Medical Legal Concerns And Risk Management Flashcards
Why is there controversy on the progress and outcome of labor and effect on the fetus
Increase instrument usage
Increase CS deliveries
Prolonged labor
Fetal occiput posterior presentation
Why is there controversy behind epidurals
Motor blockade may prevent mother from pushing
Higher incidence of occiput posterior position of fetus
Decreased threshold for instrument assisted deliveries
Residents perform them
Complications from regional
Maternal fever Backpain Neuro sequelae PDPH Neonatal effects Hypotension Inadequate analgesia Infection/hematoma
Maternal fever is caused by
Longer duration of labor with epidural
Epidural without epi has no higher incidence
Sepsis of infants is low
Back pain is associated with
Greater weight and short statue
Not with epidural attempts
Not related to neuraxial anesthesia
Continuation of antepartum pain
Resolution in cases of epidural abscess/hematoma
Monitor, early diagnosis, prompt treatment
Regional block considered causative until proven other with what complications
Neurologic
Inversely proportional to provider experience
PDPH
T of F all HAs are not PDPH
T
Spinal needle design and size affects which complication
PDPH
Caused by epidural or labor pain
causes occiput posterior which causes patient to request epidural
Neonatal effects
Most common effect of spinal for CS
Treat early and aggressively
Hypotension
Defined as SBP <100
Differential diagnoses for PDPH
Nonspecific Migraine Meningitis Pregnancy induced HTn associated with HA Cerebral tumor Subarachnoid hemorrhage (HELLP) Subdural hematoma Cerebral vein thrombosis
Recognizing what resulted in the increased use of regional for elective and emergency CS
And has led to a decrease in maternal mortality
That regional is preferable even when fetus status is not reassuring
Why are there challenges for litigation with GA
Awareness and recall risk
Avoidance of sedatives as premeds
Low concentration of IAs
Use of muscle relaxants
Reduction of dose of anesthetics
Partial neuraxial blockade requiring conversion to GA
Wrong assumption that baseline sympathetic tone is responsible for tachycardia
Leading causes of maternal death
Unsafe abortion Cardiac conditions Infections Hemorrhage embolism PIH Complications from delivery
What contributes to upward trend of MMR
Inconsistent OB practice
Increasing antenatal chronic conditions such as HTN, DM, obesity
Lack of good data and related analysis outcomes
What anesthesia is associated with the highest rate of maternal mortality
GA for CS from failed intubation or aspiration
GA higher risk with OB pt
Delayed recognition, delayed diagnosis, and treatment of problems lead to poor outcomes
Theme 1 of OB closed claims
Failed communication could lead to delay in appropriate treatment, multiple providers, treating the same problem or no on treating the problem leading to a poor outcome
Theme 2
Conflicting documentation may lead to poor outcomes and or anesthesia provider being named in claim; good documentation demonstrates appropriate care given and/or may keep anesthesia provider from being named in claim
Theme 3
Unexpected or unrecognized hemorrhage may lead to death or brain damage
Theme 4
Lack of vigilance may lead to permanent deficits or brain death
Theme 5
Major complications related to anesthesia
Aspiration pneumonitis
Maternal death or brain damage - problem with difficult intubation and pulmonary aspiration
Neonatal brain damage or death
Maternal nerve injury
Claims for minor injuries such as these are on the rise
HA, back pain, pain during anesthesia, emotional distress
How to establish malpractice
There must be duty, breach, injury, proximate cause
Must be shown that a duty to provide care existed
Duty
HCP failed to meet his or her duty to provide reasonable care
Breach
Patient experienced injury that resulted in damages
Injury
Negligence of HCP caused patient’s injury
Proximate causes
How can anesthesia avoid litigation
Communication
Documentation
Vigilance
The leading cause of errors and patient harm
Communication
How to improve communication
Team huddles
Multidisciplinary rounds
Debriefings
Structured method for passage of critical information
How does miscommunication play a factor into informed consent
Specific patient request ignored
Patient not informed of specific complication
Explicitly mention and document
Entire range of risks
Educate patient about unpredictable course of events and possible complications
Alternative treatment discussed
When are consents best done
In advance of labor
Remember to get written consent for labor epidurals
T
How does documentation lead to poor litigation outcomes
Conflicting docs
The act of being alert and watchful for potential danger of difficulties
Vigilance
Continual patient assessment, review of surgical field, anticipation, preparedness for potential adverse events, respond in timely manner to changes
Vigilance
