Annals of Long Term Care

This is part II of a two-part article. Part I addressed litigation and appeared in the April issue of the Journal.

Introduction
There has been a significant increase in medical malpractice lawsuits in long-term care (LTC).1 Therefore, the facilities and the healthcare providers who work in them need to be aware of several important risk management strategies that can reduce their likelihood of being sued for medical malpractice. Good medical practice and medical malpractice risk reduction are congruent activities.2 There are, however, several areas of practice where a limited amount of additional attention can substantially reduce the risk of being sued.

Communication
Many aggrieved patients and family members cite poor communication with their healthcare provider as a primary reason they decide to sue. Increasing time constraints may cause some providers to reduce the amount of time they spend explaining an illness, change in condition, or results of a test with their patient or patient’s guardian. Many residents in LTC have medical conditions that are chronic and will almost certainly get worse. Inadequate explanation of the condition may lead to unrealistic expectations of recovery. Many patients in LTC have dementia and are unable to understand the nature of their illness and necessary treatments.

Initial findings and significant changes in condition should be discussed with the patient’s guardian. This is particularly important if a current plan of care is not producing the desired results. Take the time to communicate with the patient or call the patient’s guardian at the time of admission and when there is a significant change in condition or an inadequate response to current treatments. Set some common goals, and if recovery is not anticipated, be sure to address this situation. Conflict may exist between family members regarding the appropriate plan of care. It is good practice to establish one family member as the primary contact person. Occasionally, it may be necessary to sit down with several family members to address particularly difficult issues and work out differences of opinion.

Adequate communication between providers is also important for good patient care and risk management. Notification of significant events should be encouraged. Significant changes and the need to follow up on ordered tests should be conveyed to covering providers. Good communication reduces malpractice cases.3

Documentation
Detailed documentation of care delivered and the plan of care is a key component of risk management. It is disconcerting to see the paucity of detail and the illegibility of most physicians’ notes when reviewing medical records pertaining to a malpractice case. Once again, perceived time constraints may result in a care provider inadequately documenting care. Good medical documentation is important to justify the providers’ professional charges, provide information regarding the case for other providers, and help defend a medical malpractice case should one occur. Illegible, scant, and incoherent notes give the appearance of irresponsibility to the care delivered.

Initial documentation of a new admission needs to be thorough. Indicate in the documentation the sources from which you gathered information and whom you talked to. State the plan of care. Document areas of concern, and if recovery is unlikely and further deterioration is anticipated, be sure to document this and the fact that it has been discussed with the patient or guardian.

The facility will in most circumstances document the provider’s notification of a significant change in condition. The provider should also document this notification.