Advanced Practice Clinicians

Sep 22, 2022
Mental Health Providers: Balancing Privacy With Public Welfare
Richard F. Cahill, JD, Vice President and Associate General Counsel, and Robert Morton, MAS, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management, The Doctors Company
Since spring 2020, patients have reported ideation of harm with increasing frequency. These encounters create a moral dilemma for mental health providers, who must maintain provider-patient privilege while adhering to legal reporting obligations for protecting the public welfare.

Professional Education
Test Tracking and Referrals: Strategies for Advanced Practice Clinicians
Tracking of tests and consults is critically important in preventing diagnostic errors and preventing patient harm. The risk factors triggering an alleged malpractice claim were primarily related to the breakdown in clinical systems for test result management. Failures of systems often prevent providers from making timely and accurate diagnoses. Testing failures included test performance issues, misinterpretation of studies, receipt, and transmittal problems. Follow-up failures included lack of physician follow-up with the patient, referral management, inadequate provider to provider communication and patient noncompliance.
0.8 credit

Sep 15, 2022
Resources for Advanced Practice Clinicians
We recognize the important role that advanced practice clinicians play in reducing risks and improving patient outcomes. You can count on The Doctors Company to support you with comprehensive expert resources.

Sep 15, 2022
Advanced Practice Clinicians: A Preventive Action and Loss Reduction Guide
Depending on the state, an APC may be permitted to practice autonomously, as part of a collaborative agreement, or under the supervision of a physician. Regardless of an APC’s practice status or employment arrangement, however, all individuals can be held liable for their own acts of negligence. Our preventive action and loss reduction guide can help APCs in every practice environment.

Professional Education
Delayed Diagnosis of Malignancy: Case Review for Advanced Practice Clinicians
In reviewing closed malpractice claims, The Doctors Company identified delayed diagnosis of a malignancy as a reoccurring problem. The following highlights the importance of recognizing a spinal abnormality and recommending further follow up of a lesion seen on imaging. Contributing factors include misinterpretation of radiologic studies, narrow diagnostic focus, lack of communication, and failure to establish a differential diagnosis.
0.5 credit

Professional Education
Medication Management: Strategies for Advanced Practice Clinicians
Medication management is by far the area providers can make the most impact within the professional practice arena. Data from closed claims shows that medication management is a risky area, most importantly the monitoring of medications. Monitoring and management begin when the patient receives the medication until the patient is no longer on the medication. An effective medication management process is essential for safe patient care. Having current patient medication information will assist with subsequent prescribing and a plan of care.
1.3 credits

Professional Education
Preventing Dictation Errors for Advanced Practice Clinicians
Emergency medicine providers are increasingly using voice recognition programs, such as Dragon Direct Voice Recognition Program, to document encounters. In reviewing closed malpractice claims, The Doctors Company identified dictation errors as a significant patient safety risk factor. The following case highlights the importance of timely recognition of dictation errors to ensure accuracy of the permanent electronic health record (EHR). This is particularly important when using a voice recognition program to document encounters in the busy emergency department. In this case, the voice recognition system was Dragon Direct Voice Recognition Program.
0.5 credit

Professional Education
Delayed Diagnosis of Stroke: Case Review for Advanced Practice Clinicians
In reviewing closed malpractice claims, The Doctors Company identified diagnostic failure as a reoccurring problem and one of the top three leading allegations that result in malpractice claims. This failure often leads to a delay in treatment and causes significant harm to patients. The following highlights the importance of recognizing the signs and symptoms of a stroke. Factors contributing to delay diagnosis and treatment included failure to recognize the window (“last known well time”) for tissue plasminogen activator-clot buster (tPA) failure to order a stat MRI and neurology consult, failed communication among providers regarding changes of recurring symptoms of ischemic stroke, failure to appreciate new signs and symptoms of a stroke, and poor or inconsistent documentation. The National Academy of Medicine (NAM) has identified the top three causes of serious harm from diagnostic failure. Number one is ischemic stroke.
0.5 credit

Professional Education
Managing Patient Information: Strategies for Advanced Practice Clinicians
This program covers the patient information system, specifically documentation of patient information in the medical record. Many times, insufficient documentation results in the provider not being able to find information needed to guide clinical decision-making. Adequate documentation will enhance patient care by ensuring that patients receive the care necessary and may prevent a mis- or delayed diagnosis.
0.5 credit

Professional Education
Diversity, Equity, and Inclusion in Healthcare
Diversity, equity, and inclusion of all patients can lead to better health outcomes in the community in which we work. Creating a culture of inclusion and understanding our own biases, will help us improve patient care. It is important to understand how we are the same and how we are different in language, education, race, ethnicity, gender, gender identify, sexual orientation, age, social class, physical ability, religion, political beliefs, and morals. Ensuring equity creates fair and just opportunities to receive and benefit from healthcare. In addition, deliberately including all peoples creates a welcoming and respectful environment for our patients. Providers may not be aware of how diversity, equity, and inclusion problems can hinder their care and relationships with patients. Some states are requiring all clinical professionals to have continuing education on cultural and linguistic competency and implicit bias.
0.5 credit

Professional Education
Preventing Diagnostic Error in Primary Care: Strategies for Advanced Practice Clinicians
Diagnostic errors occur often in primary care settings and can impact over 12 million outpatients annually. This is a top patient safety concern and a global burden among advanced practice clinicians (APCs). Significant patient harm can occur due to treatment delay, testing, or misdiagnosis. This course is an opportunity to promote awareness and visibility by identifying where these errors occur most often in the diagnostic process of care framework. Examples of some best practices for the diagnostic process involves a timely and accurate diagnosis, patient engagement, effective system processes, active follow up, and communication. The information in this course will focus heavily on prevention strategies related to the primary care setting.
0.8 credit

Professional Education
Cervical Cancer Claims: A Review for Advanced Nurse Practitioners
Cervical cancer medical negligence claims are reviewed over a 10-year period to identify the major case types in which the advanced practice clinician (APC) is the responsible party. The factors that contributed to those claims as identified by plaintiff and defense provider experts are discussed through case examples with learner questions. Risk mitigation strategies are identified to guide gynecologists in further providing the safest patient care and thereby improving their risk profile.
1.0 credit

Professional Education
Breast Cancer Claims: A Review for Advanced Nurse Practitioners
Breast cancer medical negligence claims are reviewed over a 10-year period to identify the major case types in which the gynecologist is the responsible party. The factors that contributed to those claims as identified by plaintiff and defense physician experts are discussed through case examples with learner questions. Risk mitigation strategies are identified to guide gynecologists in further providing the safest patient care and thereby improving their risk profile.
1.0 credit

Professional Education
Hidden Liability Risks Identified by Medical Office Reviews: Risky Practices for Advanced Practice Clinicians
Office practice assessments by TDC Group's patient safety risk managers uncover hidden liability risks, often exposing areas where patients can “fall through the cracks” and leave the practice vulnerable to a malpractice claim. Our Practice Risk INSIGHT, an assessment tool customized by specialty, zeros in on problematic areas. The assessments have been completed across a range of practice environments around the country—from small offices to practices that are part of large integrated delivery systems. In this course, we analyze the results of the Practice Risk INSIGHT assessments, highlight problem-prone areas, and offer strategies to minimize liability for advanced practice clinicians (APCs).
1.5 credits

Professional Education
The Advanced Practice Clinician–Patient Relationship: When Does it Begin and When Does it End?
This enduring program will assist the participant in understanding the principles which form the establishment of an advanced practice clinician (APC)–patient relationship, as well as the concerns which may result in the need for the APC to consider terminating the APC-patient relationship. Additionally, the concepts of providing patient-centered care will be presented for the learner’s consideration.
1.0 credit

Professional Education
Learning from Pain Management Closed Claim Analysis for Advanced Practice Clinicians
TDC Group has published an analysis of lawsuits and claims filed against pain management advanced practice clinicians (APC). This study completed in 2020 provides quantitative and qualitative information that an APC who practices pain management, including interventional approaches to treatment would find useful in mitigating the risks of unintended outcomes or harms. This study breaks down where most patient injuries occur, what those injuries are, and the lessons learned from those claims.
1.0 credit

Professional Education
An Introduction to Enhancing Patient Relations and Reducing Risks for Advanced Practice Clinicians
This enduring program is designed to assist advanced practice clinicians (APCs) with improvements in patient interactions by looking at how incorporating hospitality as a focus makes a difference. It has been developed to improve multiple facets of patient interaction.
1.5 credits

Professional Education
Clinical Presentations for Advanced Practice Clinicians: Failure to Diagnose Myocardial Infarctions
In reviewing closed malpractice claims, TDC Group identified missed or delayed diagnosis of myocardial infarction (MI) in the ambulatory internal medicine setting as a reoccurring problem. This course highlights the importance of recognizing the varying clinical presentations of MI and contributing factors associated with failure to diagnose and treat. Assumptions, lack of a thorough history and physical, communication failures, and failure to recognizing atypical signs and symptoms are highlighted in this case study.
0.5 credit

Professional Education
When Personal Relationships Interfere with the Standard of Care for Advanced Practice Clinicians
The Doctors Company rigorously analyzed 988 claims* against internal medicine physicians that closed from 2009–2018. Regardless of the outcome, all cases that closed from 2009–2018 were included in this analysis—an approach that helps better understand what motivates patients to pursue claims and gain a broader overview of the system failures and processes that result in patient harm.
0.5 credit

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