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...