Case Study

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Buchbinder, S. B., & Shanks, N. H. (2017). Introduction to health care management. Burlington: Jones & Bartlett Learning

Pg.514-515

Case Study: Building a Better MIS-

Chapter 8 Sharon B. Buchbinder

You are the CEO of a large health services organization (HSO) in Florida. Your HSO has inpatient and outpatient facilities, home health care services, and every other service your patient population needs. You also have a world-renowned AIDS treatment center that has been considered by many to be a model for the rest of the U.S. Your HSO has always enjoyed an excellent reputation, and your quality of care is known to be excellent. You have been very happy in your work, knowing that your HSO provides good care to people who truly need it in a caring and cost-effective manner. Your HSO has recently been featured in every media vehicle known to every man, woman, and child in the U.S. and beyond. The reason: someone downloaded the names of 4,000 HIV+ patients who had been seen in your world-renowned HIV clinic and sent the list to newspapers, magazines, and the Internet. You and your board of trustees are completely blown away. The board is furious and wants to fire you. You have been able to convince them that they need to keep you on to fix the HSO’s management information system (MIS). Their last words to you were “You had better come back with plans for building a better MIS, or you’re fired!” You hire a computer security consultant, and she comes into your organization under disguise as a nurse manager to help you determine where the security leak might be. She returns to you in three days with the following report. “While I was undercover in your organization for a mere three days, I observed the following breaches in computer security. These are the highlights (or lowlights):

· Nurses log in with their passwords, walk away, and leave the system open and up and running;

· Dr. Jones leaves his password taped to the PC on a piece of paper;

· Fax machines and printers are often in areas of high traffic and in rooms without locks;

· With my one password, I had remote access to every database in the hospital, including Human Resources’ personnel files, from my home;

· There are no programs reminding people to change their passwords on a regular basis; When I pretended to forget my password, other nurses gave me theirs;

· When I requested sensitive patient files on flash drive, even after this incident, people rarely questioned me.

In short, you have a major problem with your MIS—and your staff!” What should you do?

DISCUSSION QUESTIONS

1. What law is being violated by the employees at this health services organization?

2. Why was this law enacted?

3. What are the penalties for violating this law?

4. If an employee shares confidential medical information about a celebrity and is caught, what should the penalty be?

5. Do you think you should be updating your résumé and looking for a new job?

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Buchbinder, S. B., & Shanks, N. H. (2017). Introduction to health care management. Burlington: Jones & Bartlett Learning

P570-571

Case Study: Communication of Patient Information during Transitions in Care—

Case for Chapters 7 and 12 Sharon Saracino and Sharon B. Buchbinder

Margaret Burns is a 63-year-old woman who has suffered a left occipital hemorrhagic infarct, a cerebrovascular event. In addition to this recent stroke, Margaret has a history of rheumatoid arthritis, which limits her mobility; hypertension, which has been controlled with diet and medication; osteoporosis; gastroesophageal reflux; and depression. She is alert and oriented, and has been identified at risk for falls. She requires moderate assistance with transfers and minimal assistance with ambulation using a rolling walker. Her scheduled medications include: pantoprazole for gastroesophageal reflux disorder (GERD); alendronic acid for osteoporosis; prednisone, a steroid; metoprolol for hypertension and heart disease; and calcium with vitamin D.

Following her acute care hospitalization, she is transferred to a skilled nursing and rehabilitation facility to continue her recovery. Margaret lives alone and must be independent to return home. One week after her admission to the skilled nursing facility, Margaret develops pain and swelling in her right leg and a low grade temperature. Her blood work indicates an elevated white blood cell count. The attending physician orders a venous Doppler ultrasound of the right leg and the results are positive for an acute deep vein thrombosis (DVT). Plans are made to transfer Margaret back to the acute care hospital for possible placement of a filter as she is not a candidate for anticoagulation due to her hemorrhagic stroke.

Carol Stevens, the secretary on Margaret’s unit, had a flat tire on the way to work. After calling the auto club and waiting for them to come and change the tire, she arrives late, already behind before her day has even started. After she punches in and hurries to the unit, she learns two patients are being discharged, two patients are scheduled to arrive for admission, and Mrs. Burns is scheduled to be transferred to the acute care setting. She immediately sets to work faxing the histories, current lab results, consults, diagnostics, physician progress notes, nurses’ notes, and medication administration records to the physicians of the patients to be discharged and making copies of those items to send to the hospital with Mrs. Burns per protocol for continuity of care, keeping each set of patient records in a separate pile.

Carol’s son then calls to say that he missed the school bus. Carol sets the papers aside while she calls a neighbor to arrange transportation for her son. As she hangs up the phone, the ambulance arrives to transport Margaret to the hospital. Carol gathers the copies of Margaret’s records together and places them in an envelope. The hospital process is for a nurse to double check the records to ensure they are correct prior to the patient leaving the building, but another ambulance crew arrives simultaneously with a patient for admission, handing that patient’s paperwork to Carol. Carol hands the envelope with Margaret’s records to the first crew and directs them to Margaret’s room.

A week later, the patient care coordinator at the skilled nursing and rehabilitation facility receives a call from the acute care hospital and is informed the medication administration record sent with Margaret Burns was that of another patient. The acute care hospital failed to notice this discrepancy on admission, and the wrong medications were ordered and administered to Margaret for three days. Margaret suffered an extension of her hemorrhagic stroke and was transferred to the ICU.

Discussion Questions:

1. What are the facts of this case?

2. Review the quality improvement tools in chapter 7 and select the appropriate one to analyze this problem.

3. What are the top three management issues in this case?

4. What are the legal and ethical obligations a healthcare organization has to its patients and families, and how do they apply to this case?

5. Who should be held responsible for addressing these problems?

6. Which health care facility is responsible for the medication errors? What obligations does the facility have to Margaret? To her family?