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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
- 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?
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
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.
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
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
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
Overriding Informed Consent when...
- 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
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
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
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
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
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
Common Caues of Negligence
- Client falls
- Equipment injuries
- Failure to monitor
- Failure to communicate
- Medication errors
- Medical errors
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
- 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
- Most common is not checking the 6 rights of Rx admin.
- Right drug
- Right dose
- Right route
- Right time
- Right client
- Right documentation
Tips for Credible documentation
- FLAT: Factual, Legible, Accurate, Timely
Do's and Don'ts of Pt. documentation
- 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.
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
The 2 worst
- Altering or falsifying a record
- Violation of an internal or external standard of practice
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.