Tag Archives: assistance

WITH A LITTLE HELP FROM CNAs

Fifty years ago, subdivisions were sprouting in the cornfields and bean fields in Illinois. The 1960’s and 1970’s were a time of rapid growth in the housing stock at the edges of major metropolitan areas such as Aurora, Rockford, and Bloomington-Normal.

Ranch houses, tri-levels, and two-story homes were popular styles. Most had attached garages, and the backyards were often enclosed with chain link fences. The homeowners planted shade trees on the boulevard and in the backyard. They spent time and money mowing, watering, and fertilizing the grass. They took pride in ownership of a beautiful new home.

Margaret, her husband, and their four children lived in one of these new houses. She was a stay-at-home mom, and her children were allowed to be free range children. That meant they roller skated on the sidewalks, shot basketballs into hoops mounted on rooftops above the garages, and played baseball on the diamond at the elementary school. The boys on the street made a go-cart out of wood and an old lawnmower chassis and gave rides to the younger boys.

AND THERE WERE THE DIRT HILLS. Since this was a new subdivision, the last row of houses backed up to a large piece of vacant land. The builder had dug a retention pond, installed concrete sewer pipes, and piled up a huge mound of dirt next to the retention pond. Many a young boy rode his dirt bike down from the top of the mound of dirt. In fact, some became so skilled that they could ride at full speed down the dirt hill and land on a raft in the lake.

The children grew up, got married, and moved away. Margaret and her husband continued to live in the house. When Margaret was in her late seventies, her health began to fail. She could no longer climb the steps into the house so her husband built a ramp in the garage.

As Margaret’s illness progressed, she needed 24/7 care from CNAs who came to her home. This was a tremendous help to Margaret and to her husband. It allowed her to continue to stay in her own home for a period of time. Later, she was admitted to a hospital and died there at age eighty-one.

If you have a family member who needs private duty nursing, call American Home Health at (630) 236-3501. The agency can provide round-the-clock nursing care by Registered Nurses and (RNs), Licensed Practical Nurses (LPNs), and Certified Nursing Assistants (CNAs). Our service area covers fifteen counties in Northern Illinois including Cook, Lake, McHenry, Boone, Winnebago, Ogle, Lee, DeKalb, DuPage, Kane, Kendall, LaSalle, Grundy, Will, and Kankakee. American Home Health is licensed by the State of Illinois and accredited by the Joint Commission. For further information, go to www.ahhc-1.com, or call (630) 236-3501.

To hear the Beatles, the English rock band, sing “With A Little Help From My Friends” from their 1967 album Sgt. Pepper’s Lonely Hearts Club Band, go to With A Little Help From My Friends—You Tube at https://www.youtube.com/watch?v=0C58ttB2-Qg.

—By Karen Centowski

A DRESS FOR THE PROM

Girl with Prom Dress

When spring arrives, prom season in the United States begins. What if your daughter had been asked to attend a high school prom, but you could not afford the $100 to $600 to buy a dress for her? Just as the fairy godmother transformed Cinderella’s simple dress into a beautiful ball gown, ordinary people have developed programs to provide free prom dresses, shoes, and accessories to high school girls who cannot afford to buy them.

The Glass Slipper Project in Chicago is one of these programs. Founded in 1999, the Glass Slipper Project has helped more than 20,000 young women to attend their proms. Each girl selects her own prom dress, shoes, purse, and jewelry at “boutiques” within the building. A volunteer “personnel shopper” assists the girl in the selection of the prom dress. “Boutique” dates for the Glass Slipper Project for 2017 are April 22 and April 29. For additional information, go to https://glassslipperproject.org.

Items can be donated to the Glass Slipper Project by dropping them off at any of eight Zengeler Cleaners in Chicago. Zengeler Cleaners has participated in the Glass Slipper Project for fifteen consecutive years. Tom Zengeler, President of Illinois’ oldest cleaner, said, “The Glass Slipper Project collection drive is one of our favorite times of the year. Our entire team enjoys the opportunity to work with students from local schools, community-minded businesses and other organizations to support the project. Last year, we set an all-time record by collecting 5,287 dresses. We think we can beat that in 2017, thanks to the continued support of local schools, individual donors, and the local business community.”

Zengeler Cleaners’ stores are located in Deerfield, Hubbard Woods, Northfield, Winnetka, Long Grove, Northbrook, and two locations in Libertyville. For more information about Zengeler Cleaners, go to www.zengelercleaners.com, or contact Tom Zengeler at (847) 272-6550, ext. 14.

Other communities also have projects similar to Chicago’s Glass Slipper Project. For example, the Junior League of Kane and DuPage Counties provide free, gently-used prom dresses to girls who would have trouble affording one. This program is called Cinderella’s Closet. The 2017 event was held March 18 in Elgin.

Immanuel United Methodist Church in Lakeside Park, Kentucky, began a Cinderella’s Closet ministry in 2006. Each year the program helps nearly 450 girls in Northern Kentucky.

The Website http://www.cinderellasclosetusa.org describes the impetus for the founding of the program: “It’s an effort inspired by a teenager our founder, Erin Peterson, met while shopping at a consignment store. Erin overheard the teenager ask the clerk if the beautiful, gently-used gown on display could be put on hold while she figured out how to pay for it.

She asked her foster mother for the money, but a prom dress is an extra in life, and its price was out of their reach. Seeing her disappointment, Erin bought the dress for her. As tears flooded her eyes, she said she would look ‘just like Cinderella.’”

Indian Prairie School District 204 recently sponsored Valley Runway, a project that collects new and gently used prom dresses for students whose families might not be able to afford the expense of new ones. The idea developed as Metea Valley reading specialist Ann Cluxton and Metea Valley dean of students were driving home from a trip to Elgin’s Cinderella’s Closet last year to help nine girls get dresses to wear to the Metea Valley prom.

Cluxton’s original goal was to collect 100 prom dresses. With the help of parent-teacher associations at Metea Valley, Waubonsee Valley, and Nequa Valley high schools, Cluxton collected nearly 600 dresses. A grant from the Indian Prairie Educational Foundation paid for dress racks and materials used to build private changing rooms. A donation from the Naperville Rotary was used to buy new dresses in smaller and larger hard-to-find sizes. On March 3 and March 4, more than fifty high school girls selected prom dresses provided to them at no charge.

To see a video about the Cinderella’s Closet in Northern Kentucky, go to Cinderella’s Closet Experience You Tube at https://youtube.com/watch?v=wMTKcpaoJAw.

—by Karen Centowski

Documentation, Standards & Liability Part III

Nurse Charting

The Basics

Right Chart: Check that you have the correct chart before writing.

Penmanship: All your documentation is to be legible so anyone can read it. If you have poor penmanship, begin to print. Your printing will make it easier to read your notes. Now that your nursing notes are legible, let’s talk about the basics. Use permanent black ink pen. Other colors do not copy well.

Date and Time: Date and time every entry. The date should include the year; the time should indicate am or pm or be in military time. Don’t chart in blocks of time such as 0700 to 1500. This makes it hard to determine when specific events occurred.

Client’s history (including unhealthy conditions or risky heath habits such as scalp lice, smoking, failure to take prescribed medication, specific non-compliance issues and events, etc.) A client’s history is usually reflective of trends and may offer valuable hints about what to expect in the future.

Subjective Information: It is important that you chart any subjective information. Document what you hear, what the client says, what the caregivers say, comments to you about how they feel, feelings of anxiety or depression, etc. Use direct quotes and place quotation marks around the quote. Chart a client’s refusal to allow a treatment or take a medication. Be sure to report this to your immediate supervisor and the client’s physician and document your calls.

Objective Information: Chart your observations, what do you see, vital signs, hard data such as any and all assessment information. It is especially important to document changes in health status such as the emergence of a productive cough, difficulty in breathing or changes in vital signs from their baseline. Did you address: mental status, functional status, mobility, cognitive ability, speech? Oftentimes when you are in the home every day you forget that the people reading your notes do not know the client so you need to show them on paper.

Interventions: Document any actions that you did in response to any of your observations and the client’s response to your actions. These responses to your interventions are commonly called client outcomes. Chart the time you gave a medication, the route you gave it and the client’s response. If a medication is a PRN, chart the reason it was given and the client’s response to the medication (did it give the desired effect). Chart precautions, preventive measures used as well as any safety measures enacted, such as bed rails.

Client outcomes: Chart the client’s response to your interventions, including those that are deviations from what you expected. For example: if a client is in pain, observe and document how that pain is experienced both objectively (what you see) and subjectively (what you hear). Record where the pain is and the level of intensity or severity (use a pain scale to do that). Record the medication and the backrub you give to relieve the pain and whether or not those actions were effective, i.e., did the pain persist, recur, or go away?

Document the client, family member or significant other’s actual response (verbal or non-verbal) to any aspect of care provided even if you were not the one providing it. Doing so indicates that you have evaluated the results of care. It is perfectly acceptable to chart the client’s verbal responses in the record as long as you use quotation (“) marks. Non-verbal responses should be described in as much detail as possible.

Make sure your documentation reflects the nursing process and your professional capabilities. Chart completely, concisely and accurately (“Tell it like it is.”). Write clear sentences that get right to the point. Use simple, precise words. Don’t be afraid to use the word “I.”

Be sure to record your full name, credentials and job title in the required section on documentation forms. Some forms will ask you to record your initials as well. Your signature must be in cursive writing so a word of final caution: do take the time to sign your name legibly.

Beyond The Basics

Client Education and Instruction: Other information that needs to be recorded in the medical record includes any education or instructions you give to the client, his family or significant other. Anytime there is a new medication or treatment the client, family member and other personnel must be educated and informed. Documentation of these actions is required. Include the fact that you informed the client/caregiver of the new order; chart the education of dosage, actions, side effects and schedule; chart that you made changes on the medication administration record or task sheets (if applicable); chart how you were able to communicate the new orders to other nursing personnel responsible for the client’s care, document your communications regarding the new orders to the office.

Check Off Sheets: In some instances a pre-printed, standardized check off form may be used where all you have to do is check off or initial what you have done. The only time you may have to write any notes is when something is specific or unique to this particular client, something that can’t be included on a standardized check off form. Remember: if you do not check off items, it means that legally the care was not done.

Phone Calls: We don’t often think about phone calls, but they can contain certain information for which we have obligations such as advice that we may give to a client or a phone order that we may take from a doctor. To protect yourself in these kinds of phone conversations, a detailed summary of your conversations is charted in the client record.

Details of each call should include:

  1. Date and time of the call
  2. Caller’s name, position or credentials, call back phone number and address
  3. Reason for the call, request, complaint
  4. Your response to the call, advice you gave, protocol you followed (if applicable)
  5. Others that you notified as a result of the call
  6. Your name and credentials
  7. If taking doctor’s orders, transcription of the orders word for word and documentation that you read the orders back for verification.

More Do’s to Make Charting Successful

  • Chart as soon as possible after giving care; don’t wait to chart until the end of your work day. Chart often enough to tell the whole story.
  • If you remember an important point after you’ve completed your documentation, chart the information with a notation that it’s a “late entry.” Include the date and time of the late entry.
  • Chart all of the details relating to visits by physicians or other members of the health care team such as the teacher, therapist, case worker, dietician, social worker, etc. Describe the purpose of the visit, the name of the visitor, the time spent with the client and the outcome of the visit.
  • If you don’t give a medication, circle the time and document the reason for the omission.
  • If information on a form such as a flow sheet doesn’t apply to your client, write NA (not applicable) in the space provided.
  • Use only commonly used or approved abbreviations and symbols. Refer to the procedure manual for a list of approved abbreviations. When in doubt spell out the words. Remember many medications have similar names but very different actions.
  • When documentation continues from one page to the next, sign the bottom of the first page. At the top of the next page, write the date, time and “continued from previous page.” Make sure each page contains the client’s identifying information, date and year.
  • Re-read your documentation. You need to paint a picture of the client. Pretend you know nothing about the client. Then read your notes and see if your notes are capable of making you see the client as he/she really is.

See part I HERE and part II HERE.

 

 

Documentation, Standards & Liability Part II

Nurse Charting

In Part I we discussed what may constitute a malpractice claim against a nurse. The main point to be made in this article is to convince you to maintain a current working knowledge of nursing law, standards, policies and procedures and to document the care you provide in order to prove that you provided care which would be considered “good and accepted practice.”

The significance of medical records is both scientific and legal. As a record of illness and treatment, it saves duplication in future cases and it helps in immediate treatment. There should be thorough documentation. Documentation of patient care may not be nurses’ favorite activity; however, nurses who find themselves involved in lawsuits and have documented thoroughly will thank themselves later. Charting is almost certainly the most essential facet of proving that nurses have met the standards of care. The nurses’ notes are aids to medical diagnosis and in understanding the patient’s behavior. In addition, it serves as a legal protection for the facility, doctor, and nurse by reflecting the disease or condition of the patient and its management. Proper documentation reflects the quality of care that you give to your clients and is evidence that you acted as required or ordered. Healthcare providers must comply with established standards of care. Standards of care arise from many different sources:

  1. Regulations based on state and federal legislation or statutes.  Regardless of the term used, they are the law.
  2. State Nurse Practice Act
  3. Practice guidelines
  4. Employer’s policies and procedures
  5. Expert witnesses

When dealing with statutes and regulations, it is important to understand those in your own state. Violating any one of them would make you automatically negligent (not exercising the degree of care that a person of like training and experience would do under the same or similar circumstances) without the right to defend yourself. On the brighter side, proof of your compliance to any particular statute or regulation can be used in your defense to show that you did follow a standard of care.

Practice guidelines and agency policies and procedures are not laws. Failure to follow them does not mean that you are automatically negligent. What it does mean is that it will be up to a jury to decide whether or not you were negligent. Practice guidelines and agency policies and procedures are often introduced as standards of care by a prosecuting attorney trying to prove that negligence has occurred. On the other hand, a defense attorney will use the same guidelines and policies/procedures as evidence that standards of care were met.

Expert witnesses are used by both prosecuting and defense attorneys to establish standards of care. Depending on the kind of legal case, an expert witness could be a nurse, a doctor, a facility administrator, etc. They are usually individuals who are well known and respected in their field. An expert’s role is to explain to the jury the standard of care based upon their particular area of expertise. They are allowed to use articles, practice guidelines, policies, etc. to prove their point. The jury will interpret the opinions of the expert witnesses and determine for themselves if negligence has occurred.

Although your employer should periodically update their policies and procedures and keep you informed about new or revised standards of care and/or state legislation, it is still your responsibility to get that information for yourself so that you can minimize your risk of liability.

Along with keeping yourself informed, it is also critical that you value doing complete and accurate documentation in the medical record as yet another means of avoiding liability. It is well known that the medical record can change the entire climate surrounding a lawsuit. In fact, medical records, in themselves, may be the very source of a lawsuit. Not only is complete and accurate documentation a means of telling the story of a client’s health care history over time, but it is also often required to justify reimbursement of services that are provided to a client. When that reimbursement is coming from programs like Medicare and Medicaid, denial of those funds would certainly be a critical situation in agencies caring for the elderly and/or the poor.

Failure to document or faulty documentation on your part is risky behavior that should be avoided. Knowing that, it is highly suggested that you obtain a copy of the documentation standard (policy) where you are employed and become very familiar with it. Questions you may have can be directed to either your immediate supervisor or a member of the education department in your agency.

Above all, the best way for the nurse to avoid a lawsuit is to be aware of the standards of nursing practice and follow them by heart. Ultimately, to prevent errors, nurses should meet the standards of care. It also implies that a nurse should be aware of their employer’s policies and procedures, the state nursing practice act, and the professional standards of his specialty. Ergo, nurses should exercise their sound verdict and employ standards of nursing care in order to avert lawsuits or to protect themselves.

See part I HERE.

Part III of this article coming soon…

Documentation, Standards & Liability Part I

Nurse Charting

The expanded role of nurses and the increasing demands placed on them have led to an expansion of legal liability for malpractice. Historically, liability fell upon physicians, and the nurses were largely considered an administrative arm of the physician. However, the nurse’s responsibilities of patient care management have opened new doors for legal claims against nurses.

What Constitutes Malpractice?

  1. Not all unexpected, unintended, or even undesired medical results can be attributed to the fault of the healthcare provider. A patient must prove four elements to establish a malpractice case.
  2. There must be a nurse-patient relationship. It is out of the nurse-patient relationship that a nurse’s duty to the patient arises.
  3. The patient must establish the scope of the duty that was owed by the nurse; this is usually done though an expert witness testifying about the care that was required.
  4. There must be a departure from “good and accepted practice.” Good and accepted practice is most often defined as care that would have been provided by the ordinarily prudent nurse practicing in the particular circumstances.
  5. It must be shown that the injury was caused by the act or acts that departed from accepted nursing care. It must be proved that if the nurse had not been negligent, then more likely than not, the patient would not have suffered harm.

What Events Commonly Result in Malpractice Cases?

The primary causes of litigation arising from medication errors are wrong dose given, wrong drug administered, incorrect method of administration, and failure to assess for side effects and toxicity.

Another common cause is the failure to properly monitor and assess the patient’s condition and failure to properly supervise a patient resulting in harm. Typically, negligent monitoring cases arise from a nurse’s failure to perform an assessment and notify the treating physician of changes.

The need to advocate on behalf of a patient when the suitability of care is at issue is also a common allegation. In many instances, merely carrying out a physician’s order may insulate a nurse from liability. However, it is well established that such orders will not insulate the nurse when the orders are questionable. Therefore, a nurse has an obligation to advocate on behalf of the patient when issues arise about the course of care or treatment being provided. The issue in these cases arises from the nurse’s duty to keep the patient safe.

How to Decrease Your Risk of a Liability Claim

Utilizing the nursing process and employing critical thinking may decrease bad outcomes that commonly lead to malpractice claims. The steps of the nursing process are described as follows:

  1. Assessment;
  2. Problem/need identification;
  3. Planning;
  4. Implementation;
  5. Evaluation.

By ensuring that each step is taken and that reflection is given by using critical thinking, the likelihood of an avoidable adverse medical event occurring is less likely. In medication administration, the 5 Rs are often cited: right patient, right drug, right route, right dose, and right time. All too often one or more of these “rights” are violated, and a patient is injured. As with any order, guideline, directive, or principle within the nursing process, following these steps is only the beginning. To ensure that the clinical circumstances warrant implementation of the order, critical thinking is essential when administering any drug.

Why is Documentation so Important?

At trial, each party presents evidence, including testimony of witnesses, in an effort to prove their position. The jury then deliberates and determines the facts based on what they believe most likely happened. The jury then applies the law and decides whether the facts, as they have determined them to be, create liability.

In negligence cases, discrepancies include disputes over symptoms complained of, signs that did or did not exist, and care or treatment that was recommended and/or provided. In an effort to determine the facts, the jury will study the medical record. Each record is unique in that it is usually created at a time when there is no interest in a legal outcome. The difficulty will lie in proving that something was done when a patient’s attorney is suggesting that it wasn’t and there is no supporting documentation.

The question on the minds of the jury will be if there is no documentation, did the nurse actually perform according to nursing standards. Your credibility will most certainly be in question if you said you did perform according to standards but did not document your actions. After all, you have already proven that you don’t always perform according to nursing standards because you did not document all your actions. Without such documentation, it then becomes the task of the jury to determine the nurse’s credibility, and draw inference from the existing documentation.

Conclusion

For nurses, the chance of being named in a malpractice lawsuit remains relatively small. However, the risk clearly is increasing. Utilizing good nursing care and employing critical thinking will significantly decrease the likelihood of being named in a malpractice lawsuit. Your skill combined with good documentation technique is the best way to avoid an adverse legal outcome in the event that you are sued.

Part II of this article coming soon…