Liability begins as patients bring their own equipment

It’s probably not uncommon for patients to arrive at your facility with their own health care equipment, such as a home dialysis unit or insulin pump, not to mention personal items such as curling irons, computers, and hair dryers. Do you have a policy in place to make sure those items are safe? If you don’t, you might be risking significant liability if those items end up injuring anyone. And, if you have a policy, do you make sure that it is enforced?

It is easy for risk managers to overlook this liability risk because there is so much of your own in-house equipment to worry about, says Kathleen Shostek, RN, ARM, BBA, FASHRM, senior risk management analyst with ECRI, the group in Plymouth Meeting, PA, that assesses health care devices for safety. When patients brings in their own gear, it’s easy for the risk manager or the nurse on duty to assume it’s the patient’s responsibility to ensure the device is safe.

Not so, Shostek says. "Patients are bringing more sophisticated equipment with them to the hospital, so it’s an issue that needs to be addressed," she notes.

Facilities must decide

ECRI recently issued a report cautioning risk managers about the risks of patient-owned equipment, featuring the results of a poll that found 84% of health care facilities allow patient-owned equipment to be used and 90% said they had a written policy in place.1 But the results were not entirely reassuring. "The biggest surprise was that a small percentage, just about a quarter of respondents, said they required a physician’s approval for suitability with the patient’s condition," she says. "With clinical equipment, we would expect more physician involvement."

Shostek says the health care provider clearly has the responsibility to ensure that equipment used within the facility is safe, but you cannot assure that patient-owned equipment has been used, stored, or maintained properly. The staff may not be familiar with the equipment either.

"That places the hospital at risk, especially if the physician has not at least said the equipment is appropriate for the patient to use," she says. "Each facility would have to decide, depending on your own scope of service, when physician approval is required. But generally, I’d say that a physician should be involved for any clinical equipment like ventilators and insulin pumps."

Procedure for equipment checks

The physician would not necessarily say that the particular device is safe and adequate, but he or she would determine whether the patient even needs the equipment. If so, then the policy should require that the facility’s biomedical or engineering department inspect the equipment to ensure that there is no obvious defect and that it appears to be in good working condition.

"You should have some procedure by which nurses can call to have the equipment checked. I know of one facility that has a special phone extension posted in the nursing stations so they can reach the biomedical department quickly," Shostek says. "Most facilities have a system in which the engineers can affix a tag or a sticker showing that the item has been checked, with a corresponding record maintained in that department."

One word of caution: Make sure patient-owned equipment is held to the same high standards you use for your own equipment. Otherwise, you run the risk of the patient’s equipment injuring the patient after you certified it as safe, which will make your liability risk even worse.

A problem can arise when the professionals are not available to inspect the equipment in the middle of the night, for instance, or if the patient needs to use it immediately. In that case, Shostek says nurses and other front line staff should be required to inspect the equipment for any obvious defects such as frayed electrical cords or unclean items.

"I’ve heard some horror stories of patients bringing in things that are not well maintained or really dirty, so someone has to check it at least in a basic way," she says. "In that situation, you would have to make arrangements to provide that equipment, but you must be willing to tell the patient that their own equipment cannot be used in your facility."

Points to include in policy

So what should your policy include? Shostek suggests these points:

  • Start with a general statement on your philosophy toward patient-owned equipment. Is it is generally allowed? Or is it generally prohibited and then you will make case-by-case exceptions? Is it allowed in some areas but not in others, like pediatrics or mental health?
  • The policy also should specify the means for communicating these requirements to patients, such as whether you explain it up front or wait until they want to bring in some equipment.
  • Also specify exactly what procedure is involved for getting the equipment inspected before use.
  • The question of when physicians must approve the use of clinical equipment should be answered clearly in the policy.
  • Outline how the staff will be educated about the risks of patient-owned equipment. Shostek warns that some facilities have good policies in place, but frontline staff are not aware of them or how they are to carry them out.
  • Stipulate whether you will require a release form or waiver and, if so, how to go about that process.

Nonmedical equipment also

Shostek points out that the risk comes not from just patient-owned clinical equipment. Risk managers also should address nonclinical equipment such as electric shavers, hair dryers, curling irons, televisions, and video games. The same level of scrutiny may not be necessary, but some precautions are warranted.

In most cases, it is possible for the nursing staff to determine whether these devices are safe to use, Shostek says, but they must keep in mind that sedated or otherwise impaired patients may not be able to safely use some equipment.

One type of nonclinical equipment warrants a special warning in ECRI’s report. ECRI notes that hospital-supplied televisions are installed properly and maintained, but that patients should never be allowed to plug in video games or other devices that use cords running to the television. The risk or electric shock and tripping hazards from the cords is too great.

"Under no circumstances should patients be permitted to plug line-powered video or electronic games into hospital-supplied televisions," the report warns. "In fact, battery-operated games are preferable so that patients will not tamper with hospital-supplied televisions."

Reference

1. ECRI. Patient-owned equipment. Healthcare Risk Control 2004; 5:1-14.