Risk managers should create a checklist for responding to adverse events to ensure the most effective response in a potentially stressful and hectic environment, says David Richman, JD, partner with Rivkin Radler in Uniondale, NY.

Richman says the list should include these elements:

  • Notify hospital or facility management as soon as possible.
  • Inform either in-house or outside counsel, or both. A determination should be made whether counsel should be involved with the early stages of incident investigation.
  • Secure the chart as soon as possible. Risk management should take possession of the written chart (if one exists) immediately, and also should lock down the EMR to prevent any changes to the existing chart.
  • Risk management should identify and document all involved personnel, from each category of staff, including nonmedical technical staff assigned by equipment manufacturers who have representatives present for the treatment at issue.
  • Conduct interviews of all staff and document all witness statements.
  • If equipment is involved as a possible cause or contributor to the event, it should be taken out of service and placed in a safe location. No one should be permitted to repair or in any way alter the equipment. Locate and secure all paperwork related to the device, including but not limited to purchase and repair records.
  • Depending on the nature of the incident, the state should be informed as soon as possible of an incident to ensure everything is reported. For example, the New York State Department of Health requires that it be informed within 24 hours of an adverse event, or when the hospital reasonably believes that an adverse event has occurred. The definition of adverse events may vary from state to state but will be wide-ranging.
  • Social workers should be contacted to serve as intermediaries with the family, and be available to the family as soon as possible to answer questions, or assure family and friends that any questions will be answered subject to coordination with facility management and its counsel.
  • If the facility has a public relations department, members of that staff should be brought into the discussion in the event publicity is generated and/or it becomes necessary that a public statement be made.