LEGAL AND REGULATORY ISSUES

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LEGAL AND REGULATORY ISSUES
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Federal and State Federal Laws and Regulations

• Occupational Safety and Health Administration
  (OSHA)
• 1970 Act-Legislation requiring employers to
  furnish a place of employment free of recognized
  hazards that are causing, or are likely to cause
  death or serious physical harm
• OSHA-authorized to conduct workplace inspections
  generally in response to employer requests or
  employee complaints
• Priorities-(in order) accidents about to happen
  fatalities or serious accidents with 3 or more
  employees sent to the hospital employee
  complaints referrals from other agencies
  targeted inspections follow-up inspections

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• Since 1971 workplace deaths have been cut in half
  and injuries have declined by 40
• About 1.3 million employers with 11 or more
  employees must keep records of work related
  injuries and illnesses (20 of the establishments
  OSHA covers)
• Workplaces in low-hazard industries (retail,
  finance, insurance) are exempt from record
  keeping requirements
• Two major types of laws in the field of
  occupational health and safety
• Preventive-OSHA
• Compensatory-an employee injured or who becomes
  ill as a result of conditions on the job is
  compensated, including reimbursement of medical
  and hospital costs whether or not his own acts
  caused or contributed to causing the injury

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Americans with Disabilities Act (ADA) 1990

• ADA defines disabilities in 3 ways and an
  individual must satisfy at least one of these to
  be considered under this act
• Physical or mental impairment that limits one or
  more major life activity
• A record of such impairment
• Being regarded as having such an impairment
• Designed to ensure otherwise qualified
  individuals with disabilities have equal
  employment opportunities as non-disabled persons

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Physical or mental impairment that limits one or
more major life activity

• The ADA covers more than just people who are
  deaf, people who are blind, or people who use
  wheelchairs.
• People who have physical conditions such as
  epilepsy, diabetes, HIV infection or severe forms
  of arthritis, hypertension, or carpal tunnel
  syndrome may be individuals with disabilities.
• People with mental impairments such as major
  depression, bipolar (manic-depressive) disorder,
  and mental retardation may also be covered.

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A record of such impairment

• The ADA also protects a person with a record of a
  substantially limiting impairment.
• Example A person with a history of cancer that
  is now in remission may be covered.

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Being regarded as having such an impairment

• And the ADA protects a person who is regarded (or
  treated by an employer) as if s/he has a
  substantially limiting impairment.
• Sometimes, a person may be covered even if s/he
  has no impairment or has a minor impairment,
  particularly if the employer acts based on myths,
  fears, or stereotypes about a person's medical
  condition.
• Example An employer may not deny a job to
  someone who has a history of cancer because of a
  fear that the condition will recur and cause the
  employee to miss a lot of work.

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• The ADA only protects a person who is qualified
  for the job s/he has or wants.
• The individual with a disability must meet
  job-related requirements (for example, education,
  training, or skills requirements).
• S/he must be able to perform the job's essential
  functions (i.e., its fundamental duties) with or
  without a reasonable accommodation.
• Practice tip Employers do not have to hire
  someone with a disability over a more qualified
  person without a disability. The goal of the ADA
  is to provide equal access and opportunities to
  individuals with disabilities, not to give them
  an unfair advantage.

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Five Titles of the ADA

1. Employment-prohibits employers from
   discriminating based on an individuals
   disabilities in all facets of employment-applicati
   on and terms
2. Public services-public entities employed in
   transportation must provide accessible services
   to the disabled
3. Public accommodations and services operated by
   private entities-prohibits discrimination in
   lodgings, restaurants, educational facilities,
   etc.
4. Telecommunications relay services-requires
   telephonic services carriers to provide equal
   communication opportunities
5. Provisions-misc. provisions including state
   immunity, attorney fees and prohibition against
   employer retaliation

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Reasonable Accommodations

• EEOC regs. State that reasonable accommodations
  means
• Modifications to the job application process that
  enable a qualified disabled individual to be
  considered for a position
• Modifications to the work environment or the
  circumstances under which the position is usually
  performed that enable a qualified disabled person
  to perform the essential functions
• Modifications that enable a disabled employee to
  enjoy the same benefits and privileges as
  non-disabled employees

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What does the ADA require an employer to do?

• Employers covered by the ADA have to make sure
  that people with disabilities
• have an equal opportunity to apply for jobs and
  to work in jobs for which they are qualified
• have an equal opportunity to be promoted once
  they are working
• have equal access to benefits and privileges of
  employment that are offered to other employees,
  such as employer-provided health insurance or
  training and
• are not harassed because of their disability.

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Reasonable Accommodation and Undue Hardship

• Reasonable accommodations are adjustments or
  modifications provided by an employer to enable
  people with disabilities to enjoy equal
  employment opportunities.
• Accommodations vary depending upon the needs of
  the individual applicant or employee. Not all
  people with disabilities (or even all people with
  the same disability) will require the same
  accommodation. For example
• A deaf applicant may need a sign language
  interpreter during the job interview.
• An employee with diabetes may need regularly
  scheduled breaks during the workday to eat
  properly and monitor blood sugar and insulin
  levels.
• A blind employee may need someone to read
  information posted on a bulletin board.
• An employee with cancer may need leave to have
  radiation or chemotherapy treatments.

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• When do I have to provide an accommodation?
• You must provide a reasonable accommodation if a
  person with a disability needs one in order to
  apply for a job, perform a job, or enjoy benefits
  equal to those you offer other employees. You do
  not have to provide any accommodation that would
  pose an undue hardship.

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• What is undue hardship?
• Undue hardship means that providing the
  reasonable accommodation would result in
  significant difficulty or expense, based on your
  resources and the operation of your business.
• Practice tip If providing a particular
  accommodation would result in undue hardship,
  consider whether another accommodation exists
  that would not.

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Fair Labor Standards Act (FLSA)

• Has had profound impact on business operations
• More than 85 of all non-supervisory employees
  are covered by this act
• Establishes minimum wage
• Sets maximum weekly hours beyond which overtime
  must be paid (i.e. 40 hours)
• Minimum wage and OT must be paid by cash or check
  (with some costs lodging allowed to be deducted
  from amount paid)
• Hours worked-includes all time employee is
  required to be on duty on the employers premises
  or workplace and all time employee is required or
  allowed to work for an employer

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• Voluntarily performed work-employee stays longer
  than required-is included in hours worked (Ex
  charting) employer must be sure the employee
  finishes at the end of the assigned hours or the
  employer must pay
• Includes waiting time, on-call, educational
  sessions, meetings, training etc.
• Any method of time keeping is acceptable as long
  as it is accurate
• OT-unless specifically exempted, must receive a
  rate of not less than time and one-half regular
  rate of pay for time in excess of 40 hours in a
  workweek
• State rules regarding OT for more than 8 hours in
  one workday prevail as long as they are not less
  than the statutory minimum

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• Minimum wage and OT exemptions
• Executive employees
• Administrative employees
• Professional employees
• Learners, apprentices, students, children under
  child labor regulations
• Exemptions are determined by duties,
  responsibilities and the salary paid NOT titles
  or if salaried vs. hourly employee
• Most violations of FLSA are in areas of OT
  compensation, recordkeeping and exemption status

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• Child Labor Provisions of FLSA
• Basic minimum age for employment is 16
• Employment of 14-15 years olds is possible but
  limited certain occupations, only outside school
  hours, specified conditions of work

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• FLSA Amendments 1989
• Allow employers to require employees lacking
  basic skills to spend up to 10 hours in remedial
  training in addition to the 40 hour workweek
  without OT
• Time in remedial education can be at regular pay
• Limited to those without a high school diploma or
  whose reading level or basic skills are at or
  below the eighth-grade level

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• Equal pay act of 1963
• Requires that men and women performing equal work
  receive equal compensation
• Prohibits discrimination in wages on basis of sex
  in jobs that require qual skill, effort and
  responsibility under similar working conditions
  in the same establishment

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Equal Employment Opportunity Commission (EEOC)
and Affirmative Action

• Deals with discrimination based on race, color,
  religion, national origin, age, sex, pregnancy,
  sexual harassment or sexual orientation
• Enforces Title VII (Civil Rights Act 1964)
• Broad investigatory responsibilities
• Establishes reasonable cause for charge of
  discrimination
• Attempts agreement
• Can bring civil action against employer on behalf
  of employee's
• Employer must make whole and restore the
  rightful economic status of ALL affected
• Courts determine relief-reinstatements,
  promotions, back pay, etc.

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Civil Rights Act of 1964

• Title VII-the section of the act that is the
  cornerstone of equal employment opportunity
• Impacts interviews, hiring practices, seniority
  systems, promotion
• Prohibits discrimination re. compensation, terms,
  conditions, privileges based on race, color,
  religion, sex, national origin, handicap, age or
  sexual preference

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• Main thrust
• Prohibits discrimination based on factors not
  related to job qualifications
• Promotes employment based on ability and merit
• Seeks to correct past injustices through
  affirmative action
• Guiding principle-persons are considered on basis
  of individual capacities related to the job to be
  performed and not for the purpose of screening
  out individuals
• Exception-discrimination based on sex, religion
  or national origin allowed IF they constitute a
  Bonafide Occupational Qualification (BFOQ) for an
  employer

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Practice Implications

• Interviewing
• Advertising
• Application forms
• Employment testing

• Wage and salary structures
• Promotion
• Fringe benefits
• Seniority
• Merit systems

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Civil Rights Act (S 1745) of 1991

• Law allows compensatory punitive damages and the
  right to a jury trial for intentional
  discrimination based on sex, religion or
  disability
• Provides for technical assistance and employee
  training

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Age Discrimination and Employment Act (ADEA) 1967

• Purposes
• Promote employment of older persons based on
  their ability rather than age
• Prevent arbitrary age discrimination in
  employment
• Help employers and workers find ways of solving
  problems based on the impact of age on employment
• Requires employer not differentiate solely on the
  basis of age
• Older persons protected by the act are now 40-70
  years old (originally 65)

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• Serves 2 functions
• Prohibits arbitrary age discrimination in
  employment
• Promotes employment based on ability
• Does not lower standards
• Does not make employers ignore differences in
  qualifications

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Rehabilitation Act of 1973

• Section 504-No otherwise qualified handicapped
  individualshall, solely by reasons of his
  handicap, besubject to discrimination under any
  program or activity receiving Federal Financial
  Assistance.
• Employment decisions must be made without
  discriminating against a qualified employee
  solely because of handicap
• Imposes an obligation on employers to take
  positive steps to hire and promote qualified
  handicapped individuals
• Qualified handicapped person-one who with
  reasonable accommodation can perform the
  essential functions of a job
• Reasonable accommodations required unless they
  impose undue hardship on the operation of the
  program
• Enforcement is under the Office of Civil Rights
  of DHHS

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Immigration compliance

• Immigration Act 1990
• Restructured the 1-9 form to verify the identity
  and employment eligibility of employees
• Prohibits discrimination based on national origin
  or citizenship
• May not require more or different documents for
  verification of select individuals

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Veterans Readjustment Assistance Act

• Provides reemployment right and privileges for
  veterans to positions they held prior to entry in
  armed forces
• Employers must rehire vet who satisfactorily
  completes service if s/he applies for
  reemployment within 90 days of discharge
• Sect. of Labor aids in seeking reemployment and
  other benefits

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Pregnancy Discrimination Act (PDA)

• Prohibits discrimination on basis of pregnancy,
  childbirth and related medical conditions
• Obligates employers to treat disabilities caused
  by pregnancy the same as other disabilities
• Cant be denied a job, promotion, fired, forced
  to go on leave as long as physically capable of
  working
• Must be reinstated after maternity leave under
  the same conditions as employees who return from
  leaves following other disabilities

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Consumer Credit Protection Act

• Employer is prohibited from discharging an
  employee because job earnings have been garnished

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State Nurse Practice Acts

• Each state has a practice act that governs the
  practice of the profession
• Acts are designed to safeguard the public
• Scope of nursing practice, actions and duties
  allowable, is defined by the states nurse
  practice act and common law
• Common law-derived from principles rather than
  rules and regulations consists of broad and
  comprehensive principles based on justice, reason
  and common sense

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• The act is the law within the state
• Law administered by board of nursing-cant grant
  exceptions, waive the acts provisions or expand
  practice outside the acts provisions
• Laws and regulations under the act
• Specify conditions under which may obtain a
  license
• Conditions for suspension or revocation
• Nurse practice acts and common law define 3
  categories of nurses
• Licensed practical or vocational nurses (LPNs,
  LVNs)
• Licensed registered nurses (RNs)
• Advance practice nurses

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• Reciprocity-a nurse licensed in 1 state can apply
  for licensure in another state because the
  licensure exam is universal
• Compact states-allow licensure across state lines
  without separate applications
• Practice acts also specify educational
  requirements for schools etc.
• NCSBN (National Council of State Boards of
  Nursing)-central clearing house
• Nurses must know and understand their states
  act-states vary greatly on whether nurses can
  diagnose and treat or merely assess and evaluate
• Boards may be the same or separate for RNs and
  LP/LVNs

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Institutional Licensure

• None currently in place
• Occasionally raises as an issue (PCA)
• Allows the institution to train and license

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Labor Management Relations Three Major Principles

• Negotiating
• Collective Bargaining
• Grievances

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LABOR-MANAGEMENT RELATIONS

• Negotiations
• Negotiatingthe mutual obligation of management
  and union to meet at reasonable times and bargain
  in good faith to reach agreement re. conditions
  of employment (the union contract)
• Conditions of employmentpersonnel policies,
  practices and working conditions

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• Collective Bargaining
• An agreement negotiated between a labor union and
  an employer re terms of employment
• Wages
• Vacation time
• Working hours
• Working conditions
• Health insurance
• Collectiveagreements cover a defined population
  and are not individualized
• Collective bargaining by nurses is to secure
  reasonable and satisfactory conditions of
  employment including the right to participate in
  decision making regarding their practice and are
  directly correlated with quality of care

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• Collective bargaining is seen as a way to balance
  power and removes the fear of arbitrary
  discipline and dismissal-due process must be
  followed
• A labor contract is unrelated to being
  professional
• A non-collective bargaining environment may be
  supportive of nursing practice and provide ways
  for input into decisions regarding care and the
  environment in which care occurs
• A contract requires negotiation of these things
  within a legally binding framework

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• Grievance and Arbitration (Chapter XIV Federal
  Labor Relations Authority
• A negotiated grievance procedure a system for
  resolving disputes
• Identifies where problems exist
• Solves the problems
• A grievance is defined in the agreement
  (contract) and may cover complaints
• By employees re any matter relating to the
  employment
• By labor organizations concerning any matter
  relating to the employment of employees
• By employees, labor organization or agency
  concerning effect, interpretation or claim of
  breach of an agreement any claimed violation,
  misinterpretation or misapplication of any law,
  rule or regulation affecting conditions of
  employment

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• Unions have rights to present and process
  employee or union grievances
• Employees may represent themselves but union has
  the right to be present even if employee doesnt
  want their help
• Arbitration-implemented by union or management
  when grievance cant be resolved
• Defan impartial 3rd party is chosen by union and
  management to decide a final and binding award
  after hearing and reviewing the case
• Expensive, time and emotion consuming,
  unpredictable results (
• Decision may be appealed within 30 days to
  Federal Labor Relations Authority (did arbitrator
  violate law, rule, regulation or authority) or
  decision is binding
• Refusal to adhere to decision/award is an unfair
  labor practice

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National Labor Relations Act (NLRA)

• Known as the Wagner Act (1935) primary law
  governing relations between unions and employers
  in private sector
• Protects workers from unfair labor practices
• Requires employers to recognize and bargain with
  a union the employees elect to represent them
• Guarantees employees right to self-organization
  to form, join, or assist labor organizations, to
  bargain collectively through representatives of
  their own choosing and to engage in activities
  for the purpose of collective bargaining or other
  mutual aid and protection
• Enacted to stop strikes, takeovers and violence
  in early 1930s (factories)

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• 1945-35 workforce was unionized
• 1947-Taft-Hartley Act amended NLRA to weaken it
  and the unions power
• Placed curbs on some union activities
• Excluded employees of non-for-profit hospitals
• 1974-Taft Hartley amended and removed exemption
  of hospitals employees have same rights as
  industrial workers
• Frenzy to organize healthcare related to fact
  that thats where new potential members (power
  and money are)

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National Labor Relations Board (NLRB)

• an independent federal agency to administer the
  NLRA
• Five members with staggered terms , appointed by
  the President and approved by the Senate
• 450 volumes of decisions
• Regional offices exist near almost every Circuit
  Court . his

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• 1959-Landrum-Griffin Act
• Known as the Labor-Management Reporting and
  Disclosure Act and resulted in Senate hearings
  re. improper activities in labor and
  management-evidence of collusion between unions
  and employers, violence, diversion of union funds
• Grants rights to union members to protect
  interests by democratic procedures within the
  labor organizations (secret elections)
• All hospitals are now subject to Federal Labor
  Relations Act
• Organized facilities must carefully attend the
  NLRA provisions even if nonunion facilities dont
  have much day- to day worries

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Organization of Nurses and Other Healthcare
Workers

• Healthcare facilities have many potential members
  at a time all dwindling union membership
• Healthcare systems are broken and thus are
  vulnerable
• Technology replacing unskilled workers

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Unions Representing Nurses in the United States

• 1199 League of Registered Nurses
• American Federation of State, County And
  Municipal Employees AFL-CIO
• American Federation of Teachers
• National Education Association
• Service Employees International Union
• Teamsters International Union
• Others

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American Nurses Association

• 1946 ANA established its Economic and General
  Welfare (EG W) Program to improve working
  conditions for nurses
• State associations as constituents of ANA serves
  as a bargaining agent in some states
• CA and MA-split from ANA 2 associations exist in
  each state-1 as union, the other as professional
  association

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United American Nurses, AFL-CIO (UAN)

• an affiliate of both the American Nurses
  Association and the AFL-CIO
• Began in 2001
• 102,000 direct care nurses
• 27 affiliated state nurses associations.
• focused on RNs and the unique issues important to
  staff nurses
• staff nurses set the standard for RNs in
  organizing, collective bargaining and contracts

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Conditions of employment for registered nurses
(UNA)

• Staffing
• Professional development
• Health and safety
• Job security
• Professional practice and quality of care
• Restructuring
• Mandatory overtime
• Wages and benefits

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Rights of Management

• Direct and control its business and workforce
• Hire, fire, promote, transfer, assign, schedule,
  layoff and discipline
• Develop reasonable rules and regulations
• Enlarge, reduce, relocate or discontinue any
  facility, department or operation
• Introduce new or improved facilities or work
  benefits
• Abolish or create job classifications
• Change the number of employees working in any
  classification

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SAMHSA (Substance Abuse and Mental Health
Services Administration)

• To strengthen capacity to provide prevention,
  diagnosis and treatment services
• Partners with states, communities and private
  orgs to address the needs of people and
  contributing community risk factors
• Does not accredit
• Umbrella org for
• Center for Mental Health Services (CMHS)
• Center for Substance Abuse Prevention (CSAP)
• Center for Substance Abuse Treatment (CSAT

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• AAAHC (Accreditation Association for Ambulatory
  Care)-improve practice in ambulatory care
  facilities
• 2003-signed cooperative accreditation agreement
  with JCAHO

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CredentialingRegistration and Licensure

• State boards duty-protect the public
• Board controls the licensure process and
  register nurses to practice under the
  conditions of the regulations
• Licensure-the process by which an agency of state
  government grants permission to an individual to
  engage in a profession and perform a unique
  scope of practice
• Individual must 1st meet qualifications to
  practice nursing within a defined scope and then
  sit for the licensing exam
• Nurses are licensed in each state
• States grant reciprocity

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• Nurse compact legislation-allows compact nurses
  to practice in other compact states without
  applying for a license in each state
• Growing trend
• Mobile society makes this reasonable
• Traveling nurses
• Call centers

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National Council of State Boards of Nursing
(NCSBN)

• Oversees the development of the NCLEX-RN and
  NCLEX-PN exams
• Taken using computers
• Pass scores are set and once reached, the test
  stops
• Measures cognitive ability and ability to process
  complex situations
• Exam designed from client need perspective
• 4 main sections
• Safe, effective care environment
• Health promotion and maintenance
• Psychosocial integrity
• Physiological integrity
• All graduates (diploma, baccalaureate and
  associate) take the same exam and pass rates for
  each program type are remarkably similar over
  time

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Certification

• Recognition of nurses who meet specified
  requirements for a particular field or clinical
  specialty
• Does not include a legal scope of practice
• State boards may use certification to grant
  advance practice status
• American Nurses Credentialing Center (ANA)
• American Academy of Nurse Practitioners
• etc

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• Other Issues
• Advanced Practice
• 2000-Delegate Assembly of the National Council of
  State Boards of Nursing (NCSBN) passed the
  Uniform Advance Practice Registered Nurse
  Licensure/Authority to Practice Requirements
• RN license
• Graduation from an accredited graduate level
  advanced practice program
• Current certification in the specialty
  appropriate to educational prep
• Maintenance of certification evidence of
  maintenance of competence
• 2002 NCSBN Position Paper on Regulation of
  Advance Practice Nursing-to assure consistency in
  education, licensure, certification requirement
  and scope of practice

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Professional and Institutional Liability

• Insurance
• Liability
• Personal-individuals are responsible for their
  own actions or omissions
• Vicarious-or substituted certain parties may not
  be negligent themselves but their negligence is
  assumed because of association with the negligent
  individual
• Corporate- an organization is responsible for its
  conduct

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• Corporate Liability cond
• Responsible and accountable for maintaining an
  environment that ensures quality healthcare
  delivery, negligent hiring and firing, failure to
  maintain a safe physical environment, lack of
  qualified, competent and adequate staff
• Nurse managers are delegated the duty to ensure
  that staff remain competent, qualified, are
  currently licensed, and incompetent, illegal or
  unethical practices are corrected and reported
  appropriately

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• Health care orgs are heavily insured to protect
  against liability
• Employees are usually also covered
• However, patients injured because of substandard
  care have the right to sue both the institution
  and the individual
• Institution has the right under indemnification
  to sue staff for damages paid to an injured
  patient when the employer is held liable solely
  on the actions of the individuals negligence
• Doctrine of respondeat superior (let the master
  answer/speak) allows courts to hold employers
  accountable for the negligence of their employees
  when the employees are performing services for
  the organization (Patients can still sue both)
• Nurses should carry their own personal liability
  insurance

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• Malpractice and Negligence
• Negligence-
• Omission-failure to do what a reasonable careful
  and prudent person would do under the same or
  similar circumstances
• Commission-doing something that a reasonable,
  careful and prudent person would NOT do under the
  same or like circumstances
• Denotes conduct that is lacking care or the
  failure to exercise reasonable or ordinary care
  carelessness
• A deviation from the standard of care that a
  reasonable person would deliver

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• Malpractice-goes beyond negligence concerns the
  failure of a person with professional education
  and skills to act in a reasonable and prudent
  manner
• Elements of malpractice
• Duty owed the patient-involves both
• the existence of the duty (valid employment by
  the institution to provide care)
• the nature of the duty (involves standards of
  care that represent minimum requirements for
  acceptable practice)
• How would a reasonable and prudent provider
  behave under the same circumstances

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• Breach of duty-the falling below or breach of the
  standard of care
• Foreseeability-the concept that certain events
  may reasonably be expected to cause specific
  results prior knowledge that failure to meet a
  standard of care may result in harm
• Causation-the actions or lack of actions directly
  caused the patients harm
• A direct relationship between the failure to meet
  the standard of care and the injury
• Was the unreasonable, careless or inappropriate
  behavior on the part of the provider the
  proximate cause of the in jury or insult?

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• Injury-
• Actual injury must occur
• Resultant injury must be physical, not merely
  psychological or transient
• Damages-injured party must be able to prove
  damages
• Must be able to show financial harm (additional
  medical costs, loss of income etc.)
• If any one of the elements cant be proved beyond
  a reasonable doubt a malpractice claim may be
  dismissed
• Nurse managers must know applicable standards of
  care and ensure that employees can meet or exceed
  them (update standards as needed and routinely
  evaluate employees)

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General Nursing Liabilities

• Inadequate assessment
• Inadequate communication
• Improper medication administration
• Poor documentation
• Improper use of equipment
• Failure to follow policy and procedure
• Failure to provide for patient safety
• Failure to question orders for patient care

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• Risk Management-
• 1970s-malpractice cases exploded causing people
  to doubt the validity of their faith in quality
  healthcare
• Identifies and takes corrective action to reduce
  jeopardy to the institution, patients and staff
• Attempts to analyze problems and minimize losses
  after patient care error occurs
• Problem focused to reduce frequency and severity
  of accidents and injuries

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• Elements of a risk management program
• Identification of potential hazards and
  inspection to locate problem areas
• Review of monitoring systems to assure integrity
  (incident reports, committee minutes, patient
  complaints, audits)
• Analysis and categorization of incidents that
  result in actual or potential adverse outcomes
• Review and track laws related to patient safety,
  legal codes and care
• Elimination of risk whenever possible
• Identification of training and education needs
• Preparing administrative reports for executives
  re findings, preventive and corrective actions

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• Risk management department should
• Define situations that place the org at financial
  risk
• Determine the frequency of those situations
• Intervene and investigate identified events
• Identify potential risks or opportunities to
  improve care
• Not act in a punitive manner or underreporting
  may occur
• 1999 IOM report To Err Is Human Building a
  Safer Health Care System sent shock waves
  throughout the lay and health care world
• Estimates of 44,000-98,000 deaths per year are
  due to medical errors
• The Quality Interagency Coordination Task Force
  (QuIC) released a response outlining more than
  100 action items to be taken by federal agencies
  to document errors and search for solutions

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Employee Impairment

• Incidence in healthcare is same as general
  public-10
• State licensing boards and medical societies have
  treatment programs with intent to maintain
  individual in profession
• Names may be made public if license suspended or
  revoked
• State laws vary re reportability of chemical
  dependency and impairment
• The Americans with Disability Act (ADA) protects
  impaired successfully rehabilitated employees and
  those in a supervised rehab program
• Managers must intervene if they suspect an
  employee is impaired because patient care may be
  jeopardized
• Focus on performance problems
• Refer to EAP
• Follow policies and reporting requirements