The Forever Battle

Posted by on Jun 20, 2017 in Blog

Reducing and preventing physician medication order entry errors Physician medication orders entered for the wrong patient is a constant battle for hospitals. At MKC Medical Management, as we investigate our client’s claims and cases, we see it all of the time. Many factors can lead to medication errors. In fact, the Institute for Safe Medication Practices has identified 10 key elements with the greatest influence on medication use and notes that weaknesses in these areas can lead to medication errors. They are: patient information drug information adequate communication drug packaging, labeling and nomenclature medication storage, stock, standardization and distribution drug device acquisition, use and monitoring environmental factors staff education and competency patient education quality processes and risk management Medication administration is a complex and multistep process that involves prescribing, transcribing, dispensing and administering drugs, as well as, monitoring patient response.  An error can happen at any step, but we see many errors happening in the beginning – at the prescribing stage.   Researchers tackle issue With the introduction of electronic medical records, there have been numerous studies focused on ways to reduce and prevent order entry errors. Researchers at Montefiore Hospital in New York, for instance, wanted to find a way to detect wrong-patient orders in their electronic medical records system. They devised a tool to track errors, such as prescribing medications for the wrong patient, and to suggest ways to reduce potentially life-threatening mistakes. The study lasted from December 2010 to June 2011. It found that two different interventions could decrease the number of wrong-patient orders that were later retracted. Phase 1 of Montefiore’s research: Physician Interviews Interviews with 233 physicians over a four-month period showed that 76 percent of the original orders had been for the wrong patients. They were near misses that could have turned into actual medical errors involving orders for imaging or lab tests or medications. Their findings of the study translated to wrong-patient electronic orders being entered by one in six clinicians for one in every 37 patients admitted to the hospital, an average of 14 such orders per day. This did not include or reveal how many orders for the wrong patients went through and were carried out. Phase 2 of Montefiore’s research: Verify Patient Identifiers In the randomized controlled trial, 4,000 providers were assigned to groups, which were prompted to verify patient identifiers before entering orders, re-entering patient identifiers – or neither. The results were encouraging compared to the control group. ID verification reduced the odds of retract-and-reorder events by 16 percent; ID reentry decreased them by 41 percent. It took clinicians only half a second on average to verify a patient’s ID, versus 6.6 seconds for reentering identifiers. The latter...

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Tips, Trends and Findings

Posted by on Jun 13, 2017 in Blog

Here are studies, reports and stories that caught our eye in the last month. No “standard” claim: Isn’t one rear-end crash like every other rear-end crash? No, says an article in Property Casualty 360 that’s part of a six-part series about adjuster ethics. “Each claim is unique, the people involved are individuals, and each claim needs to be adjusted on its merits,” the article says. “When we try to do away with individualism in each loss, we either over-pay or under-pay, hence the claim is no longer ‘fair and equitable.’” Bodily injury claims: Claimants must prove both liability and damages to be entitled for compensation in bodily injury claims. But, says an article in Claims magazine, liability is often overlooked. “A good rule of thumb for all adjusters is to never underestimate the importance of liability as a critical element of the claims investigation,” the article says. “Beyond the potential accuracy improvement in indemnity payments, there is a dramatic rise in subrogation potential.” Cars could someday alert drivers to their own medical emergencies: Sudden cardiac events for drivers behind the wheel can turn into tragedies for not only the driver, but his passengers and others on the road. Toyota, along with a team of researchers at the University of Michigan, are exploring technology that could monitor a driver and predict if they are going to have a heart attack or other adverse cardiac event while driving, according to an article in Insurance Journal. The role of social media in personal injury claims: Defense attorneys are adding a new weapon in their arsenal as they fight personal injury claims: A plantiff’s social media accounts. “Many plaintiffs make things very easy for the defense, simply by posting things on social media that undermine their claims,” says an article in Forbes. “For example, a simple post about mowing the lawn could be used as evidence to refute a personal injury claim about a back injury.” Can robots review personal injury claims? The answer, at Zurich Insurance, is yes. The company is using artificial intelligence to decide personal injury claims. “We recently introduced AI claims handling … and saved 40,000 work hours, while speeding up the claim processing time to five seconds,” chairman Tom de Swaan told Reuters as reported in Claims Journal. The robots began doing the work in March to review paperwork, including medical...

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Physician Peer Review or LNC Report?

Posted by on Jun 6, 2017 in Blog

What’s the best practice? Both When reviewing medical records, it may seem redundant and not at all cost effective to pay for both a physician’s peer review and a legal nurse consultant’s examination of the same claim or case. They both, however, offer unique perspectives. And, when you combine the two, the result affords you a more complete timeline of both the events that have happened and the medical future for the patient. The Physician Peer Review A physician peer review or medical review of a case can give you a pinpointed, detailed reporting of what has happened to date. It provides intricate details about specific pieces associated with the medical event and how those pieces fit directly together. More myopic in construction than an LNC report, the medical review yields very precise answers and insight into a medical event and the subsequent treatment strategies. Simply put, it’s a very accurate snapshot in time of the patient and the event. The LNC Report Also a major standard in the industry, an LNC takes the medical review and expands it. MKC nurses create a detailed medical record summary with ongoing embedded commentary, helping the reader understand both the material and its impact on the case. Contact us if you would like to see a sample report. An LNC report provides information about peripheral factors relevant to the case as well. It also considers long-term patient care and interaction, pre-accident medical information, specific information about the mechanism of injury and ongoing details pertinent to the injury and case. This broader approach often uncovers inconsistencies that may otherwise go undetected. An LNC’s granular level of review is equally important to the case as the focused review of the physician.  As one claims examiner once explained, “We know we will never have a silver bullet on these cases, but what is more valuable is that with the nurse review the details of the record evolves into a shotgun effect, thus exposing equally important details that are often missed.” Using a Whole Person Approach The patient involved may have a single event or episode, but the effects and ramifications of that single event can weigh heavily on the future treatment of that injured party. By using both reports, you gain a more complete picture of the claim, the specific injuries and the prognosis. Without using both reports, you could very well end up making future patient decisions with one eye...

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Delayed Treatment

Posted by on May 30, 2017 in Blog

Impacts of putting off medical care after injury Legal nurse consultants frequently find that a claimant has delayed treatment. Sometimes the delay may be only days, but many times the delay extends into weeks or months after the injury. The problem Delayed treatment makes it difficult to establish what injuries, if any, are causally related to the incident. With any gap in treatment, we cannot reliably know a claimant’s clinical presentation immediately after an injury, which is key to assessing the legitimacy of an insurance claim. The medical perspective Without a complete understanding of the claimant immediately after the injury, there is no way to unequivocally relate subjective complaints reported well after an injury. What’s more, when analyzing the claim, the rule of thumb is this: Compare subjective complaints to objective findings. Delays make this more difficult. If the claimant is not evaluated within a reasonable timeframe after the incident, any bruising, contusions or lacerations, which may have occurred at the time of injury, would likely have resolved, leaving it impossible to assess for signs of direct trauma. The bottom line As legal nurse consultants, we are asked to review medical records and render an opinion if the alleged injuries are consistent with the mechanism of injury.  So another critical question is this: What the delay may indicate about the injury and treatment. An argument could be made that if someone is really injured they would NOT delay seeking treatment for an extended period of time. Any delay also allows for ADDITIONAL injuries, which could potentially draw into question the legitimacy of the original injury itself. While we may not be able to directly relate subjective complaints reported weeks or months after the injury, what we can do is provide the claims handler with information about why the delay or absence of medical care makes it very difficult to relate the complaints to the incident. Debra West, RN, BSN,CCM, LNC is a legal nurse consultant with MKC Medical Management.  Contact Debra at or...

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Chiropractors vs. Physical Therapists: What’s the difference?

Posted by on May 23, 2017 in Blog

For anyone trying to understand a medical record or condition — including patients — it helps to take a look at definitions and how they’re applied. When chiropractors and physical therapists appear in those records, we often see confusion from clients. How are the professions different? How are they the same? Can they address the same injuries or complaints? We expect those questions to keep coming as both the number of physical therapists and chiropractors grow, in part, to serve a growing aging population. According to the Bureau of Labor Statistics, the number of chiropractor jobs will grow by 17 percent through 2024. For physical therapists, it’s a whopping 34 percent. By comparison, average job growth during the same period is forecasted at 7 percent. Let’s take a look at the definitions of each profession first. Here’s how the American Chiropractic Association defines chiropractic: “Chiropractic is a healthcare profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic care is used most often to treat neuromusculoskeletal complaints.” Chiropractic therapies mainly consist of pain management through adjustment and manual manipulation. Those therapies could include: soft tissue mobilization joint adjustment electrical stimulation and acupuncture. And here’s how the American Physical Therapy Association defines physical therapy: “Physical therapists are healthcare professionals who maintain, restore and improve movement, activity and health, enabling individuals of all ages to have optimal functioning and quality of life, while ensuring patient safety and applying evidence to provide efficient and effective care.” Physical therapists have a much broader base within their systems. Physical therapy isn’t just for pain relief. It’s also critical for rehabilitation focused on restoring functions and preventing disabilities after disease, injury or the loss of a body part. These practitioners use several techniques to achieve this goal. They include: exercise to strengthen muscles encouraging improved range of motion and retraining individuals to perform activities required for day-to-day living. Promoting healing – in different ways While both professions promote healing, it’s important to remember the differences. The chiropractor focuses on manipulation on the musculoskeletal and spinal system. The physical therapist focuses on maintaining, restoring and improving movement of musculoskeletal and neuromuscular systems through strengthening programs. Most confusion about the difference between chiropractic and physical therapy is a result of how these two very different professions overlap in their treatment of the spine. Keep this in mind: While a chiropractor remains the King of Spinal Manipulation, the physical therapist is the King of Physical Rehabilitation through exercise, activity modification and muscle strengthening. Barriers to access Another significant difference relates to access. Chiropractors are accessible to the general public. Often, a medical referral is required...

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