The sweet spot is in the documentation , so that you can show your work . It also allows you to demonstrate that you did everything possible to keep patients and healthcare workers safe . Many people focus on the patient piece , and that ’ s the nature of infection prevention , as we ’ re very patientfocused .” — Catherine
Kroll , MPH , CIC
are so few of us who have done this . A couple IPs I spoke with after my presentation have this as part of their professional consulting business , while others in the room were there because they didn ’ t want to ever end up on the witness stand and they want to know how they can avoid that situation .”
Kroll adds that the room was standing-room only , indicating that IPs might have a certain level of anxiety around HAI-related litigation , the rigors for which most IPs have not been trained .
“ I noticed in the audience a kind of collective sigh of relief when I addressed the fact that if you don ’ t want to be a witness , your company definitely doesn ’ t want you to be a witness ,” she says . “ IPs can say , ‘ Hey , I don ’ t want to be a witness on behalf of the corporation .’ In most of those cases you can arrange for that not to be the case . Identifying who is the right person to be on the stand is in everyone ’ s best interest .”
Documentation is the Best Defense
For any potential litigation , a strong defense starts with documentation . In the healthcare environment , the axiom of “ if you didn ’ t document it , it didn ’ t happen ” still holds true . Kroll emphasized during her presentation that documentation not only helps healthcare providers from relying on memory , but it ’ s often the best way to avoid being called as a witness . Further , there is a correlation between quality of documentation and verdicts , according to Albano , et al . ( 2019 ).
“ The sweet spot is in the documentation , so that you can show your work ,” Kroll confirms . “ It also allows you to demonstrate that you did everything possible to keep patients and healthcare workers safe . Many people focus on the patient piece , and that ’ s the nature of infection prevention , as we ’ re very patient-focused . But there ’ s also the healthcare worker focus . In my overall career , that ’ s where I ’ ve ended up in litigation most frequently , around healthcare worker-related issues and union grievances where we ask if we did all the right things .”
Kroll continues , “ On the patient side , there are a few things that impact it . First , from an infection preventionist ’ s standpoint , very rarely are you in a situation where something that an infection preventionist did or didn ’ t do directly impacted that patient getting sick . That ’ s more the medical malpractice piece . I ’ ve been involved in situations where it involved questioning how someone conducted the investigation , and what those pieces were . I wanted to make sure that infection prevention didn ’ t get hung up on ‘ I ’ m documenting myself out of a litigation situation ’ because that ’ s not what you ’ re doing .”
Kroll says that during peer-review of documentation , “ Much of what you ’ re doing is asking , ‘ Can the story be told later through the documentation ?’ Is anything missing ? Can someone else pick it up and say , ‘ OK , there was an outbreak of COVID on this unit . What were the key mitigation efforts to show that it was reported to the appropriate public health authorities ?’ So , a lot of focus on what can you do to make processes easy , making the right thing the easy thing to do , such as in human factors engineering , comes into play .”
It is important to note that in many cases , the work of an IP may not be called into question , but the work
of a frontline clinician may be under scrutiny , especially if their documentation is not meticulous . Kroll suggests how IPs can navigate that sticky situation .
“ We do a lot of inquiry of our provider partners ,” she confirms . “ If there ’ s something that doesn ’ t seem right , or it looks like there ’ s something missing or they didn ’ t think to include it , we ’ ll reach out to them and say , ‘ Hey , it looks like Mr . Smith had a roommate , but I ’ m not seeing any documentation around that , can you tell me ?’ In my health system , infection preventionists can write a note that goes into the patient ’ s chart that relates to that patient ’ s care , so they can say , ‘ I spoke with the provider , here ’ s additional information ,’ and then it becomes part of that record so it ’ s easy to find later . Not all healthcare organizations allow their infection preventionists to do that . My perception is that what they ’ re trying to do when they don ’ t allow that is keep that quality umbrella protected , making sure that infection preventionists aren ’ t documenting things like root-cause analysis findings .”
Kroll advised IPs and clinicians to avoid conjecture in any investigation documentation , and if a hypothesis is being recorded , ensure that the final documentation shows a resolution . The litmus test , she said , was ‘ Would you want to be questioned about it by opposing counsel ?’
Kroll knows of which she speaks , sharing with the APIC audience her first-hand experience with the dangers of a tongue-in-cheek approach to naming an outbreak at her hospital .
“ I shared an embarrassing experience which was not in a courtroom setting , but certainly could have wound up there , and it was one of the first lessons I learned ,” Kroll says . “ I love that I hold the title to ‘ I ’ m the reason that in a county in Washington there is a nomenclature for how to name outbreaks ’ because In my early 20s , we were slap happy in the middle of an investigation of a big outbreak of pertussis and because it ’ s also called whooping cough and there was the song called ‘ Whoomp ! ( There It Is ),’ and so my colleague and I were like , ‘ We ’ re going to name this outbreak Whoomp ! ( There It Is !”’ To be fair , nobody stepped in and said , ‘ Hey , that ’ s a little irreverent .’ We thought we were hilarious . That is something that if I ’ d been put on a stand and asked about , I would have had nothing to say except for ‘ Gallows humor , right ?’ And then the experiences of doing preparation of documents . I thought the very first time that I was asked to make a production , I spent hundreds of hours reading and rereading and studying up on how to coach for redaction , etc . In hindsight , what I know now is a reasonable effort is what is expected to be put forward , and so , understanding what that reasonable effort is , because I probably wasted hundreds of hours ’ worth of time on this case , going through it and doing the production , and ultimately it was a case we settled , and that was when I really struggled , because I had a really hard time with us settling that case . The organization I was with at the time , and the director sat down with me and the lawyers at the time and explained to me , ‘ Listen , Catherine , this isn ’ t because you did something wrong , or we as an organization did something wrong . We settle often in healthcare because of the expense of trials and the risk of judgment . And this
14 • www . healthcarehygienemagazine . com • september 2024