Ethics Principles and values that determine appropriate behavior
Law The rules and standards of society that control the conduct of its members and set limitations for the fulfillment of natural instincts.
Types of Law • Constitutional Federal State • Statutes • Common or Case Law
Torts • Intentional • Nonintentional
Intentional Torts • Assault • Battery • False Imprisonment • Invasion of Privacy • Intentional Infliction of Mental Distress
Nonintentional Torts • Negligence Omission to do something which a “reasonable and prudent” person would do • Malpractice Professional misconduct, lack of skill, evil practice, immoral conduct
Determination of Negligence or Malpractice • Duty to the patient • Breach of Duty • Proximate Cause • Injury
Standard of Care • Defines the “duty to the patient” and “breach of duty” • Could be a local, regional or national standard • Nurse Practice Act Outlines in very general terms what a nurse may do. A nurse may not do any act which may be interpreted as the practice of medicine.
What defines the Standard of Care? • Hospital policy and protocols • Definition of each health care provider - specific for each state • Schools • Certification and licensure • Current literature • Special training • Professional organizations
Good Samaritan Act • Some variation from state to state, but general principles include: • Care not grossly negligent • Care does not have to be successful • Rescuer has a duty to use “reasonable” care • No duty to undertake a rescue if the situation exposes the rescuer to danger
Respondeat Superior “Let the Master answer” May depend upon what type of duty was deemed to be negligent: • Professional • Administrative
Categories of Negligence • Treatments • Communication • Medication • Monitoring & Observing
Documentation • “If you didn’t write it, you didn’t do it”! • Rules for documentation in the medical record: • Write legibly • Do not leave blank lines • All people giving care must be identified • Draw a line through errors and initial • Document in chronological order • Verbal orders must be signed off by MD • Late entries must be noted as such
Patient Rights • Be informed – diagnosis, treatment options including outcomes and risks • Receive/Refuse Treatment • Privacy and Confidentiality • Respectful care, no matter what the circumstance • Patient’s personal possessions must be cared for and secured
Informed Consent • Protects the patient from assault and battery • Obtained by the MD, who is responsible for all elements of this process. • Nursing may witness the patient’s signature • If the patient has any questions, hesitation or does not understand the procedure, STOP and notify the MD
6 Elements of Informed Consent • Explanation of the procedure • Benefits • Discomforts & risks (possible complications) • Description of alternative choices (including the choice of no treatment). • Offer to answer any questions • Instruction that the patient is free to change his mind at any time
Emergency Consent • Life or Limb saving interventions should not be withheld in the absence of consent. • What defines “life or Limb”?
Individuals Who Cannot Give Informed Consent : • Minors (with exceptions) • Mentally incompetent people (mentally retarded, senile, insane) • Individuals under influence of drugs or alcohol • People who speak a foreign language and may not fully comprehend English
Consent for Minors • Consent of the Legal Guardian – (1985 – AAP Committee on Bioethics - added with the assent of child) • Two Exceptions: • Emancipated minor • Unemancipated but who have decision-making capacity (“mature minors'') or who are seeking treatment for certain medical conditions, such as sexually transmitted diseases, pregnancy, and drug or alcohol abuse.
Order of Consent:Incompetent Adult • Health-care Surrogate • Spouse • Adult children • Parent • Sibling • Other
Informed Refusal • Competent patients cannot be threatened or detained from leaving (false imprisonment). • If the patient wishes to leave AMA, the decision should be based upon a clear understanding of the medical consequences. • Documentation of circumstance is important if the patient leaves without informed refusal.
Telephone Information • Do not diagnose • Encourage the caller to come in for care • You may give immediate lifesaving information. • Check hospital policy • Issues of confidentiality
Confidentiality • 1996 – Health Insurance Portability and Privacy Act (HIPPA) • “Right to know” • Exceptions -
Evidence Collection • Chain of Custody • Blood Alcohol • Reporting to Authorities • Gunshot & Stab Wounds • Violent injuries • Abuse • Animal bites • Communicable diseases • Reportable Deaths • Valuables
CASES –Who is liable? • Three nurses in Colorado were charged with CRIMINALLY NEGLIGENT HOMICIDE • Newborn died after receiving 10 times the ordered dose of Penicillin IV rather than IM • Pharmacist prepared incorrect dose • Nurses did not detect it • Nurse practitioner changed order from IM to IV without consulting the physician
CASES –Who is liable? • Patient admitted with known suicide tendencies • While on a temporary pass, sustained injuries that needed him to be transferred to an orthopedic unit • MD ordered 24hr attendants (patient observers) • Attendant was not informed of the suicidal tendencies • When the attendant was putting some of the patient’s dessert in the refrigerator , the pt jumped out of the window to his death
CASES –Who is liable? • 28 y.o woman was admitted for an ovarian cyst • After surgery, and while she was coming out of anesthesia, the surgeon left to prepare another pt. • He called the circulating nurse away to assist him • After the OR tech placed a dressing on the wound, he noticed the patient’s legs were cool and her arms were dark blue. • CPR was initiated but pt. suffered severe brain damage
Strategies for Legal Protection • Know the Standards of Care that regulate your specific practice and maintain the level of expertise and competence that reflect the standards of practice • Adhere to Established policies and Procedures in the Facility • Follow established rules of documentation • Liability Insurance • Risk Management Education • Legal Counsel (if needed)