Management Of Medico-Legal Risks In Digital Health Era Discussion Response
Management Of Medico-Legal Risks In Digital Health Era Discussion Response
RE: Discussion 2 – Week 4
COLLAPSE
My project is piloting the new non-invasive technology called ClearSight, which measures the stroke volume of the patient with severe sepsis or septic shock using a finger cuff. This technology will provide objective data for the medical and nursing teams in the Emergency Department (ED). This data will guide the clinical decisions regarding the appropriateness and timeliness of the fluid resuscitation and responsiveness for this patient population in treating hypotension Management Of Medico-Legal Risks In Digital Health Era Discussion Response.
As the nurse leader, the stakeholders, especially the ED charge nurses and educators, were encouraged to ask questions to explore other aspects of their workflow and the implications that this pilot may cause. The legal implications and documentation concerns from the staff arose. Since this is a new hemodynamic device, it is not included in the electronic health record (EHR). The concerns include the area in EHR where nurses will document the stroke volume and fluid volume that will match the doctor’s documentation and orders Management Of Medico-Legal Risks In Digital Health Era Discussion Response.
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Van Dijk et al. (2016) discussed that data processing using the new technology impacts the assessment and guides the documentation. We sought help from the nurse informaticists and information technology department if they could help add the Non-Invasive ClearSight device to the list of the existing hemodynamic monitoring devices, including the space to document the stroke volume and the volume of fluid administered. This device was added under hemodynamic monitoring, which will prevent the nurses from adding the device manually. The nurse informaticists were instrumental in making this happen as they have a better understanding of nursing documentation.
Documentation error or omission is one of the three most common categories of litigation faced by nurses, and therefore, legal risk management is critical to the nursing profession (Hwu, 2021). We also sought the advice of the Risk Management department about using a dot phrase in the narrative area of the note on EHR. According to the Risk Management department, the use of dot phrase for the pilot to capture the data elements and document the care provided is appropriate and should be included in the patient’s chart. The dot phrase will be used to standardize the narrative documentation of the nurses’ and doctors’ notes for the pilot phase.
Oliva et al. (2022) discussed the issues of patients’ data that are involuntarily left as a digital health footprint when a digital device is used. Because of this, it has been decided that no patient information will be entered into the device. This is critical information as the company only provided two non-invasive monitors for the pilot. A weekly touchpoint with the stakeholders as well as the company’s educators will be scheduled to discuss any questions or challenges that may arise.
References
Hwu, Y.-J. (2021). Creating nursing workplaces that appropriately manage legal risk. The Journal of Nursing, 68(4), 4–5. https://doi.org/10.6224/JN.202108_68(4).01
Oliva, A., Grassi, S., Vetrugno, G., Rossi, R., Della Morte, G., Pinchi, V., & Caputo, M. (2022). Management of medico-legal risks in digital health era: A scoping review. Frontiers in Medicine, 8. https://doi.org/10.3389/fmed.2021.821756 Management Of Medico-Legal Risks In Digital Health Era Discussion Response
van Dijk, N., Gellert, R., & Rommetveit, K. (2016). A risk to a right? Beyond data protection risk assessments. Computer Law & Security Review, 32(2), 286–306. https://doi.org/10.1016/j.clsr.2015.12.017
Response
Your discussion provides excellent insights on how health care providers can adequately assess patients with hemodynamic imbalance. ClearSight is an innovative approach that can be used to monitor patients with shock, severe sepsis, and stroke or as an advanced hemodynamic monitoring tool for measuring cardiovascular dynamics during intraoperative hypotension (Yamada et al.,2018). ClearSight is a non-invasive approach that offers continuous hemodynamic monitoring, including continuous blood pressure, stroke volume, variation, cardiac output and systemic vascular resistance (Kakuta et al.,2018). Thus, I agree with you that technology such as ClearSight provides critical objective data for the Emergency Department (ED) medical and nursing teams, especially in hemodynamic derangements requiring an urgent assessment to guide the clinical decisions such as fluid resuscitation interventions and responsiveness to such interventions. However, I believe that this innovation is for advanced practice, which means that staff working at the emergency department would need training on how to use and interpret the ClearSight monitoring ’readings.
As a nurse leader, you must proactively engage your team in undertaking a pilot plan to adopt ClearSight. One needs to demonstrate how ClearSight resolves an existing problem in healthcare or improves the assessment of specific clinical cases. The staff can raise concerns that can be considered when adopting the use of ClearSight, which you have highlighted well in your discussions, where documentation issues can arise given that parameters such as SV may not be integrated into electronic health records (EHR). Your plan engagement with the nurse informaticists and information technology department while seeking help on how the non-Invasive ClearSight device as hemodynamic monitoring devices could be integrated into the overall HER system is a critical component of the change process. Your efforts in consulting with the Risk Management department to address legal implication associated with documentation error or omission is equally remarkable Management Of Medico-Legal Risks In Digital Health Era Discussion Response.
References
Kakuta, N., Tsutsumi, Y. M., Murakami, C., Sakai, Y., Oyama, T., Kasai, A., … & Tanaka, K. (2018). Effectiveness of using non‐invasive continuous arterial pressure monitoring with ClearSight in hemodynamic monitoring during living renal transplantation in a recipient: a case report. The Journal of Medical Investigation, 65(1.2), 139-141.
Yamada, T., Vacas, S., Gricourt, Y., & Cannesson, M. (2018). Improving perioperative outcomes through minimally invasive and non-invasive hemodynamic monitoring techniques. Frontiers in medicine, 5, 144 Management Of Medico-Legal Risks In Digital Health Era Discussion Response.