Let me say right off the bat that my heart goes out to these parents and their child.  As those of you who read my blog know, I have grown kids of my own and am expecting two new grandbabies this summer.

At the same time, this is an opportunity to remind parents, grandparents and others who have children under their protection to please, please never use items that are not specifically intended for children.  Unless an item specifically states that it is for the use of children don’t buy it—no matter how cute it would look in “little Sally’s room.”

As a Nurse Life Care Planner, these types of cases are especially heartbreaking, because without even putting pen to paper, I have a good idea of the millions of dollars in future medical costs and sacrifices this family will have to make over the course of this little girl’s lifetime.  That misery will be heaped onto the guilt the parents must surely feel as well as the devastation of what might have been this little girl’s life.

To those unfamiliar with medical records, a review of the documentation can be a real challenge.  Not only are medical records full of abbreviations (many of which are relevant only to a particular facility), terminology composed of Latin and Greek, poor or missing punctuation, and spelling errors, but the often illegible handwriting makes interpretation downright difficult.

Legal nurse consultants play a pivotal role not only in translating medical records but in identifying their significance.  This is a common part of my daily job.

Deciphering handwriting from medical records is a skill that many legal nurse consultants learn through trial and error. Here are some tips to help you decipher your next set of records full of illegible handwriting. .

• Use your judgment to decide how much time to spend deciphering.  If the record does not have any direct bearing on the case (i.e. 8 year old family practice records about a visit with complaints of a nail fungus for a patient who died unexpectedly from a ruptured an aneurysm.) don’t waste hours trying to figure out a particular word or phrase.
• Invest in a good magnifying glass. I particularly like the full page magnifiers.  When working with electronic medical records, use the zoom option on your PDF reader to blow up hard-to-read sections.
• Review and compare typed reports such as consults, discharge documents, and histories and physicals first against that of the handwritten notes.  They often contain the same information. Consults and discharge documents usually give the name and specialty of consulting physicians too.
• If you have trouble reading the physician’s signature, check the nursing notes. Nurses will sometimes chart the names of physicians in their documentation.
• Physicians’ orders may be more legible than their progress notes or progress notes may be more legible than orders. Comparing the orders to the progress notes, especially the plan of care, often can help the legal nurse consultant identify specific words.
• Consider the context of the note.  For example, pulmonologists discuss respiratory issues so look for words and abbreviations used by the particular specialty such as DOE, SOB, dyspnea, ABGs, etc. Flipping to the nursing notes for the same time period may also give you clues to what the physician’s note entails.
• Try to interpret all the bad handwritten notes in one sitting. Sometimes you’ll be able to read words in a later note which will enable you to understand earlier notes.
• Conversely, it may help to let the task of deciphering sit for a day or two. Sometimes words that eluded you earlier will pop out at you after a few days.
• Use the process of “fresh eyes.” If you have access to another legal nurse consultant, ask her or him to view the problematic handwriting and give you suggestions.
• Lastly, consider using a yellow filter.  Sometimes the use of a yellow tinted filter will help you to focus and better identify that squiggle.

Now get to reading those records and remember the difficulty of this task the next time you leave handwritten notes for another!

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A lawsuit has been filed on behalf of a Cape Cora, Fla., police officer after he suffered severe head injuries during a car accident on June 2. The Fort Myers News-Press reported that Officer Damien Garcia was on duty when he was struck by a sport utility vehicle. The driver and passenger in the vehicle are named as defendants in the lawsuit. Damages in the case could exceed $50 million, Garcia’s attorney said. Denes Husty III, Fort Meyers News-Press

This officer was on motorcycle at the time of the accident.  The original filing listed damages of $15,000 which was the amount necessary to file in circuit court.  The calculations of damages in a case like this typically requires the expertise of a life care planner.  In my role as nurse life care planner, I have written life care plans for several individuals who has suffered head injuries.  The recovery is long, slow, and life altering.  Not only is the individual affected by the injury, but also the family, friends, and co-workers.  Memory deficits, gait changes, absence or changed taste, decreased motor function; these are just a few of the changes which can result from a head injury.

The next time you represent a head injured individual, consider a Nurse Life Care Planner to assist in determining the cost of future medical care.

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A Florida woman filed a lawsuit against an oral surgeon who allegedly left a drill bit burr in her right sinus cavity for over a year. According to the lawsuit, Donna Delgado had been experiencing severe pain, bleeding and dizziness since her surgery in August 2008. A scan at St. Joseph’s Hospital in July 2009 revealed the inch-long burr as the cause of her pain. The lawsuit claims that Delgado had sought medical attention from her oral surgeon on multiple occasions after her surgery, but he declined to help her, telling her the pain was “normal” and demanded she “stop complaining.” The lawsuit seeks unspecified damages.  Marlene Sokol, St. Petersburg Times

Before I attended to nursing school, I worked as both a dental assistant and as an orthodontist assistant.  So, I was quite surprised and troubled to see that in this case, the patient follow up was faulty to say the least.  Then to read that upon complaining about her excruciating pain and unusual symptoms after the procedure, that the surgeon didn’t take the simple precaution of x-raying the site, was an astounding incident of sub-par care.  The patient could have had a much worse outcome after having an MRI which can be very painful and dangerous for those with metal in the imaged area.

In my current role as a nurse case manager I have handled dental injuries as a result of a work accident.  In one such case a salesperson was injured when a co-worker punched him.  In another, less extreme, but nonetheless painful case, a store employee was smacked in the face with a door when a co-worker ran through it in a hurry and failed to pay attention to where she was going.

My advice: research your practitioner very carefully before the appointment, and if you feel something is amiss…get a second opinion!

Another lawsuit has been filed against Toyota Motors Inc., this time in Houston after a woman was killed in an accident when her car sped through a stop sign and smashed into a cement wall. The accident occurred on Dec. 18, a few weeks before the recall that would have included Trina Renee Harris’ 2009 Toyota Corolla. The Houston Chronicle reported that Harris told her husband that she felt the accelerator moved on its own at times, but didn’t think anything of it. Harris’ husband is seeking $200 million in damages for “gross negligence.” This is the third wrongful death lawsuit filed against Toyota in relation to the recalled vehicles.  Mary Flood, Houston Chronicle

At this point we all know what a heart breaking disaster the whole gas pedal problem has been.  I listened to the statements made by Mr. Toyoda and while I feel he is being sincere, the fact that they aren’t sure what is causing their cars to unexpectedly accelerate is not helping the millions of Toyota owners.  The stories from some of these individuals is heart wrenching.  The company will continue to replace floor mats and accelerators, but word has it that “it may be in the electronics.”  That is a direct quote from Toyota.

For any Toyota owners reading this blog, if you notice anything amiss, please, park your car until Toyota gets a game plan for a real fix.

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Every time Pat Iyer offers a teleseminar, someone asks whether 60 minutes is really enough time. I can attest to you that it is not!  Pat has accumulated knowledge and practical advice from excelling as a legal nurse consultant for the last 23 years. Here is what two of my colleagues had to say about her:

“I highly respect you and your knowledge as the author of the ‘LNC Bible’.  You are very well respected.  Your legal nurse consultant basics book is just awesome for all.”
Patricia A. Coonan RN, CEN, LNC, The Beasley Firm, LLC, Philadelphia, PA

“You are definitely the one and only leading expert in the field.”
Dolores Austin JD RN, Phoenix, AZ

Pat Iyer is ready to share her secrets with you in a no charge teleseminar. The topic is: How to Stand Out in a Crowded Field. There are still a few lines left for this teleseminar. It is happening tomorrow, Thursday, February 25 at 8 PM Eastern, 7 PM Central, 6 PM Mountain and 5 PM Pacific. You can get all of the details and register right now by going to this page.

Remember, there is no charge for this teleseminar.

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Here are 12 reasons why you should reserve your spot today…

You will learn about:

• the most important skill you need to get and keep your foot in the door of your clients
• the essential things you can do to make more money
• how this skill will gain you more work, more income, reduce frustration and gain more referrals
• why spending money on marketing is a huge waste of your valuable time and money unless you improve this skill.
• why attorneys put great emphasis on this skill
• how to avoid frustrating your client and harming your reputation
• if you can’t do this, you could be unknowingly making mistakes that cost you money and clients
• how to fix a flaw that will cause you to be instantly lose clients
• how to increase personal success through the ability to motivate, persuade, communicate with or assure others
• how to gain respect and job security by making sure your skills are valued by clients, an employer or insurance company
• how to succeed in a knowledge-driven industry
• how to save time and prevent misunderstanding

This call could change your practice forever.

Want to be part of this no-charge teleseminar? Go here:

Pat is the real deal.  I have had the pleasure of working with her and I recommend you get on this call.

Here are the details.

Date: February 25, 2010
Time: 8:00 PM – 9:00 PM Eastern, 7:00-8:00 Central, 6:00-7:00 PM Mountain, 5:00-6:00 PM Pacific

Cost: FREE

Free teleseminar: How to Stand Out in a Crowded Field
To sign up for this fantabulous free event, just click here.

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In many cases attendant care is needed. The plan will determine how many hours per day care is anticipated and what level of individual is needed to provide the care. Some care may be provided by unskilled labor while other care requires expertise of a licensed individual. Still other care could be calculated to provide respite for the family care givers.

Another large area in injury cases (and particularly those cases which involve children) are the calculations the therapy needs. Therapy needs may consist of physical therapy, speech therapy, occupational therapy, and recreational therapy and may last a lifetime.

A life care plan will also address the number of physician visits required throughout the injured party’s life, any adaptive equipment he or she may require in and around the home, home modifications, transportation needs, diagnostic testing, and often much more. It is common for the nurse life care planner to meet with the injured party’s family in their home to assess the extent of the needs. The plan is a collaborative effort that involves the life care planner as well as the multiple medical professionals involved in the medical care.

Nurses are well suited to this field of life care planning. Beginning in nursing school, nurses learned how to develop a nursing care plan. This same nursing care plan is the essence of Nurse Life Care Planning. The Nurse Life Care Planner initiates the nursing process with a nursing assessment and using a holistic approach to encompass the client, their support system, their environment, and their individual needs related to the injury or illness.

The nursing assessment is based on collecting subjective and objective data from observations, examinations, interviews and written records. The data may include symptoms, growth and development, family health history, information collected by other health team members, culture and religion, ability to perform activities of daily living, educational and vocational background, patterns of coping and interacting, and environmental factors. The Nurse Life Care Plan is intended to follow the client through his or her lifetime to ensure funds will be available to properly care for the client.

Nurse Life Care Planning is an extension of case management where the nurse has learned to perform an assessment, formulate a plan of care in collaboration with the health care team, facilitate medical needs and negotiate costs related to care. Other specialties of nursing that are also well suited to this area include rehabilitation, discharge planning, utilization review nurses and even home health nurses.

The American Association of Nurse Life Care Planners (AANLCP) was established to promote a professional practice within nurse life care planning. To learn more about this exciting field of nursing, I encourage you to contact the association and consider becoming a member.

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About 1,800 fatal falls occur among residents of US nursing homes each year.   About 10-20 percent of nursing home falls cause serious injuries. Two to six  percent cause fractures.  Many patients need to spend at least a year recovering in a long term care facility. Some never return to their homes.  In addition to fractures, elderly people suffer soft issue injuries, head trauma, and lacerations.

The 1% of elderly people who fall and sustain a hip fracture have a 20-30% mortality rate within a year of the fracture. One quarter to three quarters of people who lived in the community do not recover their prefracture level of function in ambulation or activities of living. A fall can be life-altering for this group. Fear of falling can lead to reduced mobility, deconditioning, dependency, social isolation, and diminished quality of life. A fall can result in a major disruption to an older person’s life- injury, hospitalization, and rehabilitation.

Falls have many liability issues. Some center around what should have been done to prevent the fall. Hot issues include use of side rails, frequency of monitoring to prevent a fall, responsiveness to the patient’s requests for help, and unsafe equipment such as wheelchairs. A delay in treatment can close a window of  opportunity to change the outcome- such as in head injury or spinal cord injury that results from a fall. Healthcare providers are expected to act as patient advocates to secure help for their patients.

A delay in treatment may occur because:

• The healthcare providers did not collect the appropriate data needed to assess the patient’s condition. The person who fell was not thoroughly assessed and an injury was missed.
• The appropriate data was collected but the healthcare provider did not have the knowledge to critically analyze the data to find its meaning. The signs of a fracture were overlooked.
• The data was collected and analyzed, but the appropriate healthcare provider failed to respond to another person’s concerns. The nurse could not get the attention of the physician or the nurse’s concerns were dismissed.
• The concerns of the bedside clinician were heard, but the provider did not or could not make timely decisions about what to do about the changes in the patient’s condition.

Some facilities have implemented a system of hourly rounds to reduce the factors that result in falls. Think of the four “Ps”:

• Potty
• Positioning
• Pain
• Possessions- phones, water, glasses, call lights and bedpans within reach.

Interested in learning more?

There is an upcoming teleseminar about this very subject.  MedLeague will host this seminar on February 23, 2010 at 12 EST with Dr. Deanna Gray-Miceli.  You can register for the program here.  The seminar is targeted to attorneys and legal nurse consultants and will cover how to identify the meritorious claims involving falls, look at damages as they are related for injuries from falls and the core elements that should be in place to prevent falls.

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My friend Pat Iyer, a legal nurse consultant in Flemington, New Jersey, struggled to make her practice successful. She wondered where the next client was going to come from. She worried about making ends meet. And then she cracked the code. She learned how to create outstanding work products that keep attorneys returning with case after case. Pat is past president of the American Association of Legal Nurse Consultants, and chief editor of the core curriculum of legal nurse consulting: Principles and Practices of Legal Nurse Consulting, Second Edition. She has written or coauthored over 125 chapters, books, online courses, case studies and articles.

Pat is ready to share her secrets with you on Thursday, February 25 at 8 PM Eastern, 7 PM Central, 6 PM Mountain and 5 PM Pacific. This teleseminar reveals a world of value. If you would like to discover how to dramatically improve your practice, this might be the most important message you receive all year.

The time for you to take action is now!

Here are 12 reasons why you should reserve your spot today…

You will learn about:

• the most important skill you need to get and keep your foot in the door of your clients
• the essential things you can do to make more money
• how this skill will gain you more work, more income, reduce frustration and gain more referrals
• why spending money on marketing is a huge waste of your valuable time and money unless you improve this skill.
• why attorneys put great emphasis on this skill
• how to avoid frustrating your client and harming your reputation
• if you can’t do this, you could be unknowingly making mistakes that cost you money and clients
• how to fix a flaw that will cause you to be instantly lose clients
• how to increase personal success through the ability to motivate, persuade, communicate with or assure others
• how to gain respect and job security by making sure your skills are valued by clients, an employer or insurance company
• how to succeed in a knowledge-driven industry
• how to save time and prevent misunderstanding

Here’s what your colleagues said:

“Packed with useful information and principles”
Mindy Cohen, MSN RN LNCC Immediate Past President AALNC

“Informative, entertaining and invaluable”
Jane Barone LNCC

This call could change your practice forever.

Want to be part of this no-charge teleseminar? Click here.

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