t know the resident.
 You may be given incomplete information about the
resident’s condition.
 The family may have miscommunicated the
resident’s condition or past history of behavior, diet,
tendency to wander and previous elopement
attempts.
ANTICOAGULANTS
SPECIAL ATTENTION - SPECIAL RISK
 Laboratory monitoring is essential.
 Fall precautions take on additional importance. A
small head bump can result in a life threatening
subdural hematoma.
C-DIFF
BEWARE OF THE C-DIFF SCOURGE
 This infection is becoming more prominent in
hospitals and long term care facilities and any
episode of diarrhea should involve taking into
consideration the possibility of a C-diff infection
and include an evaluation of recent antibiotic use.
DIABETES
SPECIAL MANAGEMENT CHALLENGES
 Residents who have been on stable regimens prior to
admission can develop uncontrolled blood sugars
from the change in routine and eating habits that
accompanies admission.
 If the resident has acute problems on admission,
assume that to some degree their diabetes
management needs to be closely watched and may
need adjustment.
FALLS
CLEARLY DOCUMENT FALL RISK & PRECAUTION
 Resident’s fall risk must be identified upon admission.
 Documentation should include specific actions to
prevent falls.
 New incident? → Revise the care plan.
 Communication with the family.
 The physician must document and be involved in
communications about fall risks and falls.
FALLS (Continued)
 A system must be in place to monitor for
implementation of precautions.
PHYSICIAN COMMUNICATION
COLLABORATION AND FREQUENT
COMMUNICATION IS CRITICAL
 All communications must be documented, along
with the physician direction received.
 It is always better to “over-communicate” than to
“under-communicate.”
RESIDENT TO RESIDENT
ALTERCATIONS
FAILURE TO PROTECT A RESIDENT FROM
PHYSICAL OR EVEN VERBAL ABUSE BY
ANOTHER RESIDENT INFLAMES A JURY AND
CREATES SIGNIFICANT RISK IN LITIGATION
RESIDENT TO RESIDENT
ALTERCATIONS (Continued)
 Residents who are mobile and confused present
increased risk of:
(1) physical abuse between residents; and
(2) false allegations from residents who are
confused and paranoid or who have delusions
or hallucinations.
 Careful placement on the front end is best.
 Psychiatric consultation is critical.
SKIN INTEGRITY
THERE IS NO SUBSTITUTE FOR PREVENTION
 An accurate body audit should be done within the first hour
after admission.
 Accurate admission documentation is critical.
 Diagnosis must be accurate: Is it arterial, venous stasis, or
pressure related?
 The care plan should include assessment of skin breakdown
or abrasions from other equipment (e.g., wander guards).
SKIN INTEGRITY (Continued)
 Is it really a rash or excoriation on the buttocks or is it the
first sign of underlying skin breakdown about to erupt into a
visible major decubitus ulcer?
 In post-surgical residents, consider surgical positioning
during the initial body audit.
 What is going on under a cast or brace? Obtain clear orders
as to whether any brace or other equipment is to be removed.
STANDING ORDERS
SYMPTOMATIC STANDING ORDERS SHOULD BE
RESIDENT SPECIFIC
 Treating symptoms without assessment can mask
early signs of acute and potentially serious
conditions.
UNREALISTIC FAMILY
EXPECTATIONS
UNREALISTIC FAMILY
EXPECTATIONS (Continued)
DECLINE IS MOST OFTEN INEVITABLE
 Unrealistic family expectations are commonplace.
There is no such thing as too much communication
with family members.
 Communications should be documented including
what the family is told and their response.
AND NOW,
FOR THE BIG FINALE!