Legal and Risk Management Issues in the Emergency Department

The emergency department (ED) is a high-risk area of liability for the hospital. This seminar will focus on legal and risk management issues that healthcare providers face while caring for patients in this high-risk environment. 

It will also discuss how to comply with selected CMS hospital CoP and Joint Commission standards that are problematic for emergency department staff. It includes how the visitation law affects the ED and the CMS anesthesia standards on the use of deep sedation or moderate sedation in the emergency department. The impact of the CMS worksheets will be discussed along with the CMS hospital requirements regarding the use of standing orders in the ED. The issue of alarm fatigue and the impact in the ED including the Joint Commission NPSGs and sentinel event alert.

The Joint Commission standard on patient-centered communication will be discussed including the interpreter, low health literacy, and collecting race and ethnicity data in the ED. It will also be discussed how this is related to the OCR Section 1557 requirements. There must be a sign in the ED, a revised patient rights statement, qualified interpreters, auxiliary aids, and more! Do you know what the new law says if an ED patient writes a complaint letter about being discriminated against? Additional resources will be provided on the Joint Commission's proposed pain management standards.

Medication errors are the most common medical error and the common medication errors that occur in the ED will be discussed and how to avoid them. This program will also discuss the CMS CoP changes which require all ED nurses to have training on blood transfusion and IV medication and what must be included. CMS made changes to medication management and opioid use and this is currently an area where hospitals are still struggling to meet compliance. The importance of discharge instructions will be covered and are important to prevent unnecessary readmissions and returns. The CMS five requirements for discharge instructions will be discussed.

• Discuss legal and risk management issues in the ED and recommendations including how to reduce the most common medication errors that occur in the ED.
• Recall the Joint Commission standard  and CMS to collect race and ethnicity data in the ED
• Describe the importance of documenting the use of interpreters for patients with limited English proficiency
• Describe that the visitation law requires the ED to give the patient written information on their rights including information on the hospital’s advance directive policy.

• Negligence principles
• COVID 19 and EMTALA
• High-risk patient presentations
  • Key ED risk guidelines
• Protocols and standing orders
  • CMS interpretive guideline
• Patient rights
  • CMS and Joint Commission standards (TJC)
• Interpreters
• CANDOR AHRQ
• Diagnostic errors and communication errors
• OCR Section 1557 law and how it impacts the ED
• TJC Patient Communication standard
  • Interpreters
  • Issue of low health literacy and use teach-back
  • Collecting Race and Ethnicity Data in the ED
  • Communication needs of ED Patients
• Intoxicated patients (substance use disorder)
• Safe opioid use and CMS standards
• CMS Medication management
• Alarm fatigue
• Abnormal vital signs
• CMS standing orders and protocols
• CDC intravascular guidelines
• TJC medication reconciliation
• Skin assessment
• Abnormal x-ray and lab results
• Discharge instructions
  • Things the ED can do to prevent unnecessary readmissions
• Discharges current issues and discharge instructions
• ED policies and procedures
• Reducing medication errors
• Informed Consent
  • CMS and TJC standards
• How CMS Visitation law affects the ED
• CMS Anesthesia standards and effect on the ED
  • Moderate sedation, minimal sedation, local and topical
  • ACEP and ENA standard
• ED TJC Patient Tracers
• CMS IV medication and blood transfusion training required
• CT scan interferences
• Resident orders

• ED Physicians
• ED Nurse Managers
• ED and Clinic Nurses
• Charge nurses
• Nursing Supervisors
• Risk Managers
• Consumer Advocates
• In-House Legal Counsel
• Compliance Officers
• Nurse Educators
• Patient Safety Officer
• Joint Commission Coordinator
• Director of Regulatory Affairs
• and anyone involved with the care, treatment, and liability concerns of the ED patient