AHS318_Sp11_u07_PDF - Nursing and the Law Law for Health Care Professionals Unit 7 Nursing and Other Healthcare Professionals Licensed Professional

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Unformatted text preview: 2/22/2011 Nursing and the Law Law for Health Care Professionals Unit 7 Nursing and Other Healthcare Professionals Licensed Professional Nurse (LPN) Registered Nurse (RN) Certified Nurse Practitioner (CNP) Certified Registered Nurse Anesthetist (CRNA) 1 2 Nursing and the Law Nursing and the Law Nurse Practice Act - Nursing licensure will vary depending upon educational requirements and by state Scope of Practice will define the Scope of Practice – will define the permissible permissible boundaries of practice Exceeding the scope of practice can lead to violations of licensure provisions LPN – generally limited to routine patient care activities and certain medication administration and treatments; care provided under the direction of an RN RN – generally has passed a state licensing exam CNP – has generally completed additional training basic nursing; ability to practice independently from physician will be based on state nurse practice acts CRNA – generally has completed additional training beyond basic nursing; provides anesthesia care Can lead to disciplinary action – probation, suspension, revocation 3 4 Nursing and the Law Clinical Nurse Specialists Professional RNs with advanced degrees, experience and expertise in a clinical specialty (i.e., OBGYN, Pediatrics, etc.) Nurse Midwives – specialized training in prenatal care and childbirth Special Duty/Private Duty Nurses Nursing and the Law Facility is still responsible for the care delivered to patients Nursing Assistants (CNA) Patient Care Technicians Sitters (generally not nurses; facilities is responsible for making sure that the patients’ needs are met) 5 Administration and Licensing (Alabama) Nurse Practice Act - Section 32-21-1 et. 32-21seq Code of Alabama (1975) seq. Code of Alabama (1975) Alabama Board of Nursing www.abn.state.al.us Section 610-X-6 defines the practice 610standards 6 1 2/22/2011 Nursing and the Law Requirements for Licensure Examination Agreement between states whereby a nurse licensing board in one state recognizes the license issued by the first state one state recognizes the license issued by the first state – Alabama Alabama grants reciprocity pursuant to the Nurse Practice Act License may be granted on a temporary basis when an individual moves from one state to another Waiver Licensing exam Reciprocity Nursing and the Law When applicants do not meet all of the requirements for licensure but have equivalent experience – prerequisites for education may be waived Endorsement A state determines whether another state’s licensing requirements are equivalent to its own 7 8 Nursing and the Law Nursing and the Law Licensure Verification Must verify upon hire and on a regular basis Al Alabama – every 2 years Maintain as part of employment file Status of License Probation May be allowed to work under supervision Will Will require periodic reports to the Board of th Nursing Nursing Suspension Revocation 9 10 Nursing and the Law Nursing and the Law Implications of Not Verifying License Licensure and certification issues State laws Medicare Conditions of Participation JCAHO issues Negligence Reporting to the Board of Nursing Facility has an obligation to report a nurse to the Board of Nursing if circumstances warrant such action Examples of Reportable issues: Corporate entity has an obligation to employ persons that are properly licensed 11 State and Federal surveyors can make reports to the Board as a result of survey findings Wh thi When this occurs, the facility may also receive deficiencies if it th if it failed failed to report nurse Practicing beyond scope of license Patient abandonment Falsification of medical records Practicing while under the influence of drugs/alcohol Drug diversion 12 2 2/22/2011 Nursing and the Law Potential Areas of Exposure Nursing and the Law Authority of the Board of Nursing to Investigate Investigate a Report Board has subpoena power Can request personnel records Can request medical records Conduct interviews Typical Organizational Structure Chief Nursing Officer Director(s) Assistant Director(s)/Department Heads Unit Managers Manage Supervisors Charge Nurses Staff Nurses Nursing Assistants, Patient Care Technicians, Unit Secretaries 13 14 Nursing and the Law Potential Areas of Exposure Nursing and the Law Potential Areas of Exposure Physicians Orders Orders written – hard copy or electronic order entry Orders are “taken off” the chart Orders are processed are processed Confusing, unclear or otherwise questionable orders should be clarified before orders are processed Medications Medication Errors Omissions Failure to document Wrong patient Wrong route Wrong dosage Failure to clarify orders Drug Wastage Drug Diversion Failure to clarify orders could result in negligence claims Issues with abbreviations Issues with narcotic counts Theft of drugs 15 16 Nursing and the Law Potential Areas of Exposure Falls Failure to provide prescribed treatment Nursing and the Law Potential Areas of Exposure i.e., Wound care treatment Failure to monitor i.e., fetal monitors, telemetry, cardiac monitors Monitors disconnected Failure to recognize and report a change in status Failure to identify correct patient Documentation Failure to record pertinent findings Failure to record care and treatment Illegible documentation Timeliness of documentation Falsification of records Delayed treatment i.e., blood transfusions i.e., reporting critical values resulting from a delay in processing orders 17 18 3 2/22/2011 Nursing and the Law Potential Areas of Exposure Nursing and the Law Potential Areas of Exposure CRNAs and Potential issues Improper placement of airways Failure to recognize a change in patient’s condition diti Infection Control Issues Failure to follow proper infection control practices can result in potential exposure Proper hand washing techniques – most mos effective effective means of preventing the spread of infection i.e., change in vitals Improper use of anesthetics Cross contamination issues MRSA 19 20 Liability by Department and Other Health Care Professionals Liability by Department and Other Health Care Professionals Regardless of the individual’s profession, he or she will be held to the same standard of care as another individuals practicing in the field practicing in the field Emergency Departments Generally recognized as having a duty to accept treat and transfer emergency department patients if such care is deemed medically necessary Emergency departments are considered high risks areas for hospitals High turnover of patients turnover of patients Rapid pace Potential for there to be a lack of follow-up on abnormal lab/radiology followfindings Consider the hospital that operates an emergency department, but no longer delivers babies and a women presents to ER in active labor, baby is delivered, and baby suffers injuries during the birth - any liability??? Consider failure to admit patient suffering from chest pains, and patient subsequently suffers a massive MI and dies – any liability??? 21 Liability by Department and Other Health Care Professionals Liability by Department and Other Health Care Professionals Emergency Medical Treatment and Active Labor Labor Act (“EMTALA”) Act forbids Medicare participating hospitals from “dumping” patients out of emergency “dum departments. 22 Act requires that persons presenting to the ER must be screened to determine if the person has an emergency medical condition Must conduct exams and perform ancillary services routinely available to the emergency department 23 Emergency Medical Treatment and Active Labor Act (“EMTALA”) (“EMTALA”) Emergency medical condition defined: (A) A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result immediate medical attention could reasonably be expected to result in (i) placing the health of the individual (or, w/ respect to a in pregnant woman, the health of the woman or unborn child) in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious dysfunction of any bodily organ or part; or (B) w/ respect to a pregnant woman who is having contractions, (i) that there is inadequate time to effect a safe transfer to another facility before delivery, or (ii) that transfer may pose a threat to the health or safety of the woman or the unborn child. 24 4 2/22/2011 Liability by Department and Other Health Care Professionals Liability by Department and Other Health Care Professionals Emergency Medical Treatment and Active Active Labor Act (“EMTALA”) Act requires that if the hospital determines that an emergency medical condition that an emergency medical condition exists, exists, then it must either stabilize the patient or provide for transfer of the patient to a facility capable of meeting the patient’s medical needs. Emergency Medical Treatment and Active Active Labor Act (“EMTALA”) The enforcement provision of EMTALA is explicitly limited to actions against explicitly limited to actions against Medicare Medicare participating hospitals. See case Ballachino v Anders page 229 wh/ describes allegations against Hospital and Physician 25 26 Liability by Department and Other Health Care Professionals Liability by Department and Other Health Care Professionals Emergency Medical Treatment and Active Labor Act (“EMTALA”) (“EMTALA”) Stabilized - “with respect to an emergency medical condition… to provide such medical treatment of the condition as may be necessary to assure, w/in reasonable medical probability, that no material deterioration of the condition is likely to result from or to occur during the transfer of the individual from a facility. A patient shall not be transferred from the emergency department unless: i.) patient makes a written request, ii.) physician certifies that based on information at time of transfer, benefits of expected treatment at another facility outweigh the risks of transfer, or iii.) a qualified medical person has signed a certification after a physician in consultation with the person … subsequently countersigns the certification; and the transfer is appropriate to that facility Emergency Medical Treatment and Active Active Labor Act (“EMTALA”) Failure to abide by EMTALA can result in civil monetary penalties in addition to civil civil monetary penalties in addition to civil actions actions for personal injuries 27 28 Liability by Department and Other Health Care Professionals Alabama Hospital Pays CMP Liability by Department and Other Health Care Professionals Emergency Medical Treatment and Active Active Labor Act (“EMTALA”) Hospitals receiving inappropriate transfers are required to report potential EMTALA are required to report potential EMTALA violations violations to CMS. Failure to report may lead to CMP being imposed upon the hospital receiving the patient. 11-2211-22-2010 Mobile Infirmary (MI), Alabama, agreed to pay $45,000 to resolve its liability for civil monetary penalties under the patient dumping statute. The OIG alleged that MI refused to accept an appropriate transfer to its hospital of patient in need of appropriate transfer to its hospital of a patient in need of specialized specialized capabilities available at MI. The refusal of the transfer request delayed care and treatment for a patient's gastrointestinal bleed. Two hours after the request to MI, the patient was finally transferred to another hospital approximately 60 miles away. En route, the patient's condition deteriorated and the patient had to be transported by helicopter to the receiving hospital. The patient subsequently died that day. Source: Source: DHHS OIG 29 30 5 2/22/2011 Liability by Department and Other Health Care Professionals Liability by Department and Other Health Care Professionals Other potential Areas of Vulnerability for Emergency Departments Departments Duty to contact on call physician Call lists and procedures for knowing which physician is on call Failure to respond timely Facility must not only treat, but must do so timely Refer to Futch v Attwood page 232 – child suffered from ketoacidotic coma cerebral hemorrhage and pulmonary edema – physician failed to draw labs nor did he examine patient when she presented to ER – he communicated via telephone. Laboratories - Potential areas of Liability Critical Values CV are values that indicate potentially life threatening conditions and facilities need to have procedures in place to ensure immediate and accurate place to ensure immediate and accurate communication communication of results Blood Transfusions Facilities need have strict guidelines regarding type and cross matching procedures, verification procedures that correct patient gets the correct transfusion 31 32 Liability by Department and Other Health Care Professionals Liability by Department and Other Health Care Professionals Pharmacies - Potential areas of Liability Pharmacy is responsible for ordering, storage dispensing, and labeling medications Medicines need to contain Pharmacies - Potential areas of Liability Examples of Potential Errors Prescription errors – wrong patient, wrong drug, transcription error b/c of illegible handwriting Dispensing errors improper prep of med (i Dispensing errors – improper prep of med (i.e., IV mixture), dispensing expired medications, wrong dosage, wrong patient Administration errors – wrong patient, wrong route, administering discontinued drugs Documentation error – transcription errors, errors on MAR an accurate description of the drug, the proper dosage, instructions regarding administration, potential adverse effects, precautions Prescriptions need to filled in accordance with the Physicians orders 33 34 Liability by Department and Other Health Care Professionals Liability by Department and Other Health Care Professionals Pharmacies - Potential areas of Liability Liability Facility needs to check pharmacy license at hire and periodically thereafter at hire and periodically thereafter Stocking of crash carts and periodically checking integrity of carts See page 244 for list of ways to decrease medication misadventures Other Health Care Professionals Potential areas of Liability Liability Physician Assistants – regulated by state statute, physician cannot delegate his responsibilities to the PA Respiratory Therapist – ventilator management Security – remember the Huntsville case Security the Huntsville case Sexual improprieties Alleged sexual misconduct and/or abuse Responsibility to investigate If proven, may not only lead to civil and/or criminal litigation, if it involves a practitioner, practitioner may have license revoked 35 36 6 2/22/2011 Liability by Department and Other Health Care Professionals Pharmacies - Potential areas of Liability Health care professionals will be held to the same standard of care of other individuals in the same profession To prove the standard of care for the particular individual attorney will generally engage an expert individual, attorney will generally engage an expert witness witness that is similarly situated to the defendant Professionals can only testify as to the standard of care for their specific field For example, a nurse cannot testify as the applicable standard of care for a pharmacist or physician; likewise, neither a pharmacist nor a physician can testify as to the standard of care applicable to nursing 37 Questions 38 7 ...
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This note was uploaded on 08/21/2011 for the course AHS 318 taught by Professor Estep during the Spring '11 term at University of Alabama at Birmingham.

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