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Nurse Case Manager Chronicles

Making the Connection: One Nurse Stops Tragedy by Solving a Medical Mystery

Quick-thinking nurse case managers solve a medical mystery and save a man’s life.
By: | November 1, 2017 • 5 min read

Although it’s rare, there are times when a seemingly simple injury can turn catastrophic in the blink of an eye. When it happens, nurse case managers can find themselves in a race against the clock, with a worker’s life hanging in the balance.

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Delainne Bond and her colleague found themselves in exactly that position when a scratch almost became the cause of a workplace fatality.

A worker lost his grip and fell when riding on the back of a truck. The truck was going less than 10 miles per hour and the fall was around four feet. The worker incurred a small scratch on his cheek and a chipped tooth — nothing that would be considered severe. The man was treated at an urgent care facility.

“This worker didn’t work in what we would call a ‘medically clean’ environment,” explained Bond, a registered nurse and certified case manager. So the medical professionals on staff gave him an antibiotic to prevent any infection from the scratch. They told him to follow up with his dentist about the chipped tooth.

Overnight, the worker’s face and body broke out in a rash. He went to the hospital, but after seven and a half hours of waiting, he left without medical attention. The next day, he followed up with urgent care, where he learned he should be admitted to the hospital.

Delainne Bond, national catastrophic program manager and national crisis intervention coordinator, Genex Services

Unfortunately, the worker didn’t think the rash was as bad as the doctors said and insisted on going home. By day five, the rash took a grim turn, bordering on catastrophe.

“He was super sick. He went to a local community hospital, one that didn’t have a lot of resources,” said Bond, who has 11 years’ experience working in case managing. She is the national catastrophic program manager and the national crisis intervention coordinator at Genex Services, which specializes in medical management.

“They got him on an IV, but the staff was unsure of what was going on with him.”

One of Bond’s nurse case managers was there. Even without knowing the exact diagnosis, she knew the man wasn’t receiving the proper care for his illness.

Using her network of medical professionals, said Bond, the nurse contacted the right doctor for the job. He came in and assessed the situation. He confirmed that the rash was a rare reaction — called Stevens-Johnson Syndrome — to the antibiotic the patient took.

“You don’t come into this job and expect to be saving peoples’ lives, but it happens.” — Delainne Bond, national catastrophic program manager and national crisis intervention coordinator, Genex Services

Stevens-Johnson Syndrome is a serious skin disorder that oftentimes begins with flu-like symptoms followed by a painful reddish-purple rash that spreads and blisters.

The injured worker needed to see a burn specialist, the doctor concluded. The rash blistered into his mouth, lining his digestive tract and had spread across his body and face. He no longer talked, ate or used the restroom without assistance. He faced a 70 percent mortality risk.

“By comparison,” Bond said, “hospitals consider three percent mortality risk to be unacceptable.”

Now, Bond was on the job. No stranger to intense scenarios, she oversees some of the “worst-case” injuries employees face. Amputees, motor vehicle accidents, burn cases and the like are escalated to her.

She met with the employer, carrier, lawyers and company executives to explain the severity of the situation. Those present unanimously agreed to air-lift the patient from the local hospital to a burn facility.

“A hospital-to-hospital transfer can take one to two days, or even more, to obtain authorizations and contracts with the air-lift and ambulance agencies and establish doctor-to-doctor communication,” explained Bond. Her team moved the worker within four hours.

Finally connected with the right level of care, the man made an instantaneous recovery. He was discharged 36 hours after being transferred.

Crisis Care Saves Lives, and More

“If we didn’t have that case manager on site, if she hadn’t had analyzed him and knew to bring me onto the case, and if I didn’t know where the right resources were … ” Bond began. “You don’t come into this job and expect to be saving peoples’ lives, but it happens.”

Bond’s depth of experience allows her to spot issues that might otherwise be overlooked. Clients rely on her ability to glance at a file and know what to do and what resources to tap into.

In another case that Bond worked on, a truck driver broke his neck and skull during an accident. After a few days in the hospital, the man slipped into a coma. The hospital staff thought it was related to his brain injury, but upon reviewing his chart, Bond determined it was a diabetes crisis issue.

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The truck driver received insulin, and the case manager proved that the diabetic crisis caused the accident, saving the employer’s insurance roughly $175,000 in medical bills.

“The biggest challenge is getting in there and making everybody feel like it’s going to be okay,” Bond said. “The injured worker is feeling panic. The employer is facing their own pressures, like keeping their workforce on task, while dealing with OSHA. Carriers have to analyze the injury, make sure it’s compensable. For people coming from a non-medical background, it’s easy for them to not know what’s going on.”

This is when a case manager steps in, calming the patient, setting up proper appointments and explaining the situation to employers and carriers.

“A lot of employers, and even a lot of nurses, don’t really know what case management is or what it entails,” said Bond. “Every day is new. Every case is unique. I’m still learning new things even after all these years.”

The case manager role removes barriers that might be in the way of recovery — a position that Bond said can be just as rewarding as it is challenging.

“I want to see the profession utilized more,” she said. “Case managers are very effective in minimizing injury and reducing risk.” &

Autumn Heisler is digital producer and staff writer at Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Report: Manufacturing

More Robots Enter Into Manufacturing Industry

With more jobs utilizing technology advancements, manufacturing turns to cobots to help ease talent gaps.
By: | May 1, 2018 • 6 min read

The U.S. manufacturing industry is at a crossroads.

Faced with a shortfall of as many as two million workers between now and 2025, the sector needs to either reinvent itself by making it a more attractive career choice for college and high school graduates or face extinction. It also needs to shed its image as a dull, unfashionable place to work, where employees are stuck in dead-end repetitive jobs.

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Added to that are the multiple risks caused by the increasing use of automation, sensors and collaborative robots (cobots) in the manufacturing process, including product defects and worker injuries. That’s not to mention the increased exposure to cyber attacks as manufacturers and their facilities become more globally interconnected through the use of smart technology.

If the industry wishes to continue to move forward at its current rapid pace, then manufacturers need to work with schools, governments and the community to provide educational outreach and apprenticeship programs. They must change the perception of the industry and attract new talent. They also need to understand and to mitigate the risks presented by the increased use of technology in the manufacturing process.

“Loss of knowledge due to movement of experienced workers, negative perception of the manufacturing industry and shortages of STEM (science, technology, engineering and math) and skilled production workers are driving the talent gap,” said Ben Dollar, principal, Deloitte Consulting.

“The risks associated with this are broad and span the entire value chain — [including]  limitations to innovation, product development, meeting production goals, developing suppliers, meeting customer demand and quality.”

The Talent Gap

Manufacturing companies are rapidly expanding. With too few skilled workers coming in to fill newly created positions, the talent gap is widening. That has been exacerbated by the gradual drain of knowledge and expertise as baby boomers retire and a decline in technical education programs in public high schools.

Ben Dollar, principal, Deloitte Consulting

“Most of the millennials want to work for an Amazon, Google or Yahoo, because they seem like fun places to work and there’s a real sense of community involvement,” said Dan Holden, manager of corporate risk and insurance, Daimler Trucks North America. “In contrast, the manufacturing industry represents the ‘old school’ where your father and grandfather used to work.

“But nothing could be further from the truth: We offer almost limitless opportunities in engineering and IT, working in fields such as electric cars and autonomous driving.”

To dispel this myth, Holden said Daimler’s Educational Outreach Program assists qualified organizations that support public high school educational programs in STEM, CTE (career technical education) and skilled trades’ career development.

It also runs weeklong technology schools in its manufacturing facilities to encourage students to consider manufacturing as a vocation, he said.

“It’s all essentially a way of introducing ourselves to the younger generation and to present them with an alternative and rewarding career choice,” he said. “It also gives us the opportunity to get across the message that just because we make heavy duty equipment doesn’t mean we can’t be a fun and educational place to work.”

Rise of the Cobot

Automation undoubtedly helps manufacturers increase output and improve efficiency by streamlining production lines. But it’s fraught with its own set of risks, including technical failure, a compromised manufacturing process or worse — shutting down entire assembly lines.

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More technologically advanced machines also require more skilled workers to operate and maintain them. Their absence can in turn hinder the development of new manufacturing products and processes.

Christina Villena, vice president of risk solutions, The Hanover Insurance Group, said the main risk of using cobots is bodily injury to their human coworkers. These cobots are robots that share a physical workspace and interact with humans. To overcome the problem of potential injury, Villena said, cobots are placed in safety cages or use force-limited technology to prevent hazardous contact.

“With advancements in technology, such as the Cloud, there are going to be a host of cyber and other risks associated with them.” — David Carlson, U.S. manufacturing and automobile practice leader, Marsh

“Technology must be in place to prevent cobots from exerting excessive force against a human or exposing them to hazardous tools or chemicals,” she said. “Traditional robots operate within a safety cage to prevent dangerous contact. Failure or absence of these guards has led to injuries and even fatalities.”

The increasing use of interconnected devices and the Cloud to control and collect data from industrial control systems can also leave manufacturers exposed to hacking, said David Carlson, Marsh’s U.S. manufacturing and automobile practice leader. Given the relatively new nature of cyber as a risk, however, he said coverage is still a gray area that must be assessed further.

“With advancements in technology, such as the Cloud, there are going to be a host of cyber and other risks associated with them,” he said. “Therefore, companies need to think beyond the traditional risks, such as workers’ compensation and product liability.”

Another threat, said Bill Spiers, vice president, risk control consulting practice leader, Lockton Companies, is any malfunction of the software used to operate cobots. Then there is the machine not being able to cope with the increased workload when production is ramped up, he said.

“If your software goes wrong, it can stop the machine working or indeed the whole manufacturing process,” he said. “[Or] you might have a worker who is paid by how much they can produce in an hour who decides to turn up the dial, causing the machine to go into overdrive and malfunction.”

Potential Solutions

Spiers said risk managers need to produce a heatmap of their potential exposures in the workplace attached to the use of cobots in the manufacturing process, including safety and business interruption. This can also extend to cyber liability, he said.

“You need to understand the risk, if it’s controllable and, indeed, if it’s insurable,” he said. “By carrying out a full risk assessment, you can determine all of the relevant issues and prioritize them accordingly.”

By using collective learning to understand these issues, Joseph Mayo, president, JW Mayo Consulting, said companies can improve their safety and manufacturing processes.

“Companies need to work collaboratively as an industry to understand this new technology and the problems associated with it.” — Joseph Mayo, president, JW Mayo Consulting

“Companies need to work collaboratively as an industry to understand this new technology and the problems associated with it,” Mayo said. “They can also use detective controls to anticipate these issues and react accordingly by ensuring they have the appropriate controls and coverage in place to deal with them.”

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Manufacturing risks today extend beyond traditional coverage, like workers’ compensation, property, equipment breakdown, automobile, general liability and business interruption, to new risks, such as cyber liability.

It’s key to use a specialized broker and carrier with extensive knowledge and experience of the industry’s unique risks.

Stacie Graham, senior vice president and general manager, Liberty Mutual’s national insurance central division, said there are five key steps companies need to take to protect themselves and their employees against these risks. They include teaching them how to use the equipment properly, maintaining the same high quality of product and having a back-up location, as well as having the right contractual insurance policy language in place and plugging any potential coverage gaps.

“Risk managers need to work closely with their broker and carrier to make sure that they have the right contractual controls in place,” she said. “Secondly, they need to carry out on-site visits to make sure that they have the right safety practices and to identify the potential claims that they need to mitigate against.” &

Alex Wright is a U.K.-based business journalist, who previously was deputy business editor at The Royal Gazette in Bermuda. You can reach him at [email protected]