Case Study One: Dismissing the non-compliant patient.

 Case Study One: Dismissing the non-compliant patient.

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Case Study One: Dismissing the non-compliant patient. Week 4 discussion. Legal Issues (Negligence/Malpractice/Risk Management)
Our current health care system is in a fluid state. Change is constant. As health care providers, we strive to deliver optimal, safe care. Ongoing health care research, evidenced-based care, and effective guidelines for practice offer a stabilizing force. Our duty, as health care providers, is to “do no harm.” As providers, Nurse Practitioners (NP) provide preventive, acute, and chronic care, which entails complex management. Understanding legal terminology is essential to the role. Terms such as standard of care, malpractice, and negligence are inevitable and essential components for understanding the legal challenges advanced practice nurses will experience during their careers.
Only 1% of patients actually sue for malpractice in the U.S. and NPs are the least likely to be sued of all providers (Buppert, 2015). Just because an NP is sued does not mean the provider will be reported to the State Board of Nursing. Remember, the State Board of Nursing’s focus is not to protect the NP; their role is to protect the public. In many instances, the NP will be named in a Malpractice Lawsuit and later removed. Unfortunately, their name will be forever in the National Practitioner Data Bank, which we will discuss in further detail during this week’s Discussion.
This week, as you examine legal issues related to Nurse Practitioner Practice, focus on the implications of the legal terms you will be introduced to and how they will impact your day-to-day decisions in regard to patient care and safety. Consider strategies to improve your clinical practice skills and maintain current with legislative issues in your state.
Buppert, C. (2015). Nurse Practitioner’s Business Practice and Legal Guide (5th ed..). Burlington, MA: Jones & Bartlett. Chapter 7, (pp. 271-284).
Learning Objectives
By the end of this week, students will:
Analyze legal implications for standard of care
Analyze key components of malpractice policies
Analyze collaborative agreements in relation to state rules
Analyze legal implications that exist for failure to adhere to a standard of care
Compare differences in malpractice policy options
Evaluate professional strengths and weaknesses
Evaluate mastery of NP clinical skills
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 Case Study One: Dismissing the non-compliant patient.

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Learning Resources
This page contains the Learning Resources for this module. Be sure to scroll down the page to see all of this module’s assigned Learning Resources.
Required Readings
Agency for Healthcare Research and Quality (2016). National Guideline Clearinghouse. Retrieved from http://www.guidelines.gov
Buppert, C. (2015). Risk Management. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.) (285 – 302). Burlington, MA: Jones & Bartlett.
This chapter reviews lawsuits, malpractice, the importance of working within practice guidelines, and explains the purpose of the National Practitioner Data Bank.
Buppert, C. (2015). Negligence and Malpractice. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.) (285 – 302). Burlington, MA: Jones & Bartlett.
This chapter reviews risk management as well as dismissal of the noncompliant patient.
Jordan, L. M., Quraishi, J. A., & Liao, J. (2013). The National Practitioner Data Bank and CRNA Anesthesia-Related Malpractice Payments. American Association of Nurse Anesthetists Journal, 81(3), 178-182.
Note: Retrieved from the Walden Library databases.
Miller, K. P. (2013). The National Practitioner Data Bank: An Annual Update. The Journal for Nurse Practitioners, (9)9, 576-580.

 Case Study One: Dismissing the non-compliant patient

Note: Retrieved from the Walden Library databases.
Stelmach, E. I. (2015). Dismissal of the Noncompliant Patient: Is this What We Have Come to? The Journal for Nurse Practitioners, 11(7), 723-725.
Note: Retrieved from the Walden Library databases.
Watson, E. (2014). Nursing Malpractice: Costs, Trends and Issues. Journal of Legal Nurse Consulting, 25(1), 26-31.
Note: Retrieved from the Walden Library databases.
Westrick, Susan J., & Jacob, N. (2016). Disclosure of Errors and Apology: Law and Ethics. The Journal for Nurse Practitioners, 12(2), 120-126.
Note: Retrieved from the Walden Library databases.
Required Media
Institute of Medicine. (2015, December 7). Assessing Progress on the Implementation of the Recommendations of The Future of Nursing [Video file]. Retrieved from https://www.youtube.com/watch?v=sMOjACA2ats

Note: The approximate length of this media piece is 1 hour.
Optional Resources
Buppert, C. (2016). Carolyn Buppert-Specialist in Legal and Reimbursement Issues for Nurse Practitioners and Physicians.
Goodwin, B. (2016). You’ve Been Sued for Malpractice: What Happens Next? Urology Times.
Kreimer, S. (2015). Avoiding an EHR-Related Malpractice Suit. Contemporary OB/GYN, December, 39-42.
Discussion: Clinical Challenges for the NP
Each state has laws that differ in regard to the role of the Nurse Practitioner. They also may significantly impact the NP’s practice. Legislative changes may occur annually, bi-annually, or during an emergency legislative meeting at the state or federal level. These legislative sessions and any subsequent changes may significantly impact your scope of practice as a Nurse Practitioner. Remaining current with the laws in your state is essential. For example, the recent change at the federal level changing hydrocodone-containing drugs from a Schedule III drug to a Schedule II drug has impacted NPs in some states. For states that allow for Nurse Practitioners to write Schedule III-V drugs, these NPs are now unable to write for hydrocodone- containing medications, which significantly impacts their ability to provide care for their patients. The Pearson Report, which is updated almost annually, provides a national overview of each state’s current legislature. As a future NP, you should become familiar with The Pearson Report and stay abreast of state and federal legislation.
For this Discussion, you will post an explanation that defines the legal implications for standard of care, the key components of a malpractice policy in regard to a case study. Additionally you will explain the collaborative agreements and rules for your state in regard to your NP practice and the case study you select.

 Case Study One: Dismissing the non-compliant patient

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To prepare:
Review the following case studies and select one to research in depth:
Case Study One: Dismissing the non-compliant patient.
Gwen, a 52 year old Caucasian LPN, recently joined your practice as a new patient. She currently has a BMI of 32, B/P of 142/88. Pulse is 89, Respiratory rate is 22, Pulse Ox is 96% on Room Air. She is taking Lisinopril 10mg po daily (when she can remember), Metformin 1000mg po BID and refuses lab work. Her physical exam is unremarkable and foot exam is normal. She refuses all vaccinations including Prevnar and Influenza. Gwen’s last mammogram and pap smear were “years ago.”
Case Study Two: Preventive care, why is it so important to document?
John, a 62 year old attorney, who has been a long-term patient of yours, comes to you to discuss his erectile dysfunction. You note that he has refused lab work for the past two years. He is a 30 pack/year smoker, and has not had a chest x-ray or ECG in three years. He does take his HCTZ 25 mg po daily. His BMI is 29 and all vital signs are within normal limits. He does agree to his Prevnar Vaccine today.
Case Study Three: Patient and professional relationships.
Jennifer, a 45 year old Caucasian returns to your clinic for a refill of her hydrocodone. She was diagnosed with Ovarian Cancer last year, followed by successful removal and treatment. All vital signs are stable and preventive care is up to date. She wants to discuss filing a lawsuit against the surgeon that initially turned her away and told her she had gastritis and needed to eat healthier.
Review the following articles found in this week’s Learning Resources:

 Case Study One: Dismissing the non-compliant patient

Miller, K. P. (2013). The National Practitioner Data Bank: An Annual Update. The Journal for Nurse Practitioners, (9)9, 576-580.
Stelmach, E. I. (2015). Dismissal of the Noncompliant Patient: Is this What We Have Come to? The Journal for Nurse Practitioners, 11(7), 723-725.
Review endocrine disorders and erectile dysfunction in your Primary Care Medicine text (Gorrol, Ah. & Mulley, A.G., 2009).
Consider strategies and treatment options that would be most effective for these patient scenarios to improve compliance and health outcomes.
Reflect on how to approach the non-compliant patient and the importance of a separate preventive care visit.

INSTRUCTIONS FOR PAPER:
Write an explanation that addresses the following for the Case study you selected:
Identify and briefly summarize the case study you selected
Explain any legal implications for standard of care related to the case study you selected
Identify and explain the key components of a malpractice policy related to the case study you selected
Explain the collaborative agreements and knowledge the rules for your state in regards to NP practice the case study you selected

 Case Study One: Dismissing the non-compliant patient

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By admin in Blog on September 19, 2018