An Analysis of Conjoint Roles in Hospitals: Clinical Forensic Nursing Services in Patient Care Delivery, Quality Management Review, and Oversight Inspection/Investigation

Friday, July 23, 2004
10:00 AM - 10:30 AM
Friday, July 23, 2004
3:00 PM - 3:30 PM

Mary K. Sullivan, MSN, RNC, CARN, Carl T. Hayden VA Medical Center, Department of Veteran's Affairs, Phoenix, AZ, USA, Janet Barber, MSN, RN, USAF, (Ret), Clinical Nurse Consultant, Hill-Rom, Batesville, IN, USA, Bridget Maybury, RN, MSN, ANP, Director's Office, Bronx Veteran's Affair Medical Center, Bronx, NY, USA, and Lynda Olender, RN, ANP, CNAA, Director's Office, Veterans Affair Medical center, Bronx, NY, USA.

Evidence identification, collection and preservation are vitally important to the escalating numbers of forensic investigations inherent within the health care systems. Urgent needs exist in emergency departments, clinics and in-patient areas where nurses are expected to recognize forensic implications within routine patient care scenarios and to possess the expertise to manage and secure the appropriate forensic evidence. The majority of law enforcement and investigative personnel are not trained to navigate a complicated hospital unit, nor do most comprehend the language and social structure within medical facilities. The clinical forensic nurse (CFN) is invaluable, not only for provision of direct patient care delivery, but as an interpreter of scenarios to law enforcement and to hospital administration involved in retrospective quality assurance reviews. Nurses who are facile in the forensic sciences and who maintain current knowledge of the legal and justice systems are becoming the critical link between law enforcement and healthcare practice.

A feasibility study was designed by Veterans Affairs, Office of the Inspector General, to determine synergies of practice between clinical quality management and forensic nursing. This study included 1000 case reviews over an 11-year period of known adverse patient events. Forensic implications emerged prominently including patient abuse or neglect, suicide, assault, homicide, medication delivery system tampering, medication errors, and medical equipment or device tampering. Results showed that recognizing the vital link between forensic nursing and Quality Management may in itself greatly facilitate patient safety.

The CFN is essential not only in front-line patient care delivery in recognizing forensic implications and medical evidence management, but in the after-the-fact root cause analysis of adverse events and as a vital member of any investigation team.