Transcript Slide 1
IV Medicine Administration Legal and Professional Issues September 2009 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 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 capacity to consent is assumed unless there is evidence to the contrary. • No adult can validly give consent for another adult unless legally authorised to do so - Adults with Incapacity Act (2000) • It is not necessary to document consent to routine and low-risk procedures e.g. taking a blood sample. • However, 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 2008 • Scotland 10% of register but account for only 8% of complaints • 1,487 complaints received 2008 8.4% - Employer 53% - Public 9% - Police 29% • Closed – 35% cases • Referred to conduct & competence committee - 441 (16%) cases NMC • Maladministration of medicines represent 9.9% of all cases (3rd most common) • Most common allegation is Dishonesty • Other allegations include: • • • • • 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 482 cases heard • Strike name off register (44%) • Caution 1-5 yrs (19%) • No action taken (7%) • Conditions of practise >3yrs (1%) • Suspend registration >1yr (6%) 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.