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Reducing Your
Malpractice Exposure
National claims data highlight trends in
nursing
By Michael J. Loughran
AN INTOXICATED, agitated, aggressive patient presented to the
emergency department and was placed in four-point restraints for
his own safety. An ED nurse monitored and assessed the patient
every 15 minutes.
While the nurse performed her rounds, the patient attempted
to burn off his restraints with a lighter. He ignited his bed linens
and clothing, resulting in severe burns over 25% of his body and
the loss of the fingers on one hand.
The patient sued multiple defendants, including the nurse, for
an undisclosed amount. He alleged “failure to provide proper care
in a safe environment.”
Expert witnesses for the defense testified that the nurse had
acted within her scope of practice and in compliance with hospital
policy. Her documentation was contemporaneous and supported
adherence to the organizational policy for checking on and assessing
the patient at 15-minute intervals.
The case went to trial, and a defense verdict was rendered.
Legal Issues
However, the plaintiff appealed. The case required
12 years and $500,000 in legal defense costs to
resolve. The ED nurse’s thorough documentation
proved critical in establishing that she was not
responsible for the patient’s injuries.
This scenario illustrates the type of information
included in a 5-year claim study by the Nurses
Service Organization and its insurance partner,
CNA. Besides legal case studies, “Nurse Professional
Liability Exposures: 2015 Claim Report Update”
provides statistical data and analysis derived from
the CNA database of closed claims involving
nurses. The report highlights risk management
recommendations designed to improve patient
safety and reduce nurse liability exposure.
2015 Report Update
NSO and CNA have published three nurse claim
reports over the past 8 years. A comparison of data
from the 2015 report to the 2010 report identifies
several trends, including an increase in malpractice
claims arising from care in patient homes.
• Claims involving patient homes increased
from 8.9% in 2010 to 12.6% in 2015.
• Claims involving inpatient medical settings
declined from 20.2% to 17.7%.
This shift in location of claim occurrence
could be a result of healthcare reform. Under
the Affordable Care Act (ACA), the healthcare
delivery system of the future, and the system into
which we have begun to evolve, focuses on greater
collaboration between primary care practices and
home care providers.
This new model seeks to provide two benefits:
delivery of targeted care to the patient at the
optimal time, and lower costs for care delivery.
The data are not intended to suggest that the
home is a less safe care environment. Rather, it
reflects a trend indicating a probable increase in
the volume of nursing services provided in the
home and, in turn, an increase in claim activity.
Another noteworthy trend in the current report
is the claim data involving medication administration
errors. Between 2010 and 2015:
• Malpractice claims due to medication errors
decreased by nearly half, from 14.7% to 8%.
• The average cost of a medication error claim
nearly doubled, from $113,070 to $213,005.
Over the past 10 years, significant news coverage
has reported about medications that look and
sound alike, potentially contributing to medication
errors.
Consequently, pharmaceutical companies,
manufacturers, healthcare systems and risk manwww.advanceweb.com/Nurses
n MAY 2016 n ADVANCE FOR NURSES 35