What a nursing review usually focuses on

Monitoring, medication administration, and fall prevention. A case review should reconstruct the sequence of assessment, medication administration, risk prevention, monitoring, and escalation to providers from the records available at each decision point.

Five decision points to map

  • 1. Assessment
  • 2. Medication administration
  • 3. Risk prevention
  • 4. Monitoring
  • 5. Escalation to providers

Records that can answer those questions

  • Nursing consultation, procedure, or encounter notes
  • Orders and test results used to make the clinical decision
  • Medication, monitoring, procedure, or nursing records tied to the event
  • Communication with the patient and other specialties
  • Later treatment showing the complication, corrected diagnosis, or outcome

Expert and causation questions

  • What training and specialty should the reviewing nursing expert have under state law?
  • Which of the key decision points in monitoring, medication administration, and fall prevention is actually being challenged?
  • What information was available at that time, not only in hindsight?
  • What part of the later harm is attributable to the underlying illness or known risk?
  • Would a different medical decision probably have changed treatment or outcome?

Related specialties

Use licensing, records, and medical-information sources appropriate to the specialty.