Avoiding a negligence claim: Defence organisation tips

It is well known that complaints and claims against doctors are increasing year on year, but data from the Medical Defence Union (MDU) suggests the rise in cases is even steeper among nurse practitioners in primary care. This is probably partly explained by the increased numbers of nurses with extended roles. In taking on roles such as assessing and diagnosing patients, prescribing medicines and running minor injury clinics, nurse practitioners are at an increased risk of patients holding them individually accountable if something goes wrong.

During 2015, there were 25 new clinical negligence claims brought against MDU nurse practitioner members, compared to just two claims 10 years earlier. One claim against a nurse practitioner resulted in a compensation payment of more than £2million. Meanwhile patient complaints notified by nurse practitioners rose from four 10 years ago, to over 40 last year.

The following tips are designed to help nurses in extended roles to mitigate the risks of receiving a complaint or a claim and to help you to explain and justify your decisions and actions if the worst happens.

1. Refer patients to a medical colleague if the diagnosis is unclear

With around a third of complaints and claims against nurse practitioners alleging wrong or delayed diagnosis, careful history taking and examination is essential in reaching an accurate diagnosis. If there is doubt about a diagnosis, get advice from a medical colleague or refer the patient for further investigations or treatment.

2. Clearly communicate with patients

Many claims and complaints involve an element of poor communication, or a perceived uncaring attitude of the nurse. Always take care to explain what you are doing and why, and check the patient has understood. Take particular care when providing safety netting advice such as under what circumstances and time frame the patient should seek further medical care.

3. Keep up to date and ensure you work within your level of competence

Clinical errors including prescribing errors are easily made and reasonably common, accounting for around 10% of cases we see. Ensure you are aware of and follow local and national guidelines and practice policies and procedures. If unsure, seek advice from your colleagues or refer for further investigation or treatment.

4 Respect patient confidentiality

Confidentiality is easily breached inadvertently. Do not discuss patients where you might be overheard, or leave written records where they might be seen. Do not assume that a competent child or adult would be happy to share information with a close family member or spouse. Avoid leaving messages on answer machines or voicemail unless you have specific consent from the patient to do so. Do not share information about patients on social media, even if the details seem to be unidentifiable, and take special care if communicating with patients by email, ensuring you follow your practice policy.

5. Get informed consent

Always ensure you explain fully what you intend to do before examining a patient, prescribing, performing a procedure, or referring. Tell patients about the risks, benefits and alternative options open to them, including the option of doing nothing, so that the patient can make an informed choice. Offer a chaperone for intimate examinations, in line with local and national guidance, and record in the notes full details of your discussions.

6. Keep detailed records

Accurate and detailed records are essential for good clinical care, but they are also vital when responding to a complaint or claim. Make sure you keep a record of all your discussions with patients including those over the telephone. Include negative as well as positive findings such as an absence of fever or neck stiffness. You have an ethical and legal responsibility to ensure the records are detailed and accurate.

7. Apologise if things go wrong

If you become aware of a potential problem, be open and honest. Apologise to the patient where appropriate and explain what has happened, and what can be done to rectify things. Document what has happened and your discussion with the patient carefully. Log the incident in accordance with your practice policy, which should comply with the statutory duty of candour and consider whether to submit a patient safety incident online to the National Reporting and Learning System.

8. Get advice

If you are unsure what to do or need advice, speak to a senior colleague or contact your medical defence organisation.