lpn- iv therapy and the law
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LPN- IV Therapy and the LAW. LPN IV CLASS: Day 1. HOUSEKEEPING DUTIES!. Course Requirements Evaluations Schedule Content Outline Clinical Homework Book. Legal issues related to IV therapy. - PowerPoint PPT PresentationTRANSCRIPT
LPN- IV Therapy and the LAW
LPN IV CLASS:Day 1
HOUSEKEEPING DUTIES!
Course Requirements Evaluations Schedule Content Outline Clinical Homework Book
Legal issues related to IV therapy
Objectives for this unit are to outline the LPN,s role, accountability, and responsibility relative to IV therapy in terms of law, board rules, role of the directing professional, health care setting and institutional policy
Sources of law- four primary sources in the United States
Constitution- formal set of rules for gov,t and individual rights
Statutes- Federal state and local laws, laws dealing with malpractice
Administrative law- Board of NursingCommon- court made law (malpractice)
Legal terms Criminal law Civil law Tort- private wrong by act of omission Malpractice- is the form of negligence in which any
professional misconduct, unreasonable lack of skill, or non adherence to the acceptable standard of care causes injury to a patient
Rule of personal liability- every person is liable for own wrong doing cannot say that it is ok because the doctor told me so – you are responsible to know and know your scope of practice
Malpractice
Must establish that nurse had a duty to patient A breach of standards of care or failure to carry out
that duty must be proven The patient must suffer actual harm or injury There must be a causal relationship between the
breach of duty and the injury suffered– If an act of malpractice does not create harm, legal action
cannot be initiated– Coercion of a rational adult for placement of IV constitutes
assault and battery
Breach of Duty
Failure to observe Failure to intervene or react Verbal rather than written orders
Know your scope of practice Medication errors are an area where nurses
face criminal charges what is common cause?
LAWS THAT GOVERN LPN PRACTICE
Ohio Revised Code: what is it? Ohio Board of Nursing Rules: What makes
it different from ORC? Accountability to the law Standards of Practice
– Ohio Board of Nursing– Infusion Nursing Society
Ohio Revised Code(ORC)
Laws that are made and approved by the government of the State of Ohio
Laws are adopted by official state offices such as Ohio Board of Nursing
Ohio Board of Nursing Rules
Ohio Board of Nursing (OBN) is a government agency
Must abide by the ORC laws Adopts them as rules to be followed OBN rules can be found on the website Specific rules for LPN IV Therapy – see
handout
Accountability
As nurses, when we accept a license from the state, we agree to follow what the laws of the Ohio Revised Code and rules of the Ohio Board of Rules say we will follow!
Standards of Practice VS Standards of Care
Standards of Practice govern how we as nurses practice the art of nursing.
Standards of Care govern how we provide care to our patients such as policies on starting IVs.
Standards of Practice for LPNs in the State of Ohio
Ohio Board of Nursing: 4723-4-04 Maintain knowledge Demonstrate competence Provide nursing care according to education Nursing care does not involve a function or
procedure which is prohibited by the law Implement regimens in a timely manner Will clarify prescribed regimen when unsure
Report changes in a timely manner Maintain confidentiality Not disclose patient information unless
it will have an adverse affect on their treatment or progress
Will evaluate others according to established criteria such as standards of care/practice
Standards of Practice for LPNs in the State of Ohio
But I did not Know
This excuse will never hold up in a court of law As a licensed professional you are held
accountable to know your states nurse practice act and your scope of practice.
But I was told to or asked to will not hold up. Board of nursing is responsible for protecting
the public from harm.
INFUSION NURSING SOCETY (INS)
In the INS Scope of Practice: Knowledge of A & P Infusion treatment modalities Participation in the patient’s plan of
care Knowledge of infusion therapies Knowledge of psycho/social aspects Collaborate with other team members
Breach of duty
The nurse does not want to breach standard of practice or violate employer’s policies
Five examples of Breach of duty related to IV therapy
Delay in administration of medication Unfamiliarity with the drug Inappropriate route of administration Failure to qualify orders Negligence in patient teaching
What can any LPN do with IVs (4723.171)?
Verify the type of peripheral IV solution being administered
Examine peripheral infusion site and extremity for infiltration
Regulate peripheral IV according to prescribed flow rate
Discontinue a peripheral IV device
Perform routine dressing changes at insertion site for:– Peripheral IV– Arterial line– PICC– CVP subclavian
infusion
What can no LPN do… period!
Blood and Blood components
TPN Cancer therapeutic
medication– chemotherapy– anti-neoplastics
Investigational or experimental medications
Discontinue:– CVP– PICC– art line– any line other than
peripheral• IV Medications other than
antibiotics for those trained.
• IV push/bolus medications
WHAT CAN AN “AUTHORIZED” LPN DO?
Initiate IV therapy in hand, forearm or antecubital on an adult(18 and older)
Maintain accepted IVs in CVP or PICC lines
Prepare or reconstitute an antibiotic medication
Verify blood products with an RN
Initiate an IV of:– D 5W
– Normal Saline– Lactated Ringers– 0.45% NaCl– 0.25 % NaCl– Sterile Water
What can we do cont.
Hang subsequent containers of accepted IV solutions containing vitamins or electrolytes
Initiate and/or maintain IV piggyback of an antibiotic
Inject normal saline or Heparin in an intermittent infusion devise or heparin lock
Change tubing on IV that terminates in a peripheral vein
What does your policy say?
Review your policy and see if it meets the requirements of the law.
If not, what does it need to add? Who are you going to tell?
Role of the RN in delegation
What is delegation? LPN can’t delegate IV
medication administration
Before an RN can delegate the following must be done:
Assess patient condition
Assess type of care Assess complexity Training and skill of
person delegating to Resource availability
to perform safely
RISK MANAGEMENT
What is risk management?
Why and how do we ask for informed consent?
Why is documentation important with risk management?
What is Risk Management
INS describes the process as: “ a process that identifies, analyzes, treats
and evaluates real and potential hazards.” A risk management program collects and
analyzes data to find trends and to help improve practices to increase patient satisfaction and decrease complications and adverse patient outcomes.
Risk Management, cont.
Looks at areas of actual or high risk Looks at customer satisfaction Works with PI and EOC to provide safest
environment Educates Helps facilities complies with federal and
state mandates
INFORMED CONSENT
Proactive strategy because it provides patients with information needed to make and informed decision
Medication Errors
New systemwide policy Non-punitive Anonymous reporting Investigation into the processes not the
person
DOCUMENTATION
Needs to be timely, accurate and complete Objective Legible Use only accepted abbreviations Don’t use criticism or complaints Every entry dated and timed No vacant space
10 Steps to Medication Safety
Know the patient Know the drugs Communicate clearly Beware of look-alike
and sound-alike drugs Restrict and
standardize drug storage, distribution and stock meds
Assess drug delivery devices and maintain competence
Watch the environment Educate self Encourage patient
participation Target process not
person
OCCUPATION RISKS
Physical hazards– needle stick injuries– abrasions– contusions– chemical exposure– latex allergies
Biological Hazards
Bloodborne pathogens:– OHSA regulations– Exposures– Wearing gloves– Using safety devices– The most effective way of preventing the
spread of disease is...