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.

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.

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

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.

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].)

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.

Data Insight: The Role of Documentation in Inpatient Surgical Treatment Malpractice Claims

Accurate, clear, and timely documentation of the clinical progression of patients is critically important in both acute and ambulatory care. Yet, documentation continues to represent an area of risk.

An analysis of 10 years of MedPro closed claims history shows that documentation issues consistently are in the top five risk factors associated with inpatient claims that have clinically severe outcomes (i.e., permanent disability or death).

Tips for Amending Electronic Health Records

Altering documentation in patient records can have serious consequences, including allegations of fraud and professional misconduct — and it also can make malpractice claims difficult to defend. Yet, mistakes happen and situations undoubtedly will occur that require healthcare providers to make corrections, addendums, or late entries in patient records.

Because the majority of healthcare organizations have transitioned to electronic health records (EHRs) in the last decade, policies and procedures for amending records should reflect that change. In principle, many of the same standards for amending paper records apply to EHRs, such as not obscuring the original documentation, making timely corrections, and signing all entries. What differs in EHRs is the interface (including how the information is displayed and recorded), as well as the ability of the system to track user actions through metadata and audit trails.