MEDICO – LEGAL ASPECTS

I. Behavioral Operation:
-The nurse should be able to recognize the legal implications regarding the patients and the operating room personnel.
II. Welfare and Safety of the Patient:
--All instruction to nurses concerning care of the patient emphasize the welfare and safety of the patient.
-Hospital routines and procedures are protection of the nurse as well as to the learning and carrying out the details of your
work as taught.
III. Malpractice:
-Negligence is defined as the lack of care and skills which any nurse I that situation would be expected to use.
-The legal term for negligence is malpractice.
-Each person must be familiar with the cause of lawsuits and must participate in preventive programs.
Elements of professonal negligence
 Existence of a duty
 Failure to meet the standard of due care
 The foreseebility of harm
 Breach of standard
Examples of negligence
 Failure to report observations to attending physicians
 Failure to exercise the degree of diligence which the circumstances of the particular case demands
 Mistaken identity
 Wrong medicine, wrong concentration, wrong route, wrong dose
 Defects in the equipment such as stretchers and wheelchairs may lead to falls thus injuring the patients
 Administration of medicine w/o a doctors prescription
 Errors due to family assistance
IV. Doctrine of Res Ipsa Loquitur
 “the thing speaks for itself”.

 A doctrine of law applicable to cases where the defendant has exclusive control of the things which caused
the harm ordinarily could not have occured w/o negligent conduct

V. Doctrine of Force Majeure

 An irresistible force, one that is unforeseen or inevitable

VI. Doctrine of Respondeat superior

 “let the master answer for the acts of the subordinate”

 The employer is responsible for the legal consequences of the acts of the servant or employee while acting w/in
the scope of employment.

VII. Potential Legal Involvement:

1.Loss of Sponges
 Sponge count – a method of counting for all the sponges put on the sterile table for use on a case, when the
depth and location of the wound is such a sponge could accidentally be lost or left in the patient.
a. Indications of a Sponge Count
1. Gastro-intestinal 3. Chest and thoracic
2. Genitourinary 4. Pelvic

b. When to do sponge count?

1. Before the starts of the operation 3. Immediately after the closure of the peritoneum
2. Before the closure of the peritoneum 4. Closure of fascia

c. Who’s responsibility is the accounting of the sponge?

The rest of the team, with the surgeon and his assistants; However, if the surgeon has done his part in the count and
because of a miscount by the circulating nurse, a sponge is left in the wound, the circulating nurse may be held
responsible.

d. Careful Method of Counting

1. The scrub nurse holds the entire pack of sponges in her hands at a time.
2. He picks up the sponges separately from the pack and places them in a pile on the table. He numbers each
one with the circulating nurse until all are accounted.
3. The circulating nurse immediately records the count on the sponge count notebook.
4. There should be no interruption while counting. If they are not sure of the count because of interruption,
tumbling of any other reasons, they should repeat it.
5. If a pack contains an incorrect number, the nurse discard this pack and open another. There is great danger of
error if they try to make correction for an incorrect numbers.
6. To prevent the possibility of a sponge being taken into the operating room and causing confusion in the
count. Once the operation is started, buckets should be emptied, the entire room should be cleared of loose sponges,
cotton, etc.

e. Things included in the Sponge Count

•24’s gauze •Cherries •Umbilical tape •Screws of instruments

•2/3’s gauze •Peanut •Kidney tape •Deavers’s jacket
•Abdominal pack •Cotton applicator •Needles •Spools
•Square pack •Penrose drain •Instruments

Injury to the patient

A.Burns – which may occur from:
a. hot instruments c. hot water or normal saline d. hot water bag
b. hot packs solution e. use of electrocautery
Prevention:
1. Test the temperature of the solution
2. Have a cold water available for washing hot instruments
3. Checks electrocautery frequency
4. Observe precautionary measures in used of hot water bag.
a. check the temperature c. enclose what is in the linen cover
b. check the leakage d. check frequently

B. Falls
Prevention:
1. Strap the patient securely
2. Do not leave the patient unnecessarily
C. Improper Identification of the patient
Prevention:
1. Check operating room identification card with that of the patientl
2. Address the patient by name.
3. Check the patient’s record with that of operating room schedule.
D. Giving of Wrong Drugs
Prevention:
1.Double check drug label
2.Repeat the name of drug whenever it is given to the anesthesiologist/ surgeon.
3.No prepared drugs from the ward should be given by the operating room nurse.
E. Loss of Specimen
which could mean the possibility of a second surgical procedure to obtain another.
a. Improperly labeled specimen could mean a mistake in the diagnosis with possible critical involvement for two patient.
b. The loss of specimen could be vital if the diagnosis is not made and proper treatment is not given
Prevention:
1. Label the specimen properly.
2. Whereabouts of the specimen should appear in the nurse notes
3. Have specimen notebook available
Consent for Operation
Factors for Validity are the following:
1. Signed at legal age 3. Signed in the presence of a witness
2. Signed understand by patient or relative 4. Not under the influence of alcohol or drugs.
In Summary the nurse can minimize or prevent potential hazards by:
 Never leave a sedated patient unguarded. If left unattended the patient may injure himself in a fall or equipment.
 Use good body mechanism and adequate restraints. Injury can occur to patient due to faulty body mechanism, or
the patient can fall due to inadequate assistance, restraints or stabilization during the transport or transfer to the
operating room.
 Correctly identify patients, operative note, drugs or medications. An incorrect operation of the patient or error in
medication is usually the result of inadequate identification.
 Create, maintain and control an optimal therapeutic environment in the operating room. This involves control of
the physical environment such as temperature and humidity and personnel. Traffic flow in and out of the room
should be kept to a minimum. The more operating room, it should be kept quiet so that the effects of sedation are
not counteracted. Standards of ethical conduct should be strictly a forced.
 Assure that mandatory aseptic principles are adhered to by the entire team at all times. There is no compromise
with sterility. Proper sterilization and housekeeping practices must be followed without deviations.
 Prevent a foreign body form remaining in the wound of the patient. All needles, sponges and instruments are
counted. Sharp items must be protected before disposal to prevent injury to patient.
 Carefully handle and accurately label all the specimens and cultures. An error could mean an inaccurate
diagnosis, thereby or re-operation.
 Document all that occurs as part of the patient’s permanent record. Writing nurse’s note or progress notes on the
patient’s chart and completing an intra-operative observation checklist provide a profile of what has happened to
the patient.