1. Deligations of duties
    “Transferring to a competent individual the authority to perform a selected nursing task in a selected situation”     -NCSBN- 

    Nurse retains accountability for the delegation

    • 5 Rights:
    • 1) Right person
    • 2) Right task
    • 3) Right Circumstance
    • 4) Right Directions
    • 5) Right Supervision

    • Criteria
    • Responsibilities 
  2. RN Accountability
    • The RN is held accountable to assign and delegate apppropriately to the preceptee according to their level of demonstraged or evidenced based competency.
    • --Is there evidence of saftey and effective manner?
    • --Is it documented? 
  3. Responsibilities of Delegation
    • Assess the patient to make sure that delegating the task is appropriate relative to the patients condition
    • Verify the person is qualified to perform the delegated task
    • Review the task with the UAP
    • Follow the policy of the institution
    • Monitor the patient to determine benefits of the care
    • Ensure documentation of the care
    • Regularly monitor the UAP’s performance of the task
  4. What do you need to know about informed consent?
    • Without informed consent many medical procedures could be considered battery
    • Consent to treatment by the client gives the health-care personnel the right to deliver care without fear of prosecution.
  5. What are the responsibilites associated with informed consent?
    • The physician obtains the consent
    • Gives the client the information
    • States the risks and advantages
    • The nurse may be involved in the process by gaining signatures on the appropriate forms
  6. What information is involved with informed consent?
    • Provide nature of health concern and prognosis if nothing is done
    • Description of all health treatment options
    • The benefits and risks of the treatment, any alternatives, and noninterventions
    • Possible risks and/or negative outcomes
    • Patient Bill of Rights
  7. Critical components of informed consent...
    • The consent must be given voluntarily
    • The consent must be given by an individual with the capacity and competence to be understood
    • The client must be given enough information to be the ultimate decision maker
  8. Overriding Informed Consent when...
    • Emergency
    • Can’t consent and delay would cause harm
    • Law presumes consent
    • Therapeutic Privilege
    • Pt. Who cannot cope with full disclosure – full disclosure would hinder Rx inflict damage 
  9. The finer points of informed consent
    • A mentally competent adult has voluntarily given consent
    • The client understands exactly what he or she is consenting to
    • The consent includes the risks, alternative treatments, and outcomes
    • The consent is written
  10. Nurse's role in informed consent for medical procedures
    • Witnessing the exchange between the client and the physician
    • Establishing that the client really did understand, that is, was really informed
    • Witnessing the client’s signature
  11. Preventing yourself form being dragged into court.
    • Keep yourself informed about new information related to your area of practice
    • Insist that the health-care institution keep personnel informed of all changes in policies and procedures and in the management of new technological advances
    • Always follow the standards of care or practice for your institution
    • Establish and maintain a safe environment
    • Document precisely and carefully
    • Write detailed incident reports
    • File incident reports with appropriate personnel and departments
    • Recognize client behaviors that may cause problems
    • Delegate tasks and procedures to appropriate personnel
    • Identify clients at risk for problems such as falls or the development of decubiti
  12. What to question when carrying out an MDs order.
    • Question any order a client questions
    • Question any order if the client’s condition has changed
    • Question and record verbal orders to avoid miscommunications
    • Question any order that is illegible, unclear, or incomplete
  13. What is unprofessional conduct?
    • Includes incompetence or gross negligence
    • Conviction for practicing without a license
    • Falsification of client records
    • Illegally obtaining, using or possessing controlled substances
    • Having a personal relationship with a client, especially a vulnerable client
  14. Common Caues of Negligence
    • Client falls
    • Equipment injuries
    • Failure to monitor
    • Failure to communicate
    • Medication errors
    • Medical errors
  15. Basic Nursing Care errors resulting in negligence
    • Assessment Errors              
    • Failing to:
    • Gather and chart client information 
    • Recognize the significance of information
    • Planning Errors     
    • Failing to:
    • Chart each identified problem       
    • Use language that other providers understand
    • Ensure continuity of care 
    • Give D/C instructions
  16. More Errors
    • Intervention Errors  
    • Failing to:                  
    • *  Interpret and carry out doctor’s orders                        
    • *  Perform nursing tasks correctly

    Pursue the physician if the doctor doesn’t respond to calls or notify the nurse-manager if the physician is unavailable
  17. Medication Errors
    • Most common is not checking the 6 rights of Rx admin. 
    • Right drug
    • Right dose
    • Right route
    • Right time
    • Right client
    • Right documentation
  18. Tips for  Credible documentation
    • Contemporaneous
    • Accurate
    • Truthful
    • Appropriate
    • FLAT: Factual, Legible, Accurate, Timely 
  19. Do's and Don'ts of Pt. documentation
    • DO
    • Check that you have the correct chart before you begin writing.
    • Make sure your documentation reflects the nursing process and your professional capabilities.
    • Write legibly.
    • Chart the time you gave a medication, the administration route, and the patient's response.
  20. What are the 6 F's of bad documentation
    • Failure to appropriately assess a client
    • Failure to report changes in client status
    • Failure to document in the client record
    • Failure to obtain informed consent
    • Failure to report a coworker’s negligence
    • Failure to provide adequate education
  21. The 2 worst
    • Altering or falsifying a record
    • Violation of an internal or external standard of practice
  22. Elements of Malpractice claim
    • A malpractice claim has four elements, all which  must be met to substantiate the plaintiff’s claim:
    • Duty to the patient
    • Breach of that duty
    • Injury to that patient
    • Causal relationship between breach of duty and patients injury.
Card Set
Legal issues in Nursing