Introduction from the Chairs

Mary Jane Dykeman & Kate Dewhirst
Dykeman Dewhirst O’Brien LLP
Editors, Risk Management in Canadian Health Care (LexisNexis)

Interactive Session: Assuming a Risk Management Approach

• Everyone is a risk manager
• Canadian inquests – lessons learned
  - long-term care
  - mental health settings
  - acute care
• Practical tips for addressing challenging situations involving patients, families and staff
• Privacy in risk management situations

Part 1: Consent, Capacity and Substitute Decision-making

• Unpacking the recently enacted Personal Directives Act
• Capacity at common law
• When to seek a capacity assessment
• Personal care decisions
• Who is the appropriate statutory decision-maker?

Part 2: Consent, Capacity and Substitute Decision-making

• Case studies
  - addressing difficult behaviours by patients and staff
  - tips for early intervention
  - setting boundaries for staff
• When to involve the Office of the Public Trustee

Medical Negligence Claims Against Nurses

• The standard of care
• Errors in judgment
• Emergency situations
• Causation
• Vicarious liability – who is on the hook, and for what?
• Case studies
• Defences to a malpractice claim

Nurses and Professional Misconduct

• Civil liability versus professional misconduct
• The College’s complaints process and disciplinary proceedings
• Reporting obligations
• Incapacity and incompetence
• The nurse as a witness
• Practical tips for preventing professional misconduct claims

Harassment and Violence in the Workplace

Harassment and violence occur in all organizations, but the incidences of such behaviour appear to be high in health care organizations. This not only causes obvious injury and distress to health care staff, it also leads to increased sickness, absence and poor morale. It also decreases the quality of care for patients/clients/residents.

• Definitions of harassment and violence
• Responsibilities and liabilities of employers and Boards of Directors
• Requirements of the Occupational Health and Safety Act, including the issue of “unsafe work” in health care organizations
• Conducting an effective Risk Assessment for Violence – tips & tools
• Drafting and implementing harassment and violence policies in both unionized and non-unionized environments
• Effective strategies to deal with potentially violent patients

Mini-Workshop: Documentation and Charting

Creating and dealing with documentation is an integral part of nursing procedure. Accurate charting is a key to facilitating patient care. However, the quality of recorded information can be used to defend or prosecute a nurse in disciplinary hearings or it may be used as evidence in civil or criminal proceedings. Good documentation is often a key factor in responding effectively to allegations of negligence and/or professional misconduct.

• Why is documentation so important?
• Use of documentation in a proceeding
• The health care organization’s duty to ensure proper charting is completed – the need to develop policies and clear standards of acceptable practice
• The need to provide training in documentation and developing effective documentation tools
• The types of documents that are relevant: full charts; medication records; schedules; appointment papers; employment files/reviews; hospital policies and procedures; notes and other memoranda regarding a particular event
• How to record information accurately and effectively
• Practical tips and guidance for drafting clear and accurate notes
• What are the typical problem areas in charting?
• The importance of recording at the time of the event
• Recording only what you saw or did
• Avoiding subjective conclusions and assumptions
• Why should you avoid recording the actions of other health care providers?
• The benefits of recording chronologically
• Blanks in the chart – what should you do?
• Late entries – dos and don’ts
• Making corrections to the chart – what to avoid
• “Severing” incorrect information from the chart
• Preparing hospital incident reports – what should you bear in mind?
• Staff’s personal notes – legal status, and perils and pitfalls to avoid
• Charting by exception
• Electronic charting – what are the general requirements?
• The latest cases on documentation – case studies

Program Concludes