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Theme 9

Legal Roles and Responsibilities of Nursing

Define responsibilities,accontabilities of Duty Understand issues regarding consents to treatment and the role of nursing Discuss issues pertaining to the documentation of patients information Describe NO CODE ORDER and nurses responsibilities Identify legal issues regarding DANGEROUS DRUGS

Reference and reading

Thompson.I.E.,Melia.K.M,& Boyd.K.M.[2000].Nursing Ethics[4th Ed].Edinburgh, Churchill Livingstone. Nurses ,Midwives and Nurse practitioners Board of Fiji-Scope of practice Decision- making framework.December,2006 Staunton .P & Whyburn [1997] Nursing and the Law[4th Ed] Sydney, London Standard of Nursing Care NMNP board Policy Manual for Nurses-NMNP Board-Launched 2011

Theme 9
Responsible Liable to answer for Accountable Dependable Responsibility State of being answerable Duty Obligation

Attribute indicate that the professional nurse carries out required nursing activities Reliable and trustworthy Responsible for patients/to supervisor

Means that the registered nurse accepts responsibility to be answerable for their actions within nursing including their decision to delegate


Being answerable to all actions and to be able to accept responsibilities for them

Special activities or tasks that are carried out by the nurses, that other health disciplines may or do not perform Performance with knowledge and skills indicative of a competent and responsible person

Nursing care
Duty of care Moral or legal obligation Identity and responsibility

Nursing Responsibilities Sole duty

provide care and comfort to the sick Advances in technology / Knowledge Health promotion and prevention Expanded the function today

Prescribe drugs
Rely on nurses judgment Proper administration Understand medications Observe side effects Teach clients about medication

Professional roles
Assertiveness Sound knowledge Ability to make safe judgment Communication skill-oral/written decision makers, client advocates managers, educators and communicators

2.Objective Understand issues regarding consents to treatment and the role of nursing

Consent agree to/comply permission 3 ways consent can be given 1] Implied 2] Oral 3] Written

A person has the legal capacity to give consent if they are of a legally acceptable age with no mental or legal impairment

Implied Consent
Consent to treatment and care is implied thru the action and postures of patients e.g. pt rolled up sleeves for blood pressure taking. This is a normal daily activities in health facilities.

Consent Oral
Conversation between patient and Doctor Medical examination and tests Advise-condition/treatment/medication Pt accepts and agrees-undergo Rx Pt is verbally consenting to Rx Pt can also disagree

Written Consent-documentary evidence

Consented verbally by the patient Express in writing Significant piece of evidence that a consent was given should a dispute arises

Elements of valid consent

That any consent given is free and voluntarily given That any consent given is informed That the person giving consent has the legal capacity to give such a consent

Granting permission to health care Procedures that involve risks Signature on the form: received the full explanation of the procedure including risks Must be witnessed Doctor to fully explain the procedure or surgery

To be legal
Consent MUST be informed before signing the form They must be told by the one performing the procedure What it consist of Relevant risks possible alternatives Nurses are usually asked to witness the clients signature

Consent is NOT informed

explanation was given when client: Too sleepy Distracted to process the information Under influence of sedative or other drugs Too technical cannot be comprehended by the client Incomplete no risks were mentioned

Consent informed
Do not sign consent if NOT informed Ask Doctor to repeat information Some client may not want to hear the bad news Tell them Knowing the risks and benefits of a procedure is their right and for their protection.

Informed Consent
Aim To promote and protect the clients right to self determination To remind medical practitioners of their duty to provide clients with the information necessary to make intelligent choices about accepting or not accepting the care and treatment

Informed Consent
Doctors responsibility; Explain the surgery, procedures etc Nurses to ensure that all required information is given to the patient

Consent to be fully informed

Client given the relevant information to enable an intelligent choice to be made The client to understand the information disclosed The consent given voluntarily Client was competent to make the choice Client gave the consent and understood the implications of doing so

Adult legally competent to provide a valid consent or to refuse to consent to treatment Children-parent or legal guardian is capable of consenting to the medical and dental treatment of the child. Age of 18 considered full legal capacity to decide for themselves

Informed consent
Respect the patients dignity and the family Respect the patients right to refuse treatment Respect right to privacy and confidentiality of information Respect patients concern Advice is yours/choice is theirs

Without valid consent

Legal repercussion may arise Patient entitled for to be compensated by an award for the damage Because the treatment would constitute a civil wrong[tort] of trespass to the person Patient valid consent is a legal defence against the civil wrong of trespass to the person

Consent to operation
I give permission for the staff of _________Hospital to give me an anaesthetic and perform any operation they consider necessary. Date .. Wife.. Husband.. Witness Consultants approval....


Informed patient is a satisfied patient

3.Objective Discuss issues pertaining to the documentation of patients information

Report Written, oral and computerized based communication-convey messages report at end of shift Record Written or computerized collection of data Process of making entry Recording, charting or documenting Clinical record called chart or clients record

Documents - Patient Information

Admission Patients identifications on the folder Full Name/Age/Address-Village/settlement Phone/Family Contact/Next of kin/visitor

Medical/Surgical/Obstetrical/other history Family History Admission notes Progress notes Investigations Treatment Integrated notes

Purpose Clients record

1.Communication Vehicle for different health professionals interact with client /each other Record provides a central location for notifying health professionals of clients needs progress and current health status

2.Planning Clients care

Health professionals Use data from clients record to plan care for patient Nurses use assessment to determine the effectiveness of the intervention of nursing care plan Provides a base from which all disciplines may coordinate the clients care

3.Legal documentation
Legal document Evidence in court Information given by the client to Doctor/nurse-confidential Property of the Hospital Right to read or have a copy of their record

4.Education, research and health care analysis

Student use the record as an essential educational tool Provide comprehensive view of clients illness,Rx strategies and factors that affect outcome of the illness Valuable source of data for research Helpful information for treatment of other clients

Confidentiality of information
Research and education Used in conference, Clinics Rounds Written papers on Clients studies Important Hold all information in confidence Protect privacy-not using name of client

Review of records Audit for quality assurance Meeting standards

Clients record
Individualization of care Information is recorded individually to each record according to the care given

Legal Documentation of care

Evidence in court Did I describe my care fully? Is it so clear that it will still be understood at a future date? Does it read as something I could defend at a later date

Clear Accurate Up to date Corner stone for safe care delivery Provide flow of information between providers of care

The best way to avoid having to defend yourself in court To chart factually and defensively This involves knowing How to chart What to chart When to chart and Who should chart

How to chart
A skilled nurse charts with a jury in mind and knows that how she charts is just as important as what she charts: Stick to the facts Be Specific Keep record intact Inappropriate comments in your charts increase your legal risks

All entries legible Easy to read Prevent interpretation error Proper handwriting Blue and black ink Ensures permanent record Changes can be identified

What to chart
An incomplete chart reflects incomplete nursing care

Not Charted, Not Done

Record only information that pertains to clients health Record all assessments, nursing interventions, clients problems, clients comments and responses,tests,progress and communications with other disciplines Document events in order in which they occur. No late entry Any care omitted and why

Do not erase, overwrite or use twink Draw a line and initial Write on every line never between lines Never leave blank lines above your entry or between entries Number pages and pt identification on each page used

Use objective factual information rather than opinion or interpretations E.g. client refused medications Client was uncooperative

When to chart
Document nursing care when you perform it or shortly afterwards Never document ahead of time, notes may be inaccurate and you will leave out information about patients response to treatment

Date and Time

Document date and time with each entry Make entries ASAP after performing assessment Record time using the 24 hour clock e.g. 1200hrs or 4.15pm

Frequency of documentation
Indicated by clients condition An unstable client requires more frequent assessment and documentation than a stable patient

Who should chart

No matter how busy you are, never ask another nurse to complete your charting And never cmplete another nurses charting Dangerous Practice

If sue for negligence, both you and your facility will be held accountable because delegated documentation does not meet nursing standard The best offense is a good defense

Determining factor in a great percentage of malpractice cases involving client care It is important that you document clients care Clearly Concisely and accurately


Describe NO CODE ORDER and nurses responsibilities

No Code order
No code order or

Do Not resuscitate

Terminal stage Expected death Generally written Has expressed the wish Goal facilitates comfort to a dignified and peaceful death

Nurses are always present in dying process Important Some knowledge of clients religion/cultures Help the nurse to individualized the care to the client and their relatives Respect the clients wish The family must be informed of the clients wish

No code order
For the nurse to be legally protected there must be a written physicians order for a NO CODE or DO not Resuscitate in the patients folder Hospital policy

Unprofessional to give

Less than the Best Must follow the DNR orders


Identify legal issues regarding DANGEROUS DRUGS

Dangerous Drug
Drug and Poison Act Cap 114 - Dangerous Drugs

Dangerous Drugs
Policy on Dangerous Drugs Nurses, Midwives and Nurse Practitioners Board Launched February,2011

Policy in conjunction
Laws of Fiji Cap 114 Dangerous Drug Infection Prevention and control Guidelines 2010 NMNP Code of Ethics/Conduct for Fiji Nurses 1999 PSC Code of Ethics

Group work /Dangerous Drugs

Group A Policy Maintenance of accurate recording of dangerous Drugs Policy Storage of Dangerous Drugs Group B Policy Safe administration of Dangerous drugs Procedure for Ordering of Dangerous drugs Procedure for Lost or stolen drugs Transfer of Dangerous Drugs Documentation and checking of Dangerous Drugs Group C Group D

Group E

Procedure for collection of Group F Dangerous Drugs from Pharmacy Procedure for Destruction Group H of Dangerous Drugs Use of Dangerous drugs in the Operating Theater

Group G

Guide the RNs under the provision of Dangerous Drug Documents explains the responsibilities and obligations with particular emphasis on the controlled drugs and scheduled drugs E.g. Pethidine and Morphine

Addictive nature
Procuring Storing Accessing Administering Recording ensure that no action or omission on their part of responsibility is detrimental to the interest, conduct of clients

The Sister In Charge shall maintain an accurate record and account for all Dangerous Drugs transactions in the ward/unit

A register must be maintained by sister Responsible person-Doctor Pharmacist or RN Inventory monthly check Chief Pharmacist or inspector [MOH] to check any time

Any discrepancies-report to authority Record in the register to include;| Date/Time/Pts name/NHN/ amount administered/discarded/balance remain signature[2] Administration by Doctor /Registered Nurse Telephone order discouraged-Supervisor Drug chart to be filled -12hrs Must be documented

1.The RN shall ensure the safe administration of Dangerous Drugs The dangerous drug should be administered immediately after preparation or after drawing up in the syringe and the unused portion discarded

Prescription of Dangerous Drugs for out patients are restricted to oral can be obtained from DMO/SDMO. Higher dose or a treatment beyond 4/52approval from PSH Registered MO Dental officer to obtain the approval. Prescription for patient cannot continue beyond 4/52

Prescription for parental Dangerous drugs are restricted to inpatients only Exact administration for inpatients only Prescription for DD must state: prn must be scheduled by time eg Pethidine 50mgs IV every four hours when required for pain relief up to a maximum of ten doses

Storage Kept in a double locked cupboard and labeled DD cupboard separate from other medicines. No other goods to be stored there. Sister In Charge and Shift Supervisor to handle keys Lost or stolen drugs Any theft or significant loss should be immediately reported to to Senior Pharmacist of the Hospital or the Chief Pharmacist at the Government

Transfer of Dangerous Drugs Movements of DD between hospital wards or between pharmacy and wards should be documented in the DD register.

Destruction of Dangerous Drugs DD can only be destroyed by the Chief Pharmacist at the Government Pharmacy Unused or expired dangerous drugs should be returned to the hospital pharmacy or to the Government pharmacy.

Use of Dangerous Drugs in the operating room The doctor is authorized to possess Dangerous Drugs/anesthetist may request issue of ampoules to start surgical list. Both the Doctor and the Registered nurse to sign. Return-both to count/sign

Dangerous Drugs
Ordering Order the drugs on special days Order when there is less in the stock Order the drug on the special order book Get the consultant or registrar to sign The sister In charge do sign also

Dangerous drugs
Collection from the Pharmacy The sister In charge is the ONLY one authorized to collect. On collection: Sister In Charge and pharmacist to check Expiry dates Amount of drugs General-not broken-ampules Signed the order book when received

Dangerous Drugs-In the ward

Check with 1 registered nurse Fill the DD register Book: Date of Entry Time of Entry Amount of Drugs

Dangerous Drugs
Enter number of order book Add the new drugs with balance Write the total amount in the Book and signed with the registered nurse

Dangerous Drugs Administration

Doctor to prescribe the drug To the sister in Charge/Charge Nurse Check the drug chart Patients Name Name of the drug Dosage ,Route of Administration

Dangerous Drug
Check the drug chart Name of patient/Type of drug/Dosage Sister In Charge will enter in The DD register: Date /Time /Name/Dosage/ Dr Prescribing Ensure balance is correct /Sign Actual administration of the drug Sign Drug chart / Time and Date

Dangerous Drugs Documentation

Document in the Nurses notes Date and Time Type of Drug Route of administration Effectiveness of the drug

Dangerous drugs
Checking Handing over Using the drugs Matron monthly count Expiry drugs-To be returned to the Pharmacy Missing to be reported to higher authority

Common problems
Wrong drug Right drug at the wrong time Wrong drug by the wrong route Wrong dosage

Dangerous Drugs



Dangerous drugs


Define responsibilities,accontabilities of Duty Understand issues regarding consents to treatment and the role of nursing Discuss issues pertaining to the documentation of patients information Describe NO CODE ORDER and nurses responsibilities Identify legal issues regarding DANGEROUS DRUGS

Theme 9
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