Risk Management Tools & Resources


Tips for Presenting a Patient With a Pain Management Contract

Pain management contracting is one strategy that healthcare providers can employ to help manage the risks associated with treating patients who take opioids. A pain management contract is a type of behavior contract, which is an agreement between a patient and healthcare provider or organization that defines expectations related to behavior, conduct, communication, and/or treatment. Using a pain management contract can help set standards and expectations in relation to a patient's care, the provider–patient relationship, and appropriate use of opioid therapy.

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CASE STUDY: Patient Overdoses and Dies After Inappropriate Opioid Prescribing

The patient was a male in his late thirties with a history of significant orthopaedic injuries and a previous narcotic and heroin dependency. He presented to the emergency department (ED) at a rural critical access hospital with complaints of low back pain radiating down both legs. He was diagnosed with muscle spasms, treated with non-narcotics, and referred to a family medicine physician.

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CASE STUDY: Hasty Prescribing of Pain Medication Leads to Patient Overdose

The patient was a male in his mid-forties who suffered from chronic pain of unknown etiology. He was a long-time patient of Dr. B, a MedPro-insured family practice physician. Dr. B referred the patient to an anesthesiologist, Dr. M, who subspecialized in pain management.* Dr. M started the patient on a fentanyl patch (25 mcg/hour), and then gradually increased the patient's dose to 100 mcg/hour.

After not being evaluated or treated by Dr. B for some time, the patient called the family physician's office and requested a refill for his fentanyl patch. He stated that he was leaving town and was unable to get in touch with Dr. M to secure the refill. Dr. B's medical assistant prepared the prescription, and Dr. B signed it.

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CASE STUDY: Insufficient Imaging and Poor Communication Complicate Tooth Extraction

The patient, a female who had limited English proficiency (LEP), saw Dr. B, an associate in a busy general dental practice, for extraction of tooth number 32. A dental assistant had taken a periapical X-ray that depicted most of the root but missed the last few millimeters of the apex. The tooth was partially impacted, accessible to the oral cavity, and possessed fused conical roots.

Because Dr. B had removed hundreds of teeth in similar circumstances, she was confident that she could extract the patient's tooth without difficulty. Further, she did not want to take more X-rays and expose the patient to additional radiation.

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Dousing Dirty Digits: Improving Hand Hygiene in Dental Practices

Practicing diligent hand hygiene is a well-known principle of patient and healthcare worker safety, as well as a standard precaution for infection prevention and control in healthcare organizations of all types and sizes, including dental practices. In fact, hand hygiene often is recognized as the single most important step that dental providers and staff can take to prevent the spread of infections.1

Yet, as simple as practicing hand hygiene sounds, lack of compliance to established protocols can be a vexing issue for dental practices. Barriers to proper hand hygiene can vary by practice setting, but may include a busy environment; skin irritation and dryness from cleansing agents; a false sense of protection in relation to wearing gloves; lack of appropriate hand hygiene supplies; lack of, or poorly located, sinks; low prioritization due to patient demands or the belief that infection risk is low; insufficient organizational protocols or lack of awareness of protocols; inadequate knowledge about disease transmission and the importance of hand hygiene; and general forgetfulness.2

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CASE STUDY: Patient Aspirates Foreign Material During Dental Restoration Procedure

The patient presented to Dr. J, a general dentist, for four uncomplicated restorations. After Dr. J obtained and reviewed the patient's history and physical information and received appropriate informed consent to treat, she started the procedure. Shortly after entering the patient's oral cavity, the burr dislodged from the handpiece, struck the back of the patient's mouth, and the patient aspirated it.

The patient was having some respiratory distress, so the office contacted emergency medical services (EMS). At the local hospital, an X-ray indicated the burr was in the base of the patient's lung. An otolaryngologist was unsuccessful in reaching the burr endoscopically; ultimately, a thoracic surgeon removed it.

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Providing Culturally Competent Care for LGBT Patients

Diversity is a cornerstone of American culture that is reflected in our national institutions and endeavors, including healthcare. Doctors, healthcare professionals, and staff interact on a daily basis with people of varying backgrounds. Although patient population might differ based on geographic location or type of facility, the need for culturally competent care never diminishes.

One facet of this diverse society is people in the Lesbian, Gay, Bisexual, and Transgender (LGBT) community — roughly 4 percent of the U.S. population.1 Although each component of this community is unique, the term "LGBT" often is used to describe this dynamic group as a whole and to discuss issues — such as access and barriers to healthcare — that affect various individuals within this community. (Note: To emphasize inclusivity, the initialism "LGBT" might also include other initials, such as "Q" [for queer or questioning] and "I" [for intersex].)

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Data Insight: Communication Failures in Inpatient Diagnostic Claims Involving Nursing

Diagnosis-related allegations are the third most frequent inpatient hospital claim type (Figure 1). Although medicine and surgical specialties typically are noted as the responsible service, nursing staff are identified as either primarily or secondarily responsible in 22 percent of these claims.

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