nurse shares responsibility in reporting poor techniques

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AORN JOURNAL MARCH 1984, VOL 39, NO 4 OR Nursing Law Nurse shares responsibility in reporting poor techniques I work in a 300-bed hospital where the OR department has six CRNAs and one anes- thesiologist. One CRNA has caused concern among the circulating nurses. This CRNA often fails to take blood pressures but nevertheless manages to chart readings. He often gives medi- cation that he fails to chart, and he charts medica- tion that he fails to give. I have reported this to the anesthesiologist and the OR supervisor on several occasions; no action has been taken. Who has the responsibility to monitor the CRNA’s technique? Where does the circulating nurse’s responsibility end? Q The conduct of the CRNA and the failure A of the anesthesiologist and OR supervisor to correct this situation puts the hospital and everyone in the OR at risk for a malpractice suit. Although the primary responsibility for supervis- ing the CRNA may rest with the anesthesiolo- gist, the OR supervisor cannot abrogate her re- sponsibility. It appears you have taken appropri- ate steps in calling this potentially dangerous situation to the attention of the OR supervisor and anesthesiologist. Since your pleas have been to no avail, it would now be appropriate to for- mally notify nursing administration of this situa- tion. A responsive nursing administration should act decisively to stop this intolerable technique. I am the OR supervisor of a small commu- nity hospital. Recently a new physician wit Q out privileges did a hernia repair on a six- week-old infant. A properly credentialed physi- cian was scrubbed and assisted. The new physi- cian later told me to record the credentialed physician as the surgeon of record and himself as assistant. When I expressed my reluctance to do this, I was referred to the director of nurses and to the hospital administrator. I was told the surgeon of record may allow his assistant to do a proce- dure if he is scrubbed and available to step in if necessary. I was assured that there is nothing illegal or unethical in recording the credentialed physician as the surgeon of record. Is this so? Although generally a surgeon of record A who is scrubbed and ready to step in may allow his assistant to do as much of a surgical procedure as he deems appropriate, I am con- cerned about the situation outlined. Your ques- tion implies the surgical procedure was per- formed under the direction and control of the assistant. Furthermore, the order to record the credentialed physician as surgeon and the new physician as assistant was given to you by the assistant. If, in fact, the surgical procedure was done under the direct supervision of the creden- tialed physician, there would be nothing illegal or unethical in what you were told to do. If, in fact, it was not performed under the supervision of the credentialed physician, it would be both unethical and illegal to record the credentialed physician as the surgeon of record. I recently circulated on a carpal tunnel release procedure. Suddenly, severe hemorrhaging began. The surgeon called for vascular clamps and made no mention that he had lacerated the radial artery. When I asked Q 664

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AORN JOURNAL MARCH 1984, VOL 39, NO 4

OR Nursing Law Nurse shares responsibility

in reporting poor techniques

I work in a 300-bed hospital where the OR department has six CRNAs and one anes-

thesiologist. One CRNA has caused concern among the circulating nurses. This CRNA often fails to take blood pressures but nevertheless manages to chart readings. He often gives medi- cation that he fails to chart, and he charts medica- tion that he fails to give. I have reported this to the anesthesiologist and the OR supervisor on several occasions; no action has been taken. Who has the responsibility to monitor the CRNA’s technique? Where does the circulating nurse’s responsibility end?

Q

The conduct of the CRNA and the failure A of the anesthesiologist and OR supervisor to correct this situation puts the hospital and everyone in the OR at risk for a malpractice suit. Although the primary responsibility for supervis- ing the CRNA may rest with the anesthesiolo- gist, the OR supervisor cannot abrogate her re- sponsibility. It appears you have taken appropri- ate steps in calling this potentially dangerous situation to the attention of the OR supervisor and anesthesiologist. Since your pleas have been to no avail, it would now be appropriate to for- mally notify nursing administration of this situa- tion. A responsive nursing administration should act decisively to stop this intolerable technique.

I am the OR supervisor of a small commu- nity hospital. Recently a new physician

wit Q out privileges did a hernia repair on a six- week-old infant. A properly credentialed physi- cian was scrubbed and assisted. The new physi-

cian later told me to record the credentialed physician as the surgeon of record and himself as assistant. When I expressed my reluctance to do this, I was referred to the director of nurses and to the hospital administrator. I was told the surgeon of record may allow his assistant to do a proce- dure if he is scrubbed and available to step in if necessary. I was assured that there is nothing illegal or unethical in recording the credentialed physician as the surgeon of record. Is this so?

Although generally a surgeon of record A who is scrubbed and ready to step in may allow his assistant to do as much of a surgical procedure as he deems appropriate, I am con- cerned about the situation outlined. Your ques- tion implies the surgical procedure was per- formed under the direction and control of the assistant. Furthermore, the order to record the credentialed physician as surgeon and the new physician as assistant was given to you by the assistant. If, in fact, the surgical procedure was done under the direct supervision of the creden- tialed physician, there would be nothing illegal or unethical in what you were told to do. If, in fact, it was not performed under the supervision of the credentialed physician, it would be both unethical and illegal to record the credentialed physician as the surgeon of record.

I recently circulated on a carpal tunnel release procedure. Suddenly, severe

hemorrhaging began. The surgeon called for vascular clamps and made no mention that he had lacerated the radial artery. When I asked

Q

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AORN JOURNAL MARCH 1984, VOL 39, NO 4

what procedure to record, the surgeon stated crisply, “I did a carpal tunnel release.” What should I have documented?

You have a moral, legal, and ethical re- A sponsibility to accurately document what transpired during the operative procedure. Whether the surgeon plans to similarly chart the incident in the postoperative notes is immaterial. In the event that litigation results from this inci- dent, the interest of all would be best served by an accurate and truthful charting of the operative procedure including the incident outlined.

WILLIAM A REGAN, JD MANAGING ASSOCIATE

WILLIAM ANDREW REGAN & ASSOCIATES PROVIDENCE, RI

Ifyou have any questions on OR nursing law you would like answered, please send them to William A Regan, JD, c/o AORN Journal, 101 70 E Mississippi Ave, Denver, Colo 80231. Ques- tions of general interest will be selected for re- plies in this column. Other questions will not be answered. Questions will not be acknowledged or returned.

New JCAH Standard Goes into Effect July 1 Hospitals will be permitted to open staff membership to health professionals besides physicians and dentists under a new standard from the Joint Commission on Accreditation of Hospitals (JCAH). The standard will be in effect from July 1 to Dec 31 as part of the new hospital accreditation manual.

decide to include are nurse-midwives, physician’s assistants, podiatrists, and chiropractors. Hospitals who do not comply with the standard will not lose their accreditation, however.

being approved Dec 10 by the JCAH Board of Commissioners. Each draft was reviewed by some 4,000 persons. Representatives of the American Medical Association voted for it after an amendment they offered was accepted. Representatives of the American College of Surgeons cast the only no votes. (Other groups represented on the board are the American Hospital Association, the American College of Physicians, and the American Dental Association. No nursing organization is represented.)

Under the standard, a medical staff will

Examples of practitioners hospitals might

The standard was revised four times before

include licensed physicians and may also include types of practitioners who are permitted by law and the hospital to provide independent inpatient care.

Other provisions summarized in the American Medical News (Dec 23130, 1983) are

All medical staff members will have delineated clinical privileges that allow them to provide patient services independently within the scope of their privileges.

All members of the medical staff and all others with clinical privileges are subject to medical staff and departmental bylaws and rules and regulations. They are also subject to review by the hospital’s quality assurance program.

Inpatients admitted by nonphysician members of the medical staff will have a prompt medical evaluation by a physician staff member. (This does not apply to oral surgeons with privileges.)

and a comprehensive physical examination conducted by a physician with privileges.

is the responsibility of a qualified physician member of the medical staff.

0 Each inpatient will have a history taken

0 Each patient’s general medical condition

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