Tom’s Tuesday Tech Tip: The Best Defense is to Watch Not Only What You Say – But Where You Say It

This isn’t an official Tech Tip; it’s more of a ramble so I apologize in advance. Those of you who want a Tech Tip can learn about TwitterPeek, probably the most useless handheld device ever. Read this story about TwitterPeek, a device that is designed for Twitter and only Twitter (and maybe email). If you can figure out a reason to carry another device for your legal nurse consulting business let me know. The rest of you please keep reading.

I recently had a minor procedure (it was nothing serious so rest assured the Tuesday Tech Tips will, like an old Timex^® watch, keep on tipping) with a MAC for sedation. For those legal nurse consultants who haven’t been in an OR since they stopped sharpening scalpels on a leather strop, MAC stands for Monitored Anesthesia Care.

With a MAC you’re put, not entirely under, but into a deep and somewhat restless sleep. MACs are used to keep a patient (me) immobile and also used as a supplement to the local anesthesia. I felt no real physical sensations but I did have a modicum of consciousness. Throughout the procedure, I remember drifting in and out of sleep. I also remember, from a distance, various portions of the conversations between the surgeon and the nurses. It was like having a narrated dream. In all honesty, it was probably the most boring conversation I’ve ever eavesdropped on. It was all business (at least the parts I remember).

And that, my CLNC^® amigos, is my point. I don’t know how many of you have been in the OR when they’re cutting people open, strewing blood, organs, limbs and other body parts about, but for those of you who have, you need to remember that sedated patients often do remember things. All sorts of things. My surgical team was as professional as could be. But what about you and yours? Do you make jokes, cut up (not literally), act out or make possible “statements against interest” while in the OR? What about you part-time CLNC^® consultants who are still providing some in-hospital care? Are you careful about what you say in front of a patient or family member? Do you argue with the doctors about the patient’s care within earshot of an “interested party?” Nurse supervisors: have you ever reprimanded someone in front of the patient’s family or just outside the door of a patient’s room?

A defensive strategy for any legal nurse consultant or other nurse who is still spending time inside a hospital (other than as a patient) is to watch what you say no matter where you are. This means in front of the patient (sedated or not), their family, in elevators, hallways and the cafeteria, but also be careful what you say to other staff members. I’m not talking about the HIPAA hippo, I’m talking about playing tic tac toe with Betadine on the patient or making jokes about their appearance, body parts or their procedure and about things that have gone wrong, are going wrong or have been done wrong. Statements against interest can come back to bite not only you but also your facility when someone remembers hearing you say “I thought ‘no pen’ meant to use a pencil on his chart. I never guessed it had to do with his meds.”

I was in good hands, but if something had gone wrong, there’s a good chance I would have remembered it. One “oops” from the doc or one bad joke at my expense and my somewhat cloudy attention would have been clearly focused. Be careful what you say and where you say it. When in doubt don’t say nuthin’ to nobody.

As a Certified Legal Nurse Consultant preparing a case report, you know to always ask, not only the patient what they remember during the surgery, but also what the family members and visitors heard the nurses and docs discussing around the time of the incident. There’s always a lot to be learned from the idle conversations that take place on a unit.

Until next Tuesday, keep on techin’,

Tom