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Stop harmful staff from getting hired
Experts recommend anonymous reporting
If a nurse applied for a hard-to-fill night shift at your organization who had left a previous facility under suspicion of murdering several patients, do you think she’d be hired? Would it be possible for a technician to intentionally harm patients at your hospital over a period of years, with absolutely no action taken?
If you find yourself shaking your head in disbelief, consider the much-publicized killer nurses and physicians who eluded detection at many facilities, and you may feel differently. So what steps should be taken to ensure problem practitioners don’t fall through the cracks — and how can you prevent them from getting hired in the first place?
Here are some suggestions:
• Encourage staff to report suspicions.
You need to draw upon the observations of staff throughout the facility and encourage gut instincts to be reported, says Kathleen Catalano, director of regulatory compliance at Provider HealthNet Services in Addison, TX. "Education of the nursing staff is key, with a periodic review of what types of behavior to look out for, to avoid this scenario."
After a sentinel event occurs, a literature search is required in addition to a thorough internal investigation, she notes.
"Search the literature on this subject, and glean from that the behaviors that fall into this type of scenario," Catalano recommends.
For example, a red flag might be an individual who prefers to work with little help or interruption. "Most nurses want help and accept it gratefully. That’s a clue," she says.
In general, nursing staff share their suspicions with quality, risk, and human resources, urges Catalano.
"It is extremely important, in spite of everyone’s workload, that nonpatient care managers get out of their offices and know the staff working on the units, so that they aren’t intimidated about discussing possible suspicious behavior with them," she explains.
Similarly, the lines of communication must remain open between quality managers, human resources, and risk management, says Kathryn Baikie, the facility’s director of human resources.
"Employees must feel they are able to confide in human resources professionals so that they can feel safe to blow the whistle on their co-worker if they see problems or issues, without fear of retaliation," Baikie stresses.
• Follow all steps in a process.
Catalano points to the case of physician Michael Swango, who is believed to have killed more than 60 patients over a two-decade period.
"All of the things that should have been done were somehow missed," she says. "Even when processes were in place, they were not necessarily followed."
The scenario shows that if procedures aren’t followed to the letter, a harmful practitioner could slip through the cracks, Catalano warns.
"Even if something that didn’t seem quite right showed up in the file, Swango would talk his way out of it," she says. "He was a master at this. The physicians decided there was no need to investigate further — he’s a physician, and we’ll take his word for it."
For this reason, Catalano strongly advises that each step in any process be followed, such as credentialing and privileging processes.
"Disaster can lie right around the corner when you skip steps to save time," she says.
• Have an anonymous reporting system.
An anonymous reporting system is key, says Catalano.
"Staff often don’t want to rat on a colleague," she says. "With that in mind, put your anonymous compliance or patient safety hotline to work and be certain that retaliation does not occur when something is reported."
The best system to use is a hotline allowing staff to report their concerns anonymously, Catalano recommends. "The hotline must be outsourced and not a number called in-house. There must be safeguards in place for keeping the anonymity of the person.
"And there must be a system allowing the person making the call to check back and see what is being done regarding the reported issue," she adds.
The facility uses National Hotline Services, which gives the caller a number and a date to call back. "If action is taken, that action is reported back to the hotline, and they pass it on to the person if they choose to call back with their special number," Catalano says. "This works extremely well."
Another such system is the Compliance & Ethics Hotline, a toll-free number your employees can call 24 hours a day, 365 days a year to speak anonymously with a hotline specialist trained to receive reports of perceived misconduct or wrongful behavior. (For more information on how to subscribe to this and other hotline services, see resources at the end of this article.)
• Use a web-based information service to check the disciplinary history of health care providers.
"In my opinion, the National Practitioners Data Bank (www.npdb-hipdb.com) does not provide enough timely information, and that makes it difficult to rely on," says Catalano.
Instead, the organization uses the Fraud and Abuse Control Information System (FACIS) based in Alexandria, VA. FACIS is a web-based service that allows subscribers to look up the sanction history of individuals and entities associated with the health care field.
FACIS reports from approximately 800 state and federal sources.
Possible types of sanctions include exclusions, termination of license, suspension, revocation, probation and debarments, etc.
"This is valuable, because it makes you aware of sanctions by the local, state, and federal government and adverse actions taken by various agencies," Catalano says.
"We have notice of any action that has been taken against a person at a state, local, or federal level," she points out.
All new prospective employees are screened through FACIS to be certain that they are not on the Office of Inspector General’s list of excluded individuals or entities, or the General Services Administration debarment list.
"If they were on either of these lists and we billed for services they rendered, we would be committing fraud," Catalano explains.
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