Self, Peer, & Family Member Treatment

SELF, PEER, & FAMILY MEMBER TREATMENT

There are times when employees may feel the need to provide care to family members, or someone with whom they otherwise share a personal relationship that could reasonably impact the care and objectivity of decision making and treatment.  Employees may also feel the need to provide care for a fellow employee, or for themselves.  While employees may have good intentions in these cases, there are quality and safety of care concerns that arise.  In addition, regulatory and licensing requirements also apply, and by potentially violating federal, state, and local statutes, you may place both yourself and Carilion Clinic at risk.

You should only provide treatment to patients who are not family members or close friends. If you are asked to care for a relative or friend, you should decline, unless it is impossible for another provider or employee to perform the task, and the task cannot be delayed. If the patient is an employee, they should not be clocked in at the time the care is provided, and care should never be provided after hours, when a facility is closed.  Although at times it may be convenient, you may not order, initiate, or perform a procedure for yourself, document or change your own medical records, prescribe your own medicine, or request your own refills.Any care you provide should always begin with an order, be within the scope of your practice, and be documented and billed appropriately.

7 KEY QUESTIONS

Before you provide treatment, you should always keep the following seven questions in mind:

1. Is this patient a family member, or someone with whom I share a close relationship?

You should only provide treatment to patients who are not family members or close friends. If you are asked to care for a relative or friend, you should decline, unless it is impossible for another provider or employee to perform the task, and the task cannot be delayed.

2. Am I engaging in self-treatment?

Although at times it may be convenient, you may not order, initiate, or perform a procedure for yourself, document or change your own medical records, or prescribe your own medicine.

3. Am I acting within the scope of my practice?

You should only provide treatment or perform tasks that are within the scope of your job duties and any applicable licensure.

4. Am I following the normal workflow process?

You should only provide treatment during hours your site is open, and the patient should always have an appointment. If the patient also works at your site, they should not be clocked in at the time the care is provided.

5. Is there an order for the care I am providing?

There should always be an order for any treatment provided to a patient to ensure high quality of care, continuity or care, and proper documentation.

6. Am I documenting appropriately?

All treatment must be properly documented to ensure quality of care, risk management, and proper follow-up for the patient.

7. Are we properly charging for the care provided?

Treatment must always be charged and properly billed for the benefit of our patients, and to prevent diversion or improper use of Carilion resources.

 These seven questions are available here in a printable format.

WHO DO THESE RULES APPLY TO?

These rules apply to all employees, including all non-clinical staff, management, and leadership throughout the entire organization. This includes:

• Physicians
• Nurse Practitioners
• Physician’s Assistants
• Clinical Coordinators
• Nurses (LPN & RN)
• Certified Nurses Assistants
• Medical Office Associates
• Technicians
• Administrative Staff

 

WHY ARE THESE ISSUES IMPORTANT?

Improper self, peer, and family member treatment not only place Carilion at risk, but can place our patients, medical staff, other employees, and you at risk as well. These risks include:

• Quality of care, risk management, and liability issues.  In cases of legal action, acting outside your job duties can limit your professional liability coverage.
• Potential disciplinary action by state licensing and regulatory agencies, including the state Board of Medicine.  
• Potential compliance issues with the laws and regulations related to referral sources, such as the Stark Law and anti-kickback statutes.
• HIPAA/patient privacy violations related to record access, especially when accessing and altering your own medical records.
• The appearance of conflicts of interest, or of acting outside recognized professional standards.
• Lack of stewardship, or diversion related to the use of Carilion Clinic resources.
• Disciplinary action by Carilion, up to and including separation from employment.

We understand that, especially in smaller facilities, it may be difficult to rearrange workflow to accommodate these rules.  However, it is necessary to do so in order to ensure safety, consistency, and transparency in providing quality care for our patients.

If you are unsure about what to do in a situation, help is available. Asking a question is always the right thing to do, and discussing the matter with your manager or with the Organizational Integrity and Compliance Department is encouraged.  You can reach the Organizational Integrity and Compliance Department at 540-510-4600, or, if you’d prefer your concern remain anonymous, you can contact our Integrity Help Line at 844-732-6232.