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LPN- IV Therapy and the LAW
LPN IV CLASS: Day 1 Sign-in sheet Complete documentation on forms Check for medication card and license Handout handouts Fill out the table name tags
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HOUSEKEEPING DUTIES! Course Requirements Evaluations Schedule
Content Outline Clinical Homework Book Course Requirements……….. You should have all received a memo from your educator reviewing requirements Go over supplies, policy Evaluations…………. Give evaluation and review the course objectives Schedule……………..hand out schedule Content Outline…………Give out hand out Review objectives Clinical…………………Review forms to be completed Homework…………..Homework on the content outline Book………………..go over chapters that are used and talk about CD-rom
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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
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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 Nursing Common- court made law (malpractice)
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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 Remember IV blood in SDS with ZL
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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
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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? Delay in administering the drug Not familiar with drug Wrong route, failure to qualify orders, negligence in patient teaching
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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 These are the first to be covered
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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 Hand out for the laws Laws are more specific…………………….the rules more general
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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 Most information for this class will come from the law not the rule The law is more difficult to understand because of the negatives and wording. So the back of the packet for a handout that will hopefully be helpful.
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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!
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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.
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Standards of Practice for LPNs in the State of Ohio
Ohio Board of Nursing: 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 Ohio Board of Nursing: Maintain knowledge Demonstrate competence Provide nursing care according to education Have graduated from an approved program Nursing care does not involve a function or procedure which is prohibited by the law Works only with in the law-always. Page talks about what happens to the law Implement regimens in a timely manner Will clarify prescribed regimen when unsure If you don’t understand or are concerned about medications or treatments then question it!
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Standards of Practice for LPNs in the State of Ohio
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 Evaluate others If you have to delegate or evaluate to an UAP, then you must be sure you delegate an appropriate task
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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.
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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 In the INS Scope of Practice: A nurse who is going to have a part in IV therapy they need to work with in the scope of practice. Knowledge of A & P Infusion treatment modalities catheters… Participation in the patient’s plan of care Knowledge of infusion therapies Types of fluids and why they are used How to do the ATB correctly Knowledge of psycho/social aspects Being sure we prepare the Pt. and family and provide with education and documentation Collaborate with other team members If you don’t know the answer or don’t know about something then ask or investigate
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Breach of duty The nurse does not want to breach standard of practice or violate employer’s policies
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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
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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 Let’s look at the Law more closely
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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 Under discontinue IV pus/bolus.flushing the heplock is not considered a medication bolus because it is a diluted amount and would not be considered therapeutic
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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
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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
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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?
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Role of the RN in delegation
Assess patient condition Assess type of care Assess complexity Training and skill of person delegating to Resource availability to perform safely What is delegation? LPN can’t delegate IV medication administration Before an RN can delegate the following must be done: What is delegation? Differentiate between delegation and assigning is the feedback loop LPN can’t delegate IV medication administration Re-delegation is not allowed by law Before an RN can delegate the following must be done: Assess patient condition Is the condition appropriate for on LPN to start Assess type of care Assess complexity Training and skill of person delegating to Must be sure the LPN is authorized Resource availability to perform safely What happens in am emergency
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RISK MANAGEMENT What is risk management?
Why and how do we ask for informed consent? Why is documentation important with risk management?
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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.
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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
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INFORMED CONSENT Proactive strategy because it provides patients with information needed to make and informed decision
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Medication Errors New systemwide policy Non-punitive
Anonymous reporting Investigation into the processes not the person
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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
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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
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OCCUPATION RISKS Physical hazards needle stick injuries abrasions
contusions chemical exposure latex allergies Physical hazards needle stick injuries Abrasions small abrasions I.e. cracks in fingers during this time are an open invitation to the microbes that could be found in this procedure Contusions Watch for broken glass (ampules), rough edges of containers Chemical exposure Main concern is with Chemotherapy…although do don’t give Chemo drugs what other concerned might you have with patients who are receiving these drugs????? URINE exposure Latex allergies NO latex gloves, however be careful with latex stoppers—especially if you must remove them to get a medication out or break vials
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Biological Hazards Bloodborne pathogens: OHSA regulations Exposures
Wearing gloves Using safety devices The most effective way of preventing the spread of disease is... Bloodborne pathogens: OHSA regulations Exposures Wearing gloves Using safety devices The most effective way of preventing the spread of disease is... HANDWASHING
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