responses- form for check socket home trial
Joan Cestaro
Description
Collection
Title:
responses- form for check socket home trial
Creator:
Joan Cestaro
Date:
1/31/2008
Text:
A few days ago, I posted a question asking for suggestions/advice on a form
that could be used for patients using a check socket for a home trial.
Although I did not know it at the time of my posting, our facility stopped
using this practice over a year ago. The recent home trial events that I
caught during routine file audits were conducted by a fairly new
practitioner to our facility and have now been stopped. Basically, the same
question I posed to the list was presented to our attorney (specializing in
healthcare) a year ago. His advice mirrored many of the responses posted
here. The benefits simply do not outweigh the high risk potential. The
cost difference between fabricating a check socket and a additional trial
definitive socket (for those few, rare cases) were not financially
substantial. What was most surprising about my responses were the high
number of individuals who use this check socket with fiberglass home trial
practice regularly. Perhaps this post will allow further consideration as
to the risk/benefit pendulum for all facilities.
Thank you to all who responded. I cannot post ALL of the overwhelming
number of responses, but will provide a summary.
Joan Cestaro, C.P.
RPI- Winchester, VA
I have been sending some patients home w/ check sockets as well, and seem to
be doing it more and more as it is common place in our practice. I follow
the same procedures you mentioned as far as reinforcing the socket, etc.
While I don't have a waiver form, I do have the patient sign our standard
Acknowledgement of Delivery, with the notation that this is a temporary
trial socket only. I also include the wearing schedule, any restrictions,
and when they are returning. I would be very interested in any info you
collect on this subject.
From what I've been told, if you have someone sign a waver, you are already
admitting that there is possibe flaw in the item. I dont know if this is
true, but I heard this when we had similiar situations arise. No matter how
well you think you cover yourself, people can and will sue for any reason
I have a blank special instructions form that I leave in my parallel bar
room. I hand write a bullet list of precautions as I verbally discuss them
with the pt. The pt signs this and they take a copy home w/them; original
is in their chart.
I tried printing up a standard form, but I run into so many things that I
want to say that are particular to each person/scenerio....that I end up
writing things down anyway.
Joan, it would be advisable to have an educational/instruction sheet given
to the patient and have them sign a form that they received the special
instructions for this special situation. (I would have the patient and a
family member sign the form.) Based on my experiences in expert
witnessing/consulting, the more education given to the patient, the safer
the practitioner and less problems arise.
Let me first say that the risk you take is the risk you might have to pay
for. Check sockets wrap in fiberglass or other resin sealing systems are
still a high risk for your facility to take. If the fit is so difficult it
is usually better to fall on the side of caution and just as easy to
fabricate a polypro socket and incorporate a proper attachment plate. The
use of parts on hand is not a problem as long as they are in proper working
order,but if I'm doing a new prosthesis and I'm working with a check socket
I would probably setup the socket on the new foot. The real risk is the fact
that the patient, even if he signs a waiver can still sue you. From the
legal stand point its a bad idea to let check sockets out of your office or
a totally controlled environment.
I also suggest that you speak to your attorney if you are going to use the
waiver because each state has different rules concerning waiver of legal
rights.
My family is in the insurance business, and what you want to look into is a
hold harmless agreement. This way, even if you have a problem that the
facility might take some responsibility for, the patient promises to hold
your facility harmless.
__________________________
We call that Dynamic Trial Fit, and we do that all the time. It depends how
you word what you are doing, having someone to sign a waiver I think raises
a red flag. Asking if the patient wants to take it home to give the socket
a good trial of wearing, so that the patient can come back and give us input
to improve the fit, and the patient OK's before finishing. Even when I tell
them that I cannot guarantee anything, I have yet to have a person not want
to the DTF. I have not been sued.
One last point is that I do not like Attorney's running our world!!
The only Waiver Form that I ever sign is to USHGA to get insurance to Hang
Glide. So I am someone that is out of the box, but after you pay attorney's
fees, extra staff time to control records, and clinician time to explain and
getting someone to sign, even if I had a leg brake I would still be ahead.
32years and I'm happy with my practice.
We don't have a form but when I send a patient home on a check socket I use
the OB Thermolyn Steif. I also use this plastic when walking patients over
250#. I have had 400 pounders on this stuff without it breaking.
If the patient doesn't break the test socket in the first place we are less
likely to be sued. It is my understanding that no matter what a patient
signs we are liable. This issue came up when I had a patient over the weight
limit of a particular component and I was hoping to get a waiver signed to
avoid liability
Unless your patient signs the form in front of his/her attorney, after
his/her attorney has read the form, it will offer you little or no
protection. If the patient signs the form without consulting his attorney
first, the signed form might intimidate him/her enough not to seek the
advise of an attorney after he/she fell, but I doubt it. A form signed by
the patient without legal advise might also serve to sway a smaller verdict
or settlement.
Personally, I think your playing Russian Roulette. You're providing a
service that you're probably not being reimbursed for and you're adding a
huge risk. Yes, the patient stands to benefit, but at the risk of a fall.
For you, there is some benefit in maintaining a happy patient, but the
financial risk is also very high. You're probably covered for the fall
damages by your liability insurance. But who pays for the higher premiums
that you'll be charged for a number of years if a lawsuit occurs?
Another thought is to ask your liability insurer's advise.
In such instances I have the patient sign my usual delivery acknowledgement
form with added simple wording pertaining to the risks etc. However, it is
my strong opinion that no form of such sort will help you avoid a legal
action should an accident occur because the delivery of an unfinished device
DOES put the patient in the position of an increased UNNECESSARY risk as
compared, for example, with a situation when you deliver a prosthesis to a
$500 lbs person and there are NO components that can withstand such weight.
The latter is done with the patient's consent and is necessitated by the
state of prosthetics, not by prosthetist's desire to make his/her life
easier or spend less money on fabrication. At a court hearing the question
will be asked if you could have fabricated a stronger socket. And the answer
will be YES. Then they will ask why it was not done and here you will bring
in the money issue, which will ruin your case. This is just my opinion. Good
luck.
You should use Otto Bock Thermolyn stiff material for these situations as
the material is designed for this purpose. Good for about six months or
less. It is very tough and will not crack if a 12mm -15mm material thickness
is used. It is entirely suitable for AK sockets as well. It does not need
the addition of fiberglass wrapping. You may still choose to do this until
you find your comfort level. It is commonly used at Walter Reed and many
other facilities as well.
that could be used for patients using a check socket for a home trial.
Although I did not know it at the time of my posting, our facility stopped
using this practice over a year ago. The recent home trial events that I
caught during routine file audits were conducted by a fairly new
practitioner to our facility and have now been stopped. Basically, the same
question I posed to the list was presented to our attorney (specializing in
healthcare) a year ago. His advice mirrored many of the responses posted
here. The benefits simply do not outweigh the high risk potential. The
cost difference between fabricating a check socket and a additional trial
definitive socket (for those few, rare cases) were not financially
substantial. What was most surprising about my responses were the high
number of individuals who use this check socket with fiberglass home trial
practice regularly. Perhaps this post will allow further consideration as
to the risk/benefit pendulum for all facilities.
Thank you to all who responded. I cannot post ALL of the overwhelming
number of responses, but will provide a summary.
Joan Cestaro, C.P.
RPI- Winchester, VA
I have been sending some patients home w/ check sockets as well, and seem to
be doing it more and more as it is common place in our practice. I follow
the same procedures you mentioned as far as reinforcing the socket, etc.
While I don't have a waiver form, I do have the patient sign our standard
Acknowledgement of Delivery, with the notation that this is a temporary
trial socket only. I also include the wearing schedule, any restrictions,
and when they are returning. I would be very interested in any info you
collect on this subject.
From what I've been told, if you have someone sign a waver, you are already
admitting that there is possibe flaw in the item. I dont know if this is
true, but I heard this when we had similiar situations arise. No matter how
well you think you cover yourself, people can and will sue for any reason
I have a blank special instructions form that I leave in my parallel bar
room. I hand write a bullet list of precautions as I verbally discuss them
with the pt. The pt signs this and they take a copy home w/them; original
is in their chart.
I tried printing up a standard form, but I run into so many things that I
want to say that are particular to each person/scenerio....that I end up
writing things down anyway.
Joan, it would be advisable to have an educational/instruction sheet given
to the patient and have them sign a form that they received the special
instructions for this special situation. (I would have the patient and a
family member sign the form.) Based on my experiences in expert
witnessing/consulting, the more education given to the patient, the safer
the practitioner and less problems arise.
Let me first say that the risk you take is the risk you might have to pay
for. Check sockets wrap in fiberglass or other resin sealing systems are
still a high risk for your facility to take. If the fit is so difficult it
is usually better to fall on the side of caution and just as easy to
fabricate a polypro socket and incorporate a proper attachment plate. The
use of parts on hand is not a problem as long as they are in proper working
order,but if I'm doing a new prosthesis and I'm working with a check socket
I would probably setup the socket on the new foot. The real risk is the fact
that the patient, even if he signs a waiver can still sue you. From the
legal stand point its a bad idea to let check sockets out of your office or
a totally controlled environment.
I also suggest that you speak to your attorney if you are going to use the
waiver because each state has different rules concerning waiver of legal
rights.
My family is in the insurance business, and what you want to look into is a
hold harmless agreement. This way, even if you have a problem that the
facility might take some responsibility for, the patient promises to hold
your facility harmless.
__________________________
We call that Dynamic Trial Fit, and we do that all the time. It depends how
you word what you are doing, having someone to sign a waiver I think raises
a red flag. Asking if the patient wants to take it home to give the socket
a good trial of wearing, so that the patient can come back and give us input
to improve the fit, and the patient OK's before finishing. Even when I tell
them that I cannot guarantee anything, I have yet to have a person not want
to the DTF. I have not been sued.
One last point is that I do not like Attorney's running our world!!
The only Waiver Form that I ever sign is to USHGA to get insurance to Hang
Glide. So I am someone that is out of the box, but after you pay attorney's
fees, extra staff time to control records, and clinician time to explain and
getting someone to sign, even if I had a leg brake I would still be ahead.
32years and I'm happy with my practice.
We don't have a form but when I send a patient home on a check socket I use
the OB Thermolyn Steif. I also use this plastic when walking patients over
250#. I have had 400 pounders on this stuff without it breaking.
If the patient doesn't break the test socket in the first place we are less
likely to be sued. It is my understanding that no matter what a patient
signs we are liable. This issue came up when I had a patient over the weight
limit of a particular component and I was hoping to get a waiver signed to
avoid liability
Unless your patient signs the form in front of his/her attorney, after
his/her attorney has read the form, it will offer you little or no
protection. If the patient signs the form without consulting his attorney
first, the signed form might intimidate him/her enough not to seek the
advise of an attorney after he/she fell, but I doubt it. A form signed by
the patient without legal advise might also serve to sway a smaller verdict
or settlement.
Personally, I think your playing Russian Roulette. You're providing a
service that you're probably not being reimbursed for and you're adding a
huge risk. Yes, the patient stands to benefit, but at the risk of a fall.
For you, there is some benefit in maintaining a happy patient, but the
financial risk is also very high. You're probably covered for the fall
damages by your liability insurance. But who pays for the higher premiums
that you'll be charged for a number of years if a lawsuit occurs?
Another thought is to ask your liability insurer's advise.
In such instances I have the patient sign my usual delivery acknowledgement
form with added simple wording pertaining to the risks etc. However, it is
my strong opinion that no form of such sort will help you avoid a legal
action should an accident occur because the delivery of an unfinished device
DOES put the patient in the position of an increased UNNECESSARY risk as
compared, for example, with a situation when you deliver a prosthesis to a
$500 lbs person and there are NO components that can withstand such weight.
The latter is done with the patient's consent and is necessitated by the
state of prosthetics, not by prosthetist's desire to make his/her life
easier or spend less money on fabrication. At a court hearing the question
will be asked if you could have fabricated a stronger socket. And the answer
will be YES. Then they will ask why it was not done and here you will bring
in the money issue, which will ruin your case. This is just my opinion. Good
luck.
You should use Otto Bock Thermolyn stiff material for these situations as
the material is designed for this purpose. Good for about six months or
less. It is very tough and will not crack if a 12mm -15mm material thickness
is used. It is entirely suitable for AK sockets as well. It does not need
the addition of fiberglass wrapping. You may still choose to do this until
you find your comfort level. It is commonly used at Walter Reed and many
other facilities as well.
Citation
Joan Cestaro, “responses- form for check socket home trial,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/228954.
