Lifting the right lids may reveal the pearls of potential gaps in quality care
© The Medical-Legal News 2007
By Marcia Eastlund, RN, CLNC, RAC-C
and Prudence Mitchell, RN, CLNC, NHA
There are standard areas in long-term care that will produce an abundant amount of information and consequently win or defend a case. Some are easy to identify while others are not.
If a facility receives government monies, the survey results are required to be available to the public. This is a valuable source of complaints, problems and trends in care given. Results are available from either the facility itself or from several web sites.
An assessment and care plan are required documents on all rtesidents, regardless of payment source. These identify and address problem areas particular to that person. Goals and interventions are required components. The assessment and care plan need to be compared with actual documentation of the care givers for consistency and follow-through. The MDS (Minimum Data Set) is the government-required assessment form used for assessing and planning care. Information on the MDS is based on documentation in the chart and therefore the two should agree. As a side note, all states use different formulas for payment, but all must use the MDS.
Facilities are responsible and held accountable to provide a clean and safe environment for the residents. There should be systems in place, other than just policy and procedures, to guide the employees in providing an environment that enhances quality of care and life, is clean, safe and free from abuse. A real jewel that may be more difficult to obtain is the facility’s internal audit system. There are various names for this audit system, but usually include the words “Quality Assurance.”
Another avenue to explore is staffing. What are the staffing patterns, i.e., ratio to residents? The employee records will reveal education, qualification, background check and experience, among other things. Each facility is responsible for the training of its employees in several mandated in-services on health and welfare of the elderly and handicapped.
Medications should be a key focus of any litigation involving long-term care. Are you aware that each resident’s medication regime must be reviewed monthly by the consulting pharmacist? The recommendations must be reviewed and addressed by the doctor and/or the nurse. This might be an excellent source of information regarding medication errors, psychotropic drug use, drug incompatibilities and adverse effects.
The long-term care industry is highly regulated and complex with standards the facilities must meet. The above suggestions are but a few areas that should be thoroughly explored.
If you are an attorney, a medical consultant with long term care experience will be a valuable member of your team by helping to advise on other avenues to explore and on deviations from the standards of care. The nurse consultant is advised to know how to assist an attorney in these areas. •
Marcia Eastlund and Prudence Mitchell are legal nurse consultants based in Colorado. Their company is Akros Legal Nurse Consultants,www.akroslnc.com.
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