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INTRODUCTION

Malpractice is word we don’t want to hear. What exactly is malpractice? Negligence is the failure to follow the standard of care that any reasonable NP would provide under the same or similar circumstances. Malpractice occurs when a standard of care has not been followed and results in an injury. Determining malpractice determines if the injury was a result of the provider being negligent. Practicing following established societal guidelines and staying current in the literature of your area of specialization are ways to minimize the risk of malpractice. Common allegations against NPs were found to be “failure to diagnosis or delay in diagnosis, improper care and treatment, failure to refer patients to emergency care and improper prescribing or management of medications.”1

All of us are concerned about malpractice. We promise to “do no harm” to our patients. Despite diligence and a variety of safety mechanisms that are built into our system, mistakes still happen. Medical errors are the third leading cause of death in the United States.2 The annual list of the leading causes of death in the United States is compiled by the Centers for Disease Control and Prevention. The data is retrieved from death certificates. Death certificates have a major limitation of needing to assign an International Classification of Disease (ICD) code to the cause of death. Death certificates in the United States are used to compile national statistics. They have no facility for acknowledging medical error. The system for measuring national vital statistics should be revised to facilitate better understanding of deaths due to medical care. Appeals have been made to the CDC to revise the current system and expand the causes of death beyond diseases, morbid conditions and injuries.3 ICD codes are the codes used for billing for services rendered. Until recently, there was no code for medical errors. The ICD classification of error, referred to as a misadventure diagnosis, has a separate set of ICD-10 diagnostic codes. The ICD 10 code is misadventures to patients during surgical and medical care. The codes range from Y62-Y69. The definition of misadventure is harm from or adverse reactions to medical treatment. Descriptions of misadventures include adverse reactions to medical or drug contamination, foreign objects left in the body, drug dosage errors and blood misadventures. As previously stated, using established protocols, following societal guidelines, and listening to our patients are known to reduce the error factor. Knowing your scope of practice and staying within your scope of practice can also reduce the likelihood of litigation (Table 8-1).

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TABLE 8-1 Common Reasons for NP Litigation

Failure to diagnose or a missed diagnosis

Delay in diagnosing

Failure to treat

Medication errors—relating to improper prescribing or management

Failure to refer

Source: Data from Nurse Practitioner Malpractice Statistics.1

Despite our necessary concern regarding malpractice for NPs, the incidence fortunately ...

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