What should you say in your deposition as a Professional Legal Nurse Consultant? What should you not say? These are questions you’ll probably ponder as you prepare for your expert witness deposition in a case. Below are some helpful tips that should set your mind at ease for your sworn testimony.
Five Deposition Tips for the PLNC 1. Be prepared. You cannot “wing” a deposition, even though maybe you could a test in nursing school. So, anticipate questions regarding every singlefact surrounding the medical records you reviewed.
2. You will be asked about your education. Expect to provide an overview of your education which you could do using your resume or curriculum vitae. More importantly, you will likely be asked about whether you obtained education regarding the specific facts in the case you reviewed.
3. Your nursing experience is critical. You will most definitely be asked about your nursing experience. Specifically, you should be prepared to answer questions about your experience with the facts at issue. If your experience is limited, you should consider filling it in with research you have done regarding the facts.
4. Plan to discuss how many cases you have testified in and the types of cases. If this is your first time testifying, you’ll have less baggage. If you have testified in the past as a legal nurse consultant, be sure you know the specifics of those cases.
5. Anticipate the questions in advance so you can set your mind somewhat ease. Nothing worse than “dreaming up” an answer when multiple people are awaiting your answer and you feel anxious. You most likely will be testifying about your opinion regarding all healthcare providers, not just the nurse in question.
Think About These Tips
Now that you’ve read these five tips, go back over them because you will see these come up in almost every expert witness deposition. Become more at ease and you wll be a better expert witness!
P.S. If you’ve been deposed before, how many times for the plaintiff and how many for the defendant? (Try to aim for an equal number).
What’s your goal? For the Plaintiff: To identify the TIMELINE of events so you know what was done and not done for the patient that caused harm. For the Defendant Nurse: Same thing. Your CHRONOLOGY is a unit of time. When the events happened and by whom.
As the Professional Legal Nurse Consultant (PLNC) assigned to reveiw the medical records, you are either asked to create a chronology or find it would be helpful to organize what went on with the patient. Either way, creating a chronology will help you understand the facts.
Here’s a summary of what how to create your chronology:
Receive the medical records: Acknowledge electronic receipt via your email to atty.
Organize the med records, if not done already, by sections.
Read the medical records critically. Looking for merits of case.
Now, Write up a chronology (timeline) in complex cases
Point 1: Use Word Document with Four Columns
Date, Description, Page Number, Comments: Arrange in order of occurrence.
Multiple Providers? Do a separate Chron for each Provider
KISS
Point 2: Only record relevant info
Med Recs come in REVERSE chronological order.
Your Chron should be in chronological order.
For example, pt came thru ER, then admitted to ICU, then surg, then back to ICU.
Lots of info is immaterial. Cut to the chase.
Question whether it’s relevant? Include it. Better to include than exclude.
Point 3: Use your Chronology to Draft your Report
Keep three tabs open on your computer:
Med Recs
Chron
Report you’re drafting
No need to include everything from Chron in your report. QUESTION: Is it relevant?
Primary source is med rec. Secondary source is your Chron.
Work off your Chron to draft your report.
Medical malpractice cases almost always use a chronology. A timeline is extremely helpful in cases where there are a lot of events happening. This is the way to distill it down.
To get paid for your work, you need to keep track of the time it took you to create the chronology. Often, it takes a lot of time to create a chronology, but 1) it’s essential to understanding the medical records and 2) you should be getting paid for doing it.
Creation and use of a chronology will help you in your legal nurse consultant practice so follow these points to make them easy for you to draft and use.
P.S. Do you use a four column format for your Chronology?
Your attorney-client has provided a link to the medical records of three different providers of the patient. Your assignment: Review the medical records, provide a summary, and give your nursing opinion. You’re going to get paid handsomely for it, but how do you keep track of your time spent on the case?
Attorneys, usually defense attorneys, used to keep a notepad next to them and whenever they performed a task, they’d write it down on “time slips”. They’d include the date, time it took, and short description.
Fast forward to the digital era and attorneys keep “time” electronically. While that’s an option for legal nurse consultants, in my experience the best way to keep track of the time you spend on an assignment is by simply writing it down. Later, when it’s time to create an invoice, you can easily transcribe your time directly onto your invoice for services.
Follow these three steps to make recording your “time” easier 1. Keep a notepad next to you. On your notepad that’s kept next to you while you review a medical record, record the time you start and the time you stop, even if it’s just for a break. Then, record your restart time and stop time. Next to each start and stop time, record the task you performed.
For example, if I’m reviewing the medical bills from a healthcare provider, I would record the date and the start and stop time for those precise medical bills. My entry would say: “Review medical bills from [name of healthcare provider], 17 pages”.
2. Use the page count as a gauge. Once you review medical records and medical bills, you’ll get a feel for how long it ought to take you to review them. Of course, some documents require you to scrutinize them more in which case the page count is not necessarily reflective of how long it should take you to review them.
3. Record the amount of time per task. It’s possible that you could review the medical records and medical bills in a short amount of time, say, in one hour. Still, separate out the time you spent reviewing the medical records, summarizing the medical records, reviewing the medical bills, and summarizing the medical bills.
The reason to separate the time concisely is for your attorney-client’s benefit and, as is often the case, for the insurance company’s benefit. Recipients of your legal nurse consultant services want to know exactly how you spent your time and their money.
Keep it simple sweetheart will be your motto and you’ll find it’ll keep you in good stead.
You’ve just been given 194 pages of medical records to review as a Professional Legal Nurse Consultant (PLNC). What do you do first? Just follow these six EASY steps and you’ll have them knocked out in no time. Don’t worry. Follow this path each and every time whether you’re working on a medical malpractice case, personal injury matter, or social security disability claim.
Six Easy Steps to Help You Dissect the Medical Records
Read the email instructions. Be sure to re-read the email so you don’t miss a deadline.
Write down the sections by name and include page numbers. You can expect there’ll be Nurses Notes, Medication Administration Record, and the like. Separate by section and include exact page numbers.
Read the pages. This time for content. Content is king.
Notate missing documents. Invariably, there are missing documents you’d expect to be included in the medical records.
Take notes. You’re going to be compiling your legal nurse consultant report, so jot down important facts.
Write up your report. The legal nurse consultant merit review is not necessarily lengthy, it’s the content that matters.
You’ve been reading electronic health records in your every day nursing practice. Apply that nursing knowledge here.
P.S. Have you ever read a medical record and realized a document was missing? Comment below.
A lot has happened over the past two years which permanently changed nursing and legal nurse consulting practice. The way you, as a certified Professional Legal Nurse Consultant (PLNC), review medical records will never be the same as pre-pandemic. You need to know what the legal landscape is now and going forward to make the necessary adjustments.
Let’s look at selected nursing challenges that the Covid pandemic has brought. In order to be an effective PLNC, you need to be able to size up the current documentation situation. Pre-pandemic, documentation was, on average, ample. Since the coronavirus outbreak, you’ll find charting has suffered.
Documentation Has Suffered In your medical record review, your focus is almost entirely on the patient’s history and treatment course. You’d expect to find what you’re looking for in the Medication Administration Record, the Nurses’ Notes, Healthcare Providers’ Orders, Progress Notes, and any number of sections. Absent those entries, the assumption would be that it wasn’t done.
After all, that’s what nurses are taught in nursing school. We’re told the old adage “if it’s not documented, it’s not done”. That is not necessarily true anymore. Covid has taught us that. With nurses and other healthcare workers completely overwhelmed, guess what went by the wayside? DOCUMENTATION.
Without the benefit of documentation, the challenge becomes how do we figure out what was, and was not, done for the patient? This is where your Professional Legal Nurse Consultant skills come into play. You need to make a list of what documentation should have been present but wasn’t. Furthermore, you need to make a “Missing Documents” list specifically enumerating the documents that are not there but should’ve been completed.
Nurses Not Fully Prepared For Critical Care Practice You’ll see in the patients’ charts nurses are likely not documenting in the manner you’d expect if they aren’t used to working in that specialty. For example, a pediatric nurse is likely not used to working on an Adult Covid Unit. This is especially problematic as the medication dosing for children versus adults can be significantly different. A pediatric nurse administering adult meds might not catch a medication error. You, as the PLNC, need to be on the lookout for this.
Not just with medications, but nurses who are floating to other specialty areas might not be used to providing clinical care in accordance with those standards of care. It’s up to you to research the standard of nursing care. Whether you’re consulting on legal cases for the plaintiff or defendant, you’ll need to provide some degree of research on nursing standards of care. Ultimately, you’ll have to decide if you think there was a breach of standard of care or if the facts support the standard of care.
Less Time Performing Nursing Assessments When a nurse cannot do an appropriate initial assessment of the patient, it’s a slippery slope. For example, if the nurse failed to appropriately assess the condition of the patient at hospital admission, and later there’s documentation of decubitus, the assumption will be the patient’s condition deteriorated during hospitalization. This could mean liability for the hospital and the nurses. If the patient was accurately assessed at admission and the wound was noted, this could reduce the liability exposure.
In your legal nurse consulting merit review, carefully read all nursing assessments. Are they thorough? The answer might be “yes”, but you need to decide what should’ve been in them. If your answer is “no”, be prepared to explain why.
Crises Occur Online and Offline Just because you didn’t see anything noteworthy in the medical records during your legal nurse consultant review doesn’t mean there isn’t a problem. If you’re reviewing the medical records in support of the nurse, see if you have access to Incident Reports. Still yet, see if you are allowed to read employee files, but these are usually protected documents.
If you’re reviewing records on behalf of the hospital, you might ask the attorney for their notes of the meeting or risk management’s notes. These can provide even more info that can help paint the full picture.
You need to know the legal landscape has forever changed when it comes to legal nurse consultant medical record reviews. What you might’ve come to expect from patient’s hospital or nursing course is not necessarily the norm anymore. Stay current by reading articles, blogs, and other scholarly material on how nursing practice has evolved.
Your Professional Legal Nurse Consultant skills are invaluable. Be proud. Be smart. Be sure to stay ahead of the pandemic, or endemic, curve.
P.S. Get your FREE Guide here so you can stay up-to-date on legal nurse consulting.
In your Professional Legal Nurse Consultant (PLNC) practice, your main concern is with the medical record. Whether you’re reviewing a paper document or electronic health record, your approach will be the same.
Let’s look at charting from the perspective of a nurse. Whether you’re reviewing the documentation on behalf of the plaintiff or defendant, think about how the nurse goes about documenting nursing care. After all, if the nurses’ notes are at the center of a potential lawsuit, you’ll need to understand and interpret what was in the nurse’s mind at the time the event occurred.
Attorneys Want Your Nursing and Professional Legal Nurse Consultant Opinion As a nurse, and a Professional Legal Nurse Consultant, the attorney is relying on your nursing opinion. What you say matters. So, let’s go into the mind of a nurse…
Here’s what a nurse should’ve been taught: One of the most vital components of good nursing care is proper documentation. This practice of thoroughly and completely recording each interaction with patients is made even more important when you consider the possibility of legal action against you, the nurse providing care.
The first thing a patient considering a lawsuit will do is request their medical records. This includes any and all charts and documents created. They will, of course, be searching for errors. These records are of great consequence in the legal process.
“The first thing a patient considering a lawsuit will do is request the medical records.”
Knowing that the patient will get the medical records should be motivation enough to make the records thorough and detailed. Remember, anything you write or record could be read in court. So when you chart in the medical record, think in the back of your mind that a judge or jury might both hear and see them.
“Anything you write could be read in court.”
2. Strive to document in the most comprehensive and detailed way possible. Time restraints are the biggest obstacle between a nurse and thorough charts. With the busy nature of the job, sometimes nurses are forced into leaving documents incomplete, or they make only vague notes.
It can take years for a lawsuit to culminate; it is unlikely that you’ll remember everything clearly if you get sued. Your charts and documents are the key to knowing what you did and why you did it, so be sure you write and record enough information to recall the specifics of the case, or at least what your usual and customary practice would have been in the situation.
3. Stay on top of your nursing charting. Sure, you may need to put off fully completing some charts on particularly busy days, but try not to wait too long. The longer you wait to fill out the necessary paper work, the more it may look you are trying to falsify the actual occurrence after the fact.
The nursing adage “if it is not documented, it is not done” should always be applied to your work. Also consider that, unless you documented an action or treatment, legally speaking it never occurred. Don’t just note what was abnormal in a case, record the commonplace, typical events in a patient’s care. It could be the normalcy of your treatment – the fact that you followed basic protocol – that helps you avoid getting sued.
4. Check all items and fill in every blank space, every question, every box on each form for which you’re responsible. Again, don’t think that you’ll be able to remember the details of the care given down the road if you don’t properly document. Even if it seems obvious or mundane, make a note of it.
If you’re unable to fully complete your orders for a patient’s care, be sure to note that. For example, if a patient is sleeping when you check in on them, don’t simply leave certain areas of their chart incomplete. Note the circumstance as to why the document isn’t fully complete (i.e. “patient is sleeping, therefore did not check temperature”) so you cannot be accused of deficient care later.
“It’s better to write too much in your charts than to write too little!
Of course not every mistake rises to the level of a lawsuit, and accurate charting is important for the proper care and treatment of patients. But, the need for understandable and comprehensive charting becomes far more important if a case goes to court.
5. A fundamental aspect for healthcare providers named as defendants in a lawsuit is the ability to recall. Sometimes this is years after caring for a patient and the details of a case even after examining your notes from the charts is hard to do accurately. The more information you include in your charts, the easier it will be for you avoid being unfairly accused.
Look For These Entries In The Medical Records You’re looking to see the four basic elements in the nurses’ documentation: Assessment, Plan, Implementation, and Evaluation. Whether you’re reading the Nurses’ Notes, Medication Administration Record (MAR), or Nursing Care Plan, watch for these basic elements. The more complete the nursing care record, the greater the chance the correct care was provided.
Whether you’re approaching it from the plaintiff or defense side of the case, these principles apply. Remember, while you’re focusing on the case from your perspective as a legal nurse consultant, you’ll need to consider the strengths and weaknesses or opposing counsel’s case. That’s what makes your Professional Legal Nurse Consultant services even more valuable. It’s your ability to spot issues and bring them to the lawyer’s attention.
You’ve been trained as a nurse and a Professional Legal Nurse Consultant.That’s quite an impressive combination! Rely on your legal nurse consultant training and your nursing education as well as your experience to explore all aspects of the patient’s medical record before you draw conclusions.
Looking at the clinical care that was provided to the patient, does it meet the nursing standard of care? Does it fall short or does it exceed it? You’re in the best position to determine this from reading the notes. The nursing entries should be contemporaneous with the event but consider that they might be anecdotal. It’s yours to decide.
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