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LNCtips.com: 4 Wrongs, 4 Fixes

Four wrongs: wrong dates, wrong times, wrong caregivers, wrong information.  What am I talking about?  I'm referring to some seriously bad medical chronologies that I inherited from another law firm.  The law firm transferred several cases to the firm where I work and the medical chronologies were part of that transfer.  Let's look at that LNC's mistakes, and four fixes you can use to prevent such mistakes from happening to you.

Let me give you a little background information about the medical chronologies.  I received them on a disk in CaseMap format. I also received the medical records linked to each chronology.  Because of that, I was able to glean more information from the chronologies than I could have with chronologies created in Microsoft Word.  For example, I could tell the dates that the LNC typed her entries and which records she reviewed for each line of information. Here are a few of the problems I saw.

One chronology involved an infant born in 2008.  The LNC dated two entries in 2007, months before the child's birth.  She also entered the wrong times in many entries.  For example, this child's birth occurred at noon.  However, she entered the child's newborn assessments at 6 a.m. and 10 a.m., which were before he was born. 

The LNC didn't recognize that some dates in the medical record were erroneous.  For example, one caregiver misdated her entries, a relatively common occurrence with handwritten documentation.  The LNC copied the nurse's mistake and wrote the wrong date too.

The LNC consistently entered the wrong date for night shift entries on flow sheets and medication administration records (MARs).  She apparently didn't realize that documentation for some flow sheets and MARs starts at 7 a.m. one day and ends at 6:59 a.m. the next.

She dated her entries for pathology reports one to three days later than they should have been. That's because she documented the date the lab received the specimens, not the date of specimen collection.

She made numerous duplicate entries.  I was able to determine that the LNC entered the duplicate entries on different days, sometimes months apart, from different sets of medical records.

Some of the duplicate entries listed a caregiver name in one and a different caregiver name in the other.

On a few dates, the LNC listed times for some of her entries but didn't list times for others. The mix of timed and untimed entries creates a problem in CaseMap and Microsoft Word.  When refreshed in CaseMap or sorted in Word, these programs list untimed entries of the same date prior to timed entries as shown below.  Because of this, the refreshed / sorted entries could get out of order.

CaseMap Example

It's easy to make such mistakes when you're entering tons of information into medical chronologies.  However, it's also easy to prevent and fix mistakes by following these four steps.

First, use your judgment.  If something looks out of place, it probably IS out of place.  For example, the LNC who generated the original chronology knew that the misdated entries looked abnormal - she wrote comments that the dates didn't make sense.  If she had used her judgment, she would have learned why the entries looked unusual and corrected them

Second, proofread your chronology before finalizing it.  Proofreading involves reading the chronology to detect errors in spelling, dates, times, and information.  For example, the LNC would have known immediately that she had entered information before the infant's birth if she had proofread the chronology.  With proofreading, she would also have detected duplicate entries and wrong caregiver names.

Third, use standard methods for dating and timing certain types of reports.  For lab reports, use the time of collection even though caregivers won't know the results for hours or days after the collection.  If the time or date of receipt of lab results, such as blood cultures, is important to the case, add a notation to that effect in the chronology.  If radiographs are critical to the case, use the times imprinted on the films. Otherwise, using the time of dictation for radiographs is usually sufficient.

Finally, use "anchors" to sort the chronology correctly.  An anchor is my term for a known event.  In the chronology above, the operative report, generated at 10:10 a.m., is the anchor.  It seems apparent in the chronology sample that the patient came into the ER first and then went to surgery.  During surgery, he had a biopsy. Therefore, the order of the three notations should be ER Records, Operative Report, and then Surgical Pathology Report.

A medical chronology with wrong information is a jumbled mess.  By using these four fixes, your medical chronologies will never be wrong again.

Want to learn more about LNC skills for legal nurse consultants? Check out the Archives.

...Katy Jones