Legal Issues + EXAM 4 + NPRO 2100

A charge nurse is on the phone conveying a change in the medical condition of a patient to another health care provider. A family member of the patient's roommate overhears the nurse discussing the information. This is an example of: A. A violation of HIPPA. B. An incidental disclosure. C. A violation of FERPA D. An intentional disclosure.

B. An incidental disclosure.

Liability & Malpractice

- Conduct deviating from standard of practice dictate by the profession. - Providing safe care requires more than a knowledge of anatomy and physiology, pathophysiology, and medications and therapies. - It also requires knowledge of the regulations of HCP, institutions, payment systems, and federal and state laws that are interconnected within the domain of the HCS. - Individual engages in an activity requiring special skills, education, training & licensure. - Conduct measured as conduct of a "reasonably skilled, competent, & experienced individual who is qualified member of RN licensure = conduct deviating from standard of practice dictated by the profession. - Any negligent act or omission, however unintentional, may rise to the standard of malpractice and may jeopardize the professional nurse's license and client safety.

Most actions taken against nurses by their BON included probation, revoked licenses, or suspended licenses r/t:

- Drug-related events [drug abuse, drug diversion] - Alcohol abuse - Drug related convictions - Writing illegal prescriptions - Presenting illegal prescriptions - Wasting errors - Drug diversion - Criminal actions related to medication administration

Five Elements of Professional Negligence or Malpractice

1. Duty 2. Breach of Duty 3. Forseeability 4. Causation 5. Plaintiff must demonstrate that some type of physical, financial, or emotional injury or harm resulted from the breach of owed duty.

Negligence

- Considered conduct that deviates from what a reasonable person would do in a circumstance. - Unintentional tort: unintentional actions or omissions that result in harm to another person/harm to person's property. - exercising average care, skill & judgement in conduct as a comparative standard of determining liability = in nursing = reasonable professional nursing practice standard = due to carelessness - Medication errors - Proper identification of patient before all procedures and all med administration - Assess every patient for fall safety & use safely devices & bed alarms

Informed Consent

- Did the client understand? - Based on legal principle of autonomy - Obtaining informed consent for specific medical/surgical treatments = responsibility of individual who will perform the procedure Competency = legal presumption of ability to give consent by adults [such as negotiating a will or signing contracts] - Patient's legal & ethical rights to be informed of & give permission for any HC procedure/treatment/must not be coerced/pt understanding = essential element of informed consent/must be in terms/language the pt understands - Diagnosis/condition that requires treatment - Purposes of treatment - What pt can expect to feel/experience - Intended benefits of treatment - Possible risks/neg outcomes of treatment - Advantages/disadvantages of possible alternatives to treatment

Negligence that Results in Malpractice

- Failure to follow standards of care - Failure to use equipment in a responsible manner - Failure to communicate - Failure to document - Failure to assess and monitor - Failure to act as a client advocate

Malpractice Examples

- Failure to observe and take appropriate action [failure to assess and report new or increasing pain/abd discomfort] - Failure to follow expected post-op assessments/post procedure assessments >>"catch life threatening status changes/falling BP/HR or sats" - Incorrect identification of patients - Prepping wrong pt for surgery or for wrong surgery/surgical site => liability - Failure to follow six rights of med admin: right drug, right dose, right patient, right route, right time, right documentation - Poor communication/Poor documentation - Nurse should document defensively/objectively & not rely on memory of patient or details of care [avoid subjective statements/placing blame on others]

Controlled Substance Act

- Federal Law requiring drugs to be classified based on substance's medical use, potential for abuse, & safety risks. - Enforced by US DEA: provides registration with unique identifiers for all legitimate handlers of controlled substances & required record keeping - traces flow of any drug from time of first import/manufacturing through distribution level to pharmacy or hospital and on to patient who receives it - Schedule I and II drugs have the highest potential for abuse.

Mandatory Reporting

- Legal requirement to report act, event or situation designated by state or local law as a reportable event - Neonatal deaths & abortions - Abuse or suspected abuse of vulnerable individuals and children - Abuse or neglect of a vulnerable adult or Elder by a caretaker - School nurses must report assault, sexual assault, rape, kidnapping - Injuries: (criminal) nurses are not mandating to report domestic abuse. - Bullet wounds/gunshot wounds/powder burns - Suspected poisonings - Knife injuries/suspected criminal act involved - Wound, injury or illness result of criminal act/act of violence Ø Nurses who are in violation of Nurse Practice Act • Incompetence • Unethical • Illegal- violence ag patients, abuse/neglect toward clients • Drug or Alcohol Abuse/Use while working/Drug diversion • Communicable Diseases report to MDH/CDC • Venereal diseases- Syphilis • TB (airborne) • HIV • Anthrax/Botulism/ Cholera • Diphtheria • Hepatitis • Meningococcal disease/ Meningitis • Measles outbreak • Smallpox • SARS/H1N1 • Influenza numbers & associated pediatric mortality • Shigellosis

Areas of Risk Management

- Medication Errors-Barcoding! 6 Rights! - Falls - Use bed/chair alarms & gait belts - Allergies - Double check every time - Orders - Avoid verbal orders/VORB/Question any order a patient questions! - Narcotics [CSA] - Confidentiality - Code Status/EOL care/ADs - Other high risk activities/Maintain competence

Breach of Duty

- Must occur be either commission/omission - The injury must have resulted as a direct result of nurse's breach of duty = causation. - The plaintiff must demonstrator that some type of physical, financial, or emotional injury/harm resulted. - Deviation from standard of care owed the client -- such as failure to correctly administer medication to a patient. - Breach of owed duty = patient must be able to show actual harm occurred r/t action or omission by the nurse.

Patient Abandonment

- abandoning your patient is a breach of duty and is a breach of duty and is considered negligent that could be charged into malpractice - when a physician or other medical professional withdraws treatment from a patient without providing a reasonable notice or a competent replacement. - During patient abandonment, a patient is essentially denied necessary medical treatment. - Patient abandonment is a form of negligence that can be inadvertent or intentional. - Direct harm caused to the patient as a result of patient abandonment can be grounds for a medical malpractice claim.

An alert hospitalized patient has decided to execute an advanced directive and asks the nurse's help in obtaining the necessary witness signatures. What is the best response by the new nurse who has not witnessed an advanced directive? A. "Let me contact the nursing supervisor for assistance about this important matter." B. "Hospital policy prohibits nursing staff from witnessing legal documents." C. "Anyone on the nursing unit can witness the document for you." D. "I will be pleased to sign the advance directive as a witness since I am an RN."

A. "Let me contact the nursing supervisor for assistance about this important matter.

Obtaining informed consent is the responsibility of: A. The physician performing the surgery. B. The RN manager. C. The nurse. D. The Anesthesiologist

A. The physician performing the surgery.

The nurse is administering medications and the patient states, "I've never seen that blue pill before." What would be the nurse's most appropriate action? A. Verify the order and double-check the drug label. B. Administer the medication in the existing form. C. Instruct the patient that different brands are frequently used and may account for the change of color. D. Recommend that the patient discuss the medication with the provider and give the medication.

A. Verify the order and double-check the drug label.

The nurse responds to a voice calling out from a room on the nursing unit. Upon entering the room, the nurse sees a patient lying on the floor near the foot of the bed. After attending to the patient and notifying the healthcare provider, which notation would be most appropriate to record on the incident/unusual occurrence report? A. Patient fell while walking to the bathroom. B. Patient found lying on floor at foot of the bed. C. Patient states nursing staff did not respond to call bell. D. Patient was rushing to the bathroom to avoid incontinence.

B. Patient found lying on floor at foot of the bed.

Nursing staff members are sitting in the lounge taking their morning break. A nursing assistant tells the group that she thinks the unit secretary has HIV and proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband who is supposedly a drug addict. Which legal tort has the nursing assistant violated? A. Libel B. Slander C. Assault D. Negligence

B. Slander

A patient brought to the emergency department is dead on arrival [DOA]. The family of the patient tells the physician that the patient had terminal cancer. The ED physician examines the patient and asks a nurse to contact the medical examiner regarding an autopsy. The family of the patient tells the nurse that they do not want an autopsy performed. Which of the following responses to the family is appropriate? A. "It is required by federal law. Why don't we talk about it and why don't you tell me why you don't want the autopsy done?" B. The decision is made by the medical examiner. C. "I will contact the medical examiner regarding your request." D. "An autopsy is mandatory for any patient who is DOA."

C. "I will contact the medical examiner regarding your request."

The principle behind negligence law is that: A. All injury is caused by the misconduct of another person. B. Anyone who suffers an injury deserves help getting medical care. C. A person who is injured by another individual's dangerous conduct should be compensated for his/her loss. D. Intentional harmful acts should be punished.

C. A person who is injured by another individual's dangerous conduct should be compensated for his/her loss.

A nurse who works on the night shift enters the medication room and finds a co-worker with a tourniquet wrapped around the upper arm. The co-worker is about to insert a needle, attached to a string containing a clear liquid, into the antecubital area. The appropriate initial action by the nurse is which of the following? A. Call security. B. Call the police. C. Call the nursing supervisor. D. Lock the co-worker in the medication room until help is obtained.

C. Call the nursing supervisor.

A nurse on the intermediate care medical unit reports to work and is told to float (report to) the emergency department [ED] because of short staffing. The nurse has never worked in the ED. What should be the initial action by the nurse? A. Refuse to float, giving a full rationale for the decision. B. Ask the ED charge nurse to page the nursing supervisor. C. Identify nursing activities that the nurse can safely perform in the ED. D. Telephone the hospital risk management department for advice.

C. Identify nursing activities that the nurse can safely perform in the ED.

An Urgent Care nurse is caring for a patient who has been identified as a victim of physical abuse. In planning care for the patient, which of the following is the priority nursing action? A. Adhering to the mandatory abuse reporting laws. B. Notifying the case worker of the family situation. C. Removing the client from immediate danger. D. Obtaining treatment for the abusing family member.

C. Removing the client from immediate danger.

A new staff nurse wants to clarify legal responsibilities regarding delegation while working on the unit. To which document would the nurse mentor refer this nurse? A. Policy manual for the hospital or facility. B. Job description. C. American Nurses Association [ANA] standards of practice. D. Current state nurse practice act.

D. Current state nurse practice act

A motorcyclist involved in a MVC has sustained trauma to the chest and head and is unresponsive in the emergency department. The patient requires emergency surgery but known family members cannot be reached. What action is appropriate at this time regarding informed consent? A. Keep trying to reach family members by telephone. B. Have police contact a judge to obtain a court order for surgery. C. Proceed with surgery despite the absence of a signed consent form. D. Have the emergency department provider sign the consent form.

D. Have the emergency department provider sign the consent form.

As the nurse enters a room to administer medications [including a Schedule II narcotic for pain control], the patient states, "I'm in the bathroom. Just leave my pills on the table and I'll take them when I come out." What is the nurse's best response? A. Leave them on the table as requested and check back with the patient later to verify they were taken. B. Leave the medications with the patient's visitors so they can verify that they were taken. C. Inform the patient that the medications must be taken now, otherwise they must be documented as "refused". D. Inform the patient that the nurse will return in a few minutes when the patient is available to take the medications.

D. Inform the patient that the nurse will return in a few minutes when the patient is available to take the medications.

Situations that health care providers or entities are required to report to law enforcement include: A. Injuries to visitors. B. Deaths resulting from medical error. C. Patients who leave health care facilities against medical advice. D. Suspicions of child abuse.

D. Suspicions of child abuse.

Expressed Consent vs Implied Consent

Expressed: - Specific treatment or intervention - Oral or written - Whose responsibility? Implied: - Part of daily care/routine - Pt positions body for med adm/procedure - Ex = Assessments/Vitals