Presentation on theme: "LPN- IV Therapy and the LAW"— Presentation transcript:
1 LPN- IV Therapy and the LAW LPN IV CLASS: Day 1Sign-in sheetComplete documentation on formsCheck for medication card and licenseHandout handoutsFill out the table name tags
2 HOUSEKEEPING DUTIES! Course Requirements Evaluations Schedule Content OutlineClinicalHomeworkBookCourse Requirements……….. You should have all received a memo from your educator reviewing requirementsGo over supplies, policyEvaluations…………. Give evaluation and review the course objectivesSchedule……………..hand out scheduleContent Outline…………Give out hand outReview objectivesClinical…………………Review forms to be completedHomework…………..Homework on the content outlineBook………………..go over chapters that are used and talk about CD-rom
3 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
4 Sources of law- four primary sources in the United States Constitution- formal set of rules for gov,t and individual rightsStatutes- Federal state and local laws, laws dealing with malpracticeAdministrative law- Board of NursingCommon- court made law (malpractice)
5 Legal terms Criminal law Civil law Tort- private wrong by act of omissionMalpractice- 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 patientRule 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 practiceRemember IV blood in SDS with ZL
6 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 provenThe patient must suffer actual harm or injuryThere must be a causal relationship between the breach of duty and the injury sufferedIf an act of malpractice does not create harm, legal action cannot be initiatedCoercion of a rational adult for placement of IV constitutes assault and battery
7 Breach of Duty Failure to observe Failure to intervene or react Verbal rather than written ordersKnow your scope of practiceMedication errors are an area where nurses face criminal charges what is common cause?Delay in administering the drugNot familiar with drugWrong route, failure to qualify orders, negligence in patient teaching
8 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 lawStandards of PracticeOhio Board of NursingInfusion Nursing SocietyThese are the first to be covered
9 Ohio Revised Code (ORC) Laws that are made and approved by the government of the State of OhioLaws are adopted by official state offices such as Ohio Board of NursingHand out for the lawsLaws are more specific…………………….the rules more general
10 Ohio Board of Nursing Rules Ohio Board of Nursing (OBN) is a government agencyMust abide by the ORC lawsAdopts them as rules to be followedOBN rules can be found on the websiteSpecific rules for LPN IV Therapy – see handoutMost information for this class will come from the law not the ruleThe 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.
11 AccountabilityAs 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!
12 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.
13 Standards of Practice for LPNs in the State of Ohio Ohio Board of Nursing:Maintain knowledgeDemonstrate competenceProvide nursing care according to educationNursing care does not involve a function or procedure which is prohibited by the lawImplement regimens in a timely mannerWill clarify prescribed regimen when unsureOhio Board of Nursing:Maintain knowledgeDemonstrate competenceProvide nursing care according to educationHave graduated from an approved programNursing care does not involve a function or procedure which is prohibited by the lawWorks only with in the law-always.Page talks about what happens to the lawImplement regimens in a timely mannerWill clarify prescribed regimen when unsureIf you don’t understand or are concerned about medications or treatments then question it!
14 Standards of Practice for LPNs in the State of Ohio Report changes in a timely mannerMaintain confidentialityNot disclose patient information unless it will have an adverse affect on their treatment or progressWill evaluate others according to established criteria such as standards of care/practiceEvaluate othersIf you have to delegate or evaluate to an UAP, then you must be sure you delegate an appropriate task
15 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.
16 INFUSION NURSING SOCETY (INS) In the INS Scope of Practice:Knowledge of A & PInfusion treatment modalitiesParticipation in the patient’s plan of careKnowledge of infusion therapiesKnowledge of psycho/social aspectsCollaborate with other team membersIn 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 & PInfusion treatment modalitiescatheters…Participation in the patient’s plan of careKnowledge of infusion therapiesTypes of fluids and why they are usedHow to do the ATB correctlyKnowledge of psycho/social aspectsBeing sure we prepare the Pt. and family and provide with education and documentationCollaborate with other team membersIf you don’t know the answer or don’t know about something then ask or investigate
17 Breach of dutyThe nurse does not want to breach standard of practice or violate employer’s policies
18 Five examples of Breach of duty related to IV therapy Delay in administration of medicationUnfamiliarity with the drugInappropriate route of administrationFailure to qualify ordersNegligence in patient teaching
19 What can any LPN do with IVs (4723.171)? Verify the type of peripheral IV solution being administeredExamine peripheral infusion site and extremity for infiltrationRegulate peripheral IV according to prescribed flow rateDiscontinue a peripheral IV devicePerform routine dressing changes at insertion site for:Peripheral IVArterial linePICCCVP subclavian infusionLet’s look at the Law more closely
20 What can no LPN do… period! Blood and Blood componentsTPNCancer therapeutic medicationchemotherapyanti-neoplasticsInvestigational or experimental medicationsDiscontinue:CVPPICCart lineany line other than peripheralIV Medications other than antibiotics for those trained.IV push/bolus medicationsUnder discontinueIV pus/bolus.flushing the heplock is not considered a medication bolus because it is a diluted amount and would not be considered therapeutic
21 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 linesPrepare or reconstitute an antibiotic medicationVerify blood products with an RNInitiate an IV of:D 5WNormal SalineLactated Ringers0.45% NaCl0.25 % NaClSterile Water
22 What can we do cont.Hang subsequent containers of accepted IV solutions containing vitamins or electrolytesInitiate and/or maintain IV piggyback of an antibioticInject normal saline or Heparin in an intermittent infusion devise or heparin lockChange tubing on IV that terminates in a peripheral vein
23 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?
24 Role of the RN in delegation Assess patient conditionAssess type of careAssess complexityTraining and skill of person delegating toResource availability to perform safelyWhat is delegation?LPN can’t delegate IV medication administrationBefore an RN can delegate the following must be done:What is delegation?Differentiate between delegation and assigning is the feedback loopLPN can’t delegate IV medication administrationRe-delegation is not allowed by lawBefore an RN can delegate the following must be done:Assess patient conditionIs the condition appropriate for on LPN to startAssess type of careAssess complexityTraining and skill of person delegating toMust be sure the LPN is authorizedResource availability to perform safelyWhat happens in am emergency
25 RISK MANAGEMENT What is risk management? Why and how do we ask for informed consent?Why is documentation important with risk management?
26 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.
27 Risk Management, cont. Looks at areas of actual or high risk Looks at customer satisfactionWorks with PI and EOC to provide safest environmentEducatesHelps facilities complies with federal and state mandates
28 INFORMED CONSENTProactive strategy because it provides patients with information needed to make and informed decision
29 Medication Errors New systemwide policy Non-punitive Anonymous reportingInvestigation into the processes not the person
30 DOCUMENTATION Needs to be timely, accurate and complete Objective LegibleUse only accepted abbreviationsDon’t use criticism or complaintsEvery entry dated and timedNo vacant space
31 10 Steps to Medication Safety Know the patientKnow the drugsCommunicate clearlyBeware of look-alike and sound-alike drugsRestrict and standardize drug storage, distribution and stock medsAssess drug delivery devices and maintain competenceWatch the environmentEducate selfEncourage patient participationTarget process not person
32 OCCUPATION RISKS Physical hazards needle stick injuries abrasions contusionschemical exposurelatex allergiesPhysical hazardsneedle stick injuriesAbrasionssmall abrasions I.e. cracks in fingers during this time are an open invitation to the microbes that could be found in this procedureContusionsWatch for broken glass (ampules), rough edges of containersChemical exposureMain 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 exposureLatex allergiesNO latex gloves, however be careful with latex stoppers—especially if you must remove them to get a medication out or break vials
33 Biological Hazards Bloodborne pathogens: OHSA regulations Exposures Wearing glovesUsing safety devicesThe most effective way of preventing the spread of disease is...Bloodborne pathogens:OHSA regulationsExposuresWearing glovesUsing safety devicesThe most effective way of preventing the spread of disease is...HANDWASHING