As the first medical professional liability insurer to establish a patient safety department, The Doctors Company remains the leader in developing innovative tools that can help you reduce risk and keep your patients safe.
Follow safe medication practices.
Be aware of look-alike/sound-alike (LASA) medications, in particular medications common to dermatology with a LASA not associated with the specialty, such as Accutane and Accupril, Aldara and Alora, or Elidel and Elavil. Avoid verbal orders when possible, but spell out the drug name when verbal orders must be used. Write the brand and generic names on prescriptions, and include the diagnosis or indication on the prescription. Not only does this help the pharmacist in the case of LASA, but it also helps the patient to recall the purpose of each medication.
Be meticulous about specimens and reports.
Assure that a stringent collection and labeling protocol is in effect. Identify “who does what” in the process, and be consistent in its use and require staff to be consistent as well. Utilize a courier or transport that is reliable and provides receipts. Create a mechanism to track when specimens are sent, and follow up to assure that reports are returned. When results/reports are reviewed, the provider initials or signs so that staff know the report may then be filed in the medical record. Advise patients they will be given the results of every test and not to expect that “no news is good news.”
Practice laser safety.
Remember the human eye is more vulnerable to injury than human skin but both are susceptible to laser injury. Practice “read back/repeat back” with techs and assistants, especially as to the laser settings. Whether you own the laser or you utilize a vendor, assure that the equipment is properly maintained and that staff is properly trained. Be clear about the licensure and training needed to operate a laser.
Inform your patients.
Remember that informed consent is required when there are risks associated with a procedure and that informing patients and providing them with the opportunity to ask questions are the responsibility of the physician.
Be specific about lesions and locations.
Avoid wrong-side or wrong-site procedures, but also take precautions against the “wrong lesion.” Claims have occurred when a misdiagnosis or delay in diagnosis results from failure to carefully document the exact location of a lesion and the wrong lesion is excised. Be sure that you and the patient are clear about which lesion is being treated, and document locations carefully when the patient has multiple lesions in a particular area of the body.
Avoid allegations of delay in diagnosis and/or treatment.
Do not defer important tests or procedures because a patient is concerned about costs. If the patient refuses a test or biopsy after being advised of its need and importance, carefully document the refusal in the patient record. If, for example, you are concerned about a possible malignancy, document that the patient was advised of the specific risk or concern and include the patient’s comments. Consider asking the patient to sign a specific refusal of treatment form (available in the Miscellaneous category of our informed-consent form resource center at www.thedoctors.com/consent). Great care should also be utilized in managing patients who require periodic follow-up examination or testing due to risk factors, such as prior history. Document efforts to schedule return visits carefully, and if the patient misses or fails to keep an appointment, consider sending him or her a letter explaining the need for follow-up and the risks associated with failure to follow up.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.