IV MEDICINE ADMINISTRATION Legal and Professional Issues.
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Transcript of 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
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
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:• 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
• 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