Transcript Legal Issues in Role Expansion

IV MEDICINE ADMINISTRATION
Legal and Professional Issues
Why expand roles?
• Clinical need
• Nurses CAN - The NMC supports this
growth in expertise
• Legislation supports this development
• Reduction in junior doctors working hours
• Ultimately it will benefit the patient
Four Arenas of Accountability
To the public
To the patient
To the employer
To the profession
Code of Conduct
• New Code launched
1st May 2008
• Competency
• Consent
• Delegation
The Code:
Standards of conduct,
performance and
ethics for nurses
and midwives
PICTURE AWAITED
Competency
• Recognise & work within the
limits of your competence
• You must have the
knowledge & skills for safe
& effective practice when
working without direct
supervision
Consent
• All individuals (adults aged 16 & over and
children/young people who can give valid
consent), with decision-making capacity, have a
fundamental legal and ethical right to determine
what happens to their own bodies
• No adult can validly give consent for another adult
unless legally authorised to do so.
• It is not usually necessary to document a patient’s
consent to routine and low-risk procedures,.
However, if the consent may be disputed later, or
if the procedure is of particular concern to the
patient it would be helpful to do so.
Delegation
• You must establish that anyone you delegate to
is able to carry out your instructions
• You must confirm that the outcome of any
delegated task meets the required standards
• You must make sure that everyone you are
responsible for is supervised and supported
Case Study
• Patient A had a urinary catheter in situ which
was draining well, it was not felt that intake and
output required monitoring
• The task of washing Patient A was delegated to
HCSW who did this everyday for 4 days
• Patient A became very unwell - PTE
• Further investigation – distended abdomen 4 L
urine drained. Swollen bladder pressing on her
iliac arteries which caused DVT which lead to
PTE
• Patient A later died as a result of PTE
Law & Nursing
• 2 Types of Law:
– Criminal Law
(Public)
– Civil Law
(Patient)
Negligence – Elements
• For this action to be successful, 3 criteria
must be established
– A duty of care is owed by the defendant to the
plaintiff
– There is a breach in the standard of the duty of care
owed
– This breach caused reasonably foreseeable harm.
Misconduct
• 686,886 nurses on the register 2007
• Scotland 10% of register but account for
only 6% of complaints
• 1,624 complaints received 2007  17.8%
- Employer 50%
- Public 15%
- Police 23%
• Closed - 808 cases
• Referred to conduct & competence
committee - 315 cases
NMC
• Maladministration of medicines represent
10.5% of all cases (3rd most common)
• Most common allegation is Dishonesty
• Other allegations include:
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Patient abuse
Neglect of basic care / Unsafe clinical practice
Failure to maintain adequate records
Colleague abuse
Failing to report incidents / act in an emergency
Example Case
• Failed to attach an additive label to infusion of
antibiotics
• Administered IV therapy to patient with no
evidence of competency in IV Drug
administration
• Hung bag of Vancomycin & failed to connect
infusion but signed to say it had been given
• On the label of the bag of Vancomycin recorded
patients name as Mary no other details
Example Case
• On 8 October 2004, administered a
Patient Controlled Analgesia infusion of
morphine to Patient A which had expired
• On 8 April 2005, administered Vancomycin
to Patient C by way of a bolus injection
when it should have been administered as
an intermittent infusion
Conduct & Competency
Committee
Stages:
I. Are the facts alleged proved?
II. Is it misconduct?
III. What is known about the practitioner’s
previous history and in mitigation?
Conduct & Competency
Committee Outcomes
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Strike name off register (52%)
Caution 1-5 yrs (12%)
No action taken (9%)
Conditions of practise >3yrs (4%)
Suspend registration >1yr (3%)
Right patient?
• Patient A awakened at 6 am and given
RISEDRONATE 35mg intended for Patient B.
Should have been given ALENDRONATE 70mg
once weekly clearly prescribed on Kardex
Patient B given correct medication
• Wrong patient given OXYNORM as nurse
entered wrong room - patient did not have
wristband on but responded positively to patient
name.
Right rate?
• Patient given FRUSEMIDE over 2-5
hours instead of 6 hours as
prescribed. Pump set incorrectly
(10mls hourly instead of 4mls/hourly
.
as prescribed. One nurse only
checked pump
• 24hr 5FU infusion delivered at
500mls/hr - at least half bag given to
patient before noticed
Right drug?
• SHO prescribed via phone 10 international
units of ACTRAPID Insulin in 50mls of
50% dextrose over 1 hr but sister drew up
50 international units (showed same to
JHO who acknowledged as correct) and
infused into patient.
• GENTAMICIN 175mg IV prescribed and
given 20/1/06 - patient with significant
renal impairment Cr >500 on 21/1/06.
Policies and compatibilities?
• VELOSULIN SYRINGE out of date.
Protocol - change syringes every 24 hrs.
Syringe in question dated 2l/6/06 - today's
date 26/06/06
• Patient allergic to penicillin - given
TAZOCIN IV in error which was meant for
another patient.
Where there is error, Let us bring
truth! ( St Francis)
• Critical incident and near miss reporting
– Learn from our mistakes
• System errors
– Spot procedures that could lead to error
Liability
Each NHS Acute Division
has two forms of liability in
Negligence:
• Direct liability, i.e. the
employer itself is at fault
• Vicarious liability or indirect
liability
The employer will usually
only support the employee if
they have practiced within
local policies and
procedures.