From the Frontlines: Why Documentation Is So Important

HEALTHCARE Jul 14, 2021 120 minutes
01:00 PM EST 12:00 PM CST 11:00 AM MST 10:00 AM PST

Description:-

This program will cover the basics of documentation, including the “why” and “what”.  Principles of the documentation set out by ANA, expectations from CMS and Joint Commission regarding documentation will be covered.  Additionally, legal implications surrounding documentation will be addressed.

Included in the discussion will be case studies that present documentation and how the content, or lack thereof, resulted in either a decision for the healthcare provider or the plaintiff.

Objectives:-

  • Recall ANA’s principles for nursing documentation.
  • Describe the regulatory and professional requirements and expectations for documentation.
  • Recall the basic requirements for documentation of clear, accurate, timely, and complete.
  • Recall the importance of documentation in preventing and/or defending medical malpractice cases.

Who Should Attend?

  • Clinical leads – charge nurses
  • Nursing Educators
  • Managers
  • Compliance officers
  • Patient Safety/Risk Managers
  • Legal Counsel
  • Nurses
Presenter BIO

Laura A. Dixon

(BS, JD, RN, CPHRM)

Laura A. Dixon served as the Director, Facility Patient Safety and Risk Management, and Operations for COPIC from 2014 to 2020. In her role, Ms. Dixon provided patient safety and risk management consulting and training to facilities, practitioners, and staff in multiple states. Such services included the creation of and presentations on risk management topics, assessment of healthcare facilities; and development of programs and compilation of reference materials that complement physician-oriented products. Ms. Dixon has more than twenty years of clinical experience in acute care facilities, including critical care, coronary care, peri-operative services, and pain management. Prior to joining COPIC, she served as the Director, Western Region, Patient Safety and Risk Management for The Doctors Company, Napa, California. In this capacity, she provided patient safety and risk management consultation to the physicians and staff for the western United States. Ms. Dixon’s legal experience includes representation of clients for Social Security Disability Insurance providing legal counsel and representation at disability hearings and appeals, medical malpractice defense, and representation of nurses before the Colorado Board of Nursing. As a registered nurse and attorney, Laura holds a Bachelor of Science degree from Regis University, RECEP of Denver, a Doctor of Jurisprudence degree from Drake University College of Law, Des Moines, Iowa, and a Registered Nurse Diploma from Saint Luke’s School Professional Nursing, Cedar Rapids, Iowa. She is licensed to practice law in Colorado and California.

 

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