Treatment Injury and Falls. John Lowe ACC & Eligibility Team GNB Level 7 CCDHB
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1 Treatment Injury and Falls John Lowe ACC & Eligibility Team GNB Level 7 CCDHB John.lowe@ccdhb.org.nz
2 Treatment Injury and Learning objectives Falls 1.Nurses can and should lodge ACC claims 2.Lodging ACC claims is straightforward 3.There is a significant benefit to your patient when you lodge an ACC claim
3 Purpose To ensure our patients are given the opportunity to access ACC support and entitlements in the event of a personal injury.
4 Treatment Injury and Falls 1. What is a Treatment Injury? 2. When to lodge a Treatment Injury 3. Why lodge a Treatment Injury? 4. How to lodge a Treatment Injury
5 What is Treatment Injury? Medical Misadventure?
6 What is Treatment Injury? Section 32 of the Accident Compensation Act 2001 Treatment injury means: a personal injury suffered by a person seeking or receiving treatment from a registered health professional; and Is caused by treatment; and Is not a necessary part nor ordinary consequence of that treatment.
7 What is Treatment Injury? Personal Injury = actual bodily damage or harm. Symptoms alone are not sufficient. Treatment = giving of treatment, diagnosis, treatment decision, failure to treat, provision of prophylaxis, equipment failure, application of health care support systems (policies, administrative systems etc) Necessary part = A necessary injury as part of the treatment is not a treatment injury (Eg. surgical incision) Ordinary consequence of treatment = if the injury was of a high risk of occurring then it may be seen as being an ordinary consequence of treatment and declined as such.
8 What is Treatment Injury? Key points: A treatment injury is a personal injury caused by treatment. Even though an injury is a known risk of that treatment it is still a treatment injury There does not have to be any fault in the treatment provided no fault scheme.
9 Why lodge an ACC Treatment Injury? Greatly increased ACC entitlement and support for our patients Impact on clinical decisions Increased revenue
10 Patient Entitlements Weekly compensation Lump sum entitlements Home help Childcare Transport costs Treatment costs Funeral grants And lots more...
11 When to lodge a claim?
12 Case study 1 78yo female admitted with confusion. History of LRTI, adrenal insufficiency on steroid therapy, stage 4 ovarian cancer and bony metastatic disease Mobilising to bathroom with assistance from RN, tripped over walking frame and fell against bed resulting in a 5x2cm skin tear to her left forearm Required district nurses for 6/52 post discharge Developed wound infection requiring GP visit and further district nursing input.
13 Case study 1 No claim lodged = Impact on DHB: Lost revenue for community nursing $1,200 Impact on the patient denied access to ACC support for the following: Transport costs Treatment costs (GP visits)
14 Case study 2 83yo female admitted with confusion secondary to UTI. History of AF on Warfarin, previous TIA and hypertension. Patient unable to find call bell so mobilised herself to toilet Patient fell onto her sacrum in bathroom Noted to have increasingly reduced sensation and weakness in both legs following fall.
15 Case study 2 MRI showed T7/8 haematoma with cord compression and myelopathy T4 to T7 Patient unable to move or feel legs. Flaccid paralysis with 0/5 power bilaterally Transferred to Burwood Hospital for rehabilitation. ACC Treatment Injury claim lodged Access to significant support from ACC established promptly
16 Case study 2 Support and entitlement available: Lump sum Accommodation costs for family/support person Travel costs Home help Personal cares House alterations/equipment And lots more...
17 How to lodge a Treatment Injury claim 1. Complete an ACC45/ACC46 injury lodgement form 2. Get the patient to sign the ACC45/ACC46 (next of kin if patient is unable) 3. Complete an ACC2152 Treatment Injury specific lodgement form 4. Send both forms to John Lowe, ACC & Eligibility Team, Level 7 GNB, Wellington hospital or Treatment.injury@ccdhb.org.nz
18 ACC46 form If you are not sure of the correct code then ensure you write a decent description of the injury being claim for. If your patient needs time off work then a doctor or nurse practitioner needs to complete the form Patient or NoK must sign here. If unavailable then sign on patient s behalf (must document) CCDHB provider number T95743 Nurses can sign this section
19 ACC2152 form
20 Questions? John Lowe DD Ext
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