Case Management Chapter 8: Legal Issues in Case Management

Question 1

Distinguish the difference between negligence and malpractice:

Answer 1

Negligence is the failure to act as a reasonable person would in a given situation. Malpractice is professional negligence; based on the idea that someone with specialized knowledge and skill by virtue of education and experience, should know how to act in his or her personalized field.

Question 2

2. Recognize the importance of documentation in avoiding risk for litigation:

Answer 2

a. Document the facts and be objective; only use subjective as “patient states”. b. Only use approved abbreviations (TJC, URAC). c. Use eligible penmanship. d. Record info as promptly as possible; use actual time, chronological order.

Question 3

3. List for strategies to ensure appropriate discharge or case closure:

Answer 3

Discharge planning starts on admission; have complete assessment completed (including psychosocial and financial); promote safe and efficient planning; ensure meds are understood; ensure proper education received; informed consent for necessary referrals obtained; document changes in the plan; document interventions and response; document communication with patient/caregiver, particularly day of discharge; education on side effects, potential complications; documentation of clinical condition and medical stability within 24 hours of discharge.

Question 4

4. Describe informed consent process:

Answer 4

A legal requirement that rests with the physician. Includes the patient’s condition or problem; the nature of proposed test/treatment; any risks hazards, potential complications; alternative and feasible options; expected outcome; risks and prognosis if proposed treatment is not done.Case Manager notations include: who informed patient; information disclosed; who the explanation was given to; who was present; how long discussion took; teaching materials utilized; offering of Q & A; indication of comprehension.

Question 5

Explain the role of advanced directives in the planning and case management of patient’s care:

Answer 5

It is a constitutional right; assistance in getting patient’s wishes for care and treatment in writing and fulfilled

Question 6

6. Identify five strategies case managers may use to reduce legal risk:

Answer 6

Documentation, communication, knowing state and federal laws, certification, knowing the standards of accreditation, offer choices, minimum necessary, refer medical decision-making to the physician, operate under scope of practice, explain appeals process, obtain consent, abide by HIPAA, listen and be responsive (good customer service).