client’s care if the medical record shows
that a doctor ignored repeated attempts
to contact him or her or that a nursing
supervisor needed to intervene in your
client’s case. Another sign is a history
of disciplinary actions taken against the
doctor, so be sure to ask for this in your
request for production.
Last year, the Joint Commission
mandated that hospital administrators
formulate a code of conduct to define
inappropriate conduct and implement a
zero-tolerance policy toward disruptive
behaviors.19 In your production request,
also ask for the hospital’s policy on
addressing inappropriate behavior.
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While doctor behavior is important,
face-to-face interaction between doctors and nurses represents only a fraction of the communication process.
Much information exchange occurs
when one party to the communication
is not present—for example, orders
regarding a patient’s medications, diet,
mobility, and treatments are conveyed
primarily through the doctor’s entry and
the nurse’s review of the patient chart or
electronic medical record (EMR).
The use of EMR and the implementation of specialized computer software
have had a huge impact on communication between doctors and nurses in hospitals. This technology has dramatically
reduced adverse events by improving the
legibility of orders and including “forcing
functions,” which operate as automatic
safeguards. For example, a software program may refuse to accept a medication
order if the patient’s profile reveals a
prior allergic reaction, “forcing” the
doctor to choose another drug.
You’ll need to determine whether
communications technology—or the lack
of it—contributed to a miscommunication in your client’s case. Request identifying information about any software
the hospital uses to help you prepare for
the deposition of its information technology (IT) representative. The client’s
EMR will generate questions for the IT
specialist, such as one asking for him or
her to clarify the significance of multiple entry times and safeguards against
alterations. The IT specialist will also
be able to speak to the preservation of
evidence and back-up procedures for
the computerized records.
You also may want to retain an expert
in health care informatics as it relates
to management of data via information
technology in the hospital setting. This
expert would be of assistance in speaking to the accuracy and validity of the
information provided by the facility’s
IT specialist.
