LegalEase: Handling non-compliant patients and caregivers
Handling non-compliant patients and caregivers
By Elizabeth E. Hogue, Esq.
The non-compliance of home health and home medical equipment (HME) patients is legendary. Diabetic patients do not stick to their diets. Wound care patients or their caregivers do not follow instructions for dressing wounds. Bed-bound patients do not regularly change position as instructed. Patients smoke while they are on oxygen.
Staff members are tempted to overlook non-compliance on the basis that patients need services. It may be especially difficult to act based on non-compliance by primary caregivers. After all, say some providers, patients should not be penalized because of the non-compliance of their caregivers.
On the contrary, it is absolutely imperative for providers to take action to bring patients and/or their primary caregivers into compliance or, if they cannot achieve compliance, to discontinue services with them.
When providers continue to render services to non-compliant patients, their risk of legal liability is greatly enhanced. The bottom line is that it is extremely difficult to separate sub-standard care on the part of staff from non-compliance by patients and primary caregivers. Sooner or later, patients' attorneys are likely to get to the heart of the matter — if practitioners knew that patients or their primary caregivers were non-compliant, why did they continue services?
Providers should first attempt to assist patients and/or primary caregivers to achieve compliance by taking the following steps:
- Staff must document every instance of non-compliance by both patients and their primary caregivers regardless of the risk associated with the non-compliant behavior.
- Documentation must be very specific. It is not sufficient to document as follows: "Patient (or primary caregiver) non-compliant." Staff, for example, may document failure to change the diapers of a bed-bound patient who is incontinent of both bowel and bladder as follows: "RN discovered patient with urine and feces in diaper. RN removed diaper, cleaned patient, and placed clean diaper on patient. RN marked the right tab of the clean diaper with a red X. When the RN visited the following day, the patient was again lying in urine and feces. When the RN removed the diaper, she observed a red X on the right tab of the diaper the patient was wearing when she arrived."
Staff must then counsel patients and primary caregivers regarding each instance of non-compliance and document that they have done so.
If it appears that patients and primary caregivers may benefit from additional teaching, staff must provide additional instruction and document that they have done so. Documentation of teaching must include a successful return demonstration, if appropriate.
Staff also may wish to use contracts with patients or primary caregivers that spell out what patients and primary caregivers must do or services will be discontinued.
The number of times staff members are willing to repeat this "protocol" depends on the risk of injury/damage to patients associated with the non-compliance. If patients are likely to be injured or damaged, agencies will not tolerate additional instances of non-compliance after taking the above steps.
There is an old legal adage that "every dog is entitled to one bite." When an instance of non-compliance has been identified, the "dog" has had its bite!
In some instances, the non-compliance may be so serious that immediate termination is warranted. On the other hand, chronic non-compliance may be acceptable, if it involved very little risk, if any, of injury to patients.
With enhanced emphasis on outcomes and quality of care, agencies cannot afford to care for patients whose non-compliance hampers the results of their treatment. Now is the time to confront non-compliant patients and their caregivers and to take action.
[To obtain a book entitled "Use of Policies and Procedures to Avoid Liability for Abandonment," which includes a complete set of policies and procedures to avoid liability for abandonment in a variety of situations, send a check for $105 that includes shipping and handling made out to Elizabeth E. Hogue, Esq., 15118 Liberty Grove, Burtonsville, MD 20866. Office: (301) 421-0143. Fax: (301) 421-1699. E-mail: [email protected].]
The non-compliance of home health and home medical equipment (HME) patients is legendary. Diabetic patients do not stick to their diets.Subscribe Now for Access
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