Transcript 02 Legal Issues

Legal Issues of the NP Role
Nursing 870
Who determines the NP Scope of
Practice?
Scope of Practice
• Role provided by SBON and Certifying Bodies
based on education, role (AANP, AACN)
– http://www.aanp.org/about-aanp
• Regulated by the State Board of Nursing (The law,
regulations, “PA Code”)
– May be more limiting
– http://www.pacode.com/secure/data/049/chapter21/
subchapCtoc.html (PA Code)
• Clinical Practice Sites
– May be more restrictive than the law
NP Licensure
• Provided by each State
– Provides the APRN legal scope of practice
– Recognized roles and titles of APRN
– Specific criteria for licensure
– Use certification as entry level competency
assessment
• Licensure considered for public protection
• NP certification required for APRN license in
most states
Legal Aspects of the NP Role
• Determined by each State
• Scope of Practice determined by:
– SBON in most states
– SBON and SBOM in 3 states (VA, NC, SD)
• Prescriptive Authority
– NPs can prescribe independent of physician
collaboration in 15 states
– NPs can prescribe with some degree of physician
collaboration in 34 states
– Limitation of prescribing controlled substances; FL, AL
Legal Aspects : Malpractice
• Malpractice
– The failure of a healthcare professional to exercise
such care as would a reasonable prudent healthcare
professional under the same or similar circumstances
– A type of negligence, where a licensed professional
fails to provide services as per standards set by the
governing body
– A medical professional performs their job in a way
that deviates from the accepted medical standard of
care, causing injury or death.
Components of Malpractice
•
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Duty
Breach of Duty
Proximate Cause
Damages
Duty
• Exists when there is a relationship between
patient and provider
– Includes using standards of care accepted by the
medical community
Breach of Duty
• After this duty of care has been established,
the provider is required to exercise reasonable
care and treat the patient as would other
providers doctors in the field, following
procedures and actions accepted by peers
• Violations of standards of care
Proximate Cause
• The providers actions, or failure to act, results
in harm/injury
Damages
• Permanent or substantial damages occur as a
result of the malpractice
– Placing a value on the harm done to the patient
• Damages might include lost wages and medical bills
• May also include general damages, such as pain and
suffering
Malpractice in Primary Care
• Primarily sued for drug errors and
misdiagnoses
– Diagnoses include cancer, MI, meningitis (BMJ
Quality and Safety, 2013)
– Diagnosis errors cause up to 160,000 death
annually in the US (BMJ Quality and Safety, 2013)
Malpractice in Primary Care
• Common chief complaints that are red flags
for malpractice
– The top 3 are:
• Breast lump, nipple discharge, breast rash or enlarged
lymph node in supraclavicular or axillary area
– Chest pain in an adult
– Lower abdominal pain
• Rule out the worst thing first
– Ruppert, C. Available at:
http://www.buppert.com/
NP Malpractice
• Rates remain low; but is climbing
• Of all malpractice cases in 2006; 9.6% for NPs
• Most often for medications, treatment and
misdiagnosis
Wright, W. Malpractice prevention: What NPs
and PAs need to know. Available at:
http://nurse-practitioners-and-physicianassistants.advanceweb.com/Web-Extras/OnlineExtras/Malpractice-Prevention.aspx
Avoiding Malpractice
• What can you think of here??
Issues in Prescribing
• Keep abreast of current therapy
– CE requirements for State and National
certification
• Provider lack of time
– Inadequate H&P
• Pressure from patients
– Requesting specific medications
Issues in Prescribing
• Medication confusion
– Similar names or spelling
• Failure to anticipate drug interactions
– CYP 450 interactions
Actions to Avoid Malpractice with
Medication Use
• Write clear prescription
• Warn patients about potential side effects or
adverse reactions
• Monitor for potential side effects
• Discontinue medications when no longer
needed
• Use high risk medications for short periods
only
Actions to Avoid Malpractice with
Medication Use
• Look up unfamiliar medications
• Know current standards of care
• If using a drug off label; document rationale
• From: C. Buppert JD, Available at
www.buppert.com
PA Malpractice
• In 2012, over 1500 cases of malpractice filed
– A decrease of 44.8%
• 135 jury verdicts
– The Unified Judicial System of Pennsylvania,
available at: http://www.pacourts.us/news-andstatistics/research-and-statistics/medicalmalpractice-statistics
• Breakdown by county
Legal Aspects of the NP Role
• For annual updates to Scope of Practice and
Legislation for NP’s :
– Summary published annually in The Nurse
Practitioner at: www.tnpj.com
– Updated Jan 16, 2016: