Have you read the "CNA HealthPro Nurse Practitioner Claims Analysis 1998-2008"? I recently did and learned several things that we as clinicians, and more importantly business owners, should pay more attention to in order to reduce our risk for a liability claim. Here are two of the highlights that you'll want to be aware of and incorporate into your own risk management plan for your practice.

1. Medication errors. More than 80% of medication errors are prescribing related AND one third of the errors involve prescribing the WRONG medication, followed by wrong dose and failure to properly discontinue medications.
   

   What you can do. In addition to using an eRx system, make sure that your scripts are clearly written (avoid medical jargon) with the indication on the script. Make sure you have reviewed the indications along with dosing, side effects and precautions with the patient and document that you have. It's a plus if you have handouts to give the patient, just make sure you document that you gave it to them.

2. Diagnosis Related Errors. Failure to diagnose and treat correctly is something all of us are aware of and it's one of those things that results in nightmares for the patient and the clinician. These things include missing the diagnosis all together, giving a wrong diagnosis or being late to make the diagnosis. In terms of treatment related errors, improper treatment and failure to make timely referrals is also of concern.
   

   What you can do. Rule out the worst diagnosis first. Know which screening test are indicated for which risk factor. Make sure you follow up to completion... In other words, follow up until you either rule in or rule out the diagnosis. Never ignore a patient complaint, stay within your scope of practice, refer when necessary, follow standards of practice and document everything you do or don't do (and why).

While claims against NPs remain low, they are climbing both in terms of numbers and amounts paid out. As we become more autonomous and more of us are in practice, we can expect these numbers to continue to rise. Take a good look at your practice. Identify any problems with your practice as well as the practice of any employees (both providers and clinical staff) and do what you need to do to take corrective action now. And don't forget to make sure everyone is covered.

©2011, Barbara Phillips, NP All Rights Reserved.

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