Risk Management Tools & Resources


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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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).

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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.

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The Role of Documentation in Diagnosis-Related Malpractice Allegations

Allegations associated with diagnostic errors — i.e., wrong diagnoses, delayed diagnoses, and missed diagnoses — are a top cause of malpractice lawsuits. A number of risk factors can lead to diagnostic errors, including issues related to documentation of clinical care.

MedPro Group's closed claims data from 2007 to 2016 show that documentation issues occur in almost 1 in 5 diagnosis-related claims. These issues generally fall into three categories: (1) insufficient/lack of documentation, (2) content, and (3) mechanics.

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Strategies for Reducing Polypharmacy in Senior Care

Polypharmacy is a serious concern among adults, and especially among seniors. Although polypharmacy is preventable, it is a significant contributor to morbidity and mortality.1 Polypharmacy is generally defined as taking multiple medications or more medications than are medically necessary (including over-the-counter drugs and supplements). A 2016 study showed that 36 percent of community-dwelling older adults (ages 62-85 years) were taking five or more prescription medications in 2010 to 2011 — up from 31 percent in 2005 to 2006.

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