Case Study Legal Issues Health Care Mrs G

RN Jane is on her second post graduate rotation in a large general medical ward. One of Janes assigned patients is Mrs. G who is 40 years of age was very ill and required 6 pm IV antibiotics as part of her treatment. Jane needs to get this re-ordered as the medication chart shows the older order has expired and at handover it was confirmed that Mrs. G was to continue on the antibiotics. Mrs. G is one of two of Jane’s patients going for an X-ray at 4 pm. At 3:30pm X-ray Department phones and asks for the two clients to be transported to them. Jane requests two wardsmen to assist with the transfers. Both patients were transferred to X-ray.

Jane then placed a call for the medical officer to update Mrs. G’s medication and also to get an order for pain relief for Mrs. Y as she had not responded to simple analgesic. The medical officer returned Jane’s call and said that he would order Pethidine 50 mgs for Mrs. Y and renew the antibiotic order as soon as he could.

As 5.55 pm, Mrs. Y was very distressed. Jane went to another RN and asked her to check Pethidine 50 mgs for Mrs. Y, stating that the medical officer has given a verbal order and will write it up soon. They do this together and administer the drug as per ward protocol.

Jane went to have tea. Mrs. G was still at X-ray. Meanwhile the other patient had been transferred back to the ward. Jane assumed that Mrs. G was still being treated by the x-ray staff.

Some time later, Jane noticed that Mrs. G was still not back from X-ray and she went to telephone the X-ray Department to check on Mrs. G. Her plans changed when she was called urgently to attend to Mrs. Y who was confused, sweating and agitated. It was then 7:15pm. Mrs. G’s sister visited the ward at that time and was told that Mrs. G was still in the X-ray Department. She wheeled Mrs. G back to the ward stating, “My sister was left alone and everyone in X-ray has gone.” The sister was furious. Jane immediately assessed Mrs. G and she was so unstable she initiated a Medical Emergency Team (MET) Call.

ASSIGNMENT TASK:

Write an essay that:

applies the elements of negligence to the situation of Mrs. G. Discuss how you would analyze the actions of RN Jane and other staff, and

with reference to professional governance, describe the activities that relate to the administration of the Pethidine to Mrs. Y. How would investigators analyze these activities.

INTRODUCTION

Nurses should be familiar with legal and professional issues in healthcare that would help them recognize situations in need of boundaries and make decisions with sound judgment and critical skills in rendering healthcare. In the case mentioned above, RN Jane’s judgment led to a series of complications and injury to her clients. Negligent conduct applies to RN Jane and the healthcare professionals’ actions who were responsible of the safety and healthcare of Mrs. G and Mrs. Y in which the behavior resulted in unintended harm (Savage 2007, p. 63). Negligence is only one of the many torts or ‘civil wrong made against a person or property’ (Potter & Perry 2005, p. 402) and is also one of the most widely known tort (Staunton & Chiarella 2003, p. 35). However, the plaintiff would have to prove four important elements of negligence in order to have a successful action.

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Nevertheless, the professional governing bodies aid nurses by setting codes for professional practice and competency provided by the Australian Nursing Council that offers a benchmark in which the profession is measured and should be constantly reviewed by the nurses to maintain professional discipline (Savage 2007, pp. 97-98). Other guidelines are provided in terms of evidence based researches and other updates regarding the nursing practice including new medication guidelines especially in administering Pethidine which was the case regarding Mrs. Y.

Considering the legal and professional boundaries of a registered nurse, the essay will further discuss the issue of negligence and its elements in relation to the case. Furthermore, the essay will bring forward professional governance specifically an update with regards to the administration of Pethidine.

Write an essay that:

1. applies the elements of negligence to the situation of Mrs. G. Discuss how you would analyze the actions of RN Jane and other staff

The case speaks about negligence which is an incidence in which a client was caused harm or injury may it be physical, psychological, social or financial due to someone else’s act or omission which fell below the expected standard of care (Potter & Perry 2005, p. 402). However, the plaintiff must prove their case on the balance of probabilities meaning that all four elements of negligence are present for an appropriate action to be successful through the production of the burden of proof such as evidences, witnesses and subpoenaed documents and charts in order to prove negligence (Daly, Speedy & Jackson 2004, p. 108). It must be established by the client who was caused injury that the nurse who was in charge owed them a duty of care and that duty of care was breached because of the action of the nurse or the lack of it that resulted to the injury of the client.

Duty of care

Each of the professional persons owes his client a duty of care. Health professionals owe their clients a duty of care when the nurse-patient therapeutic relationship begins (Steward, Kerridge & Parker 2008, p. 34). RN Jane holds a duty to render reasonable care in providing professional and competent service to Mrs. G. ‘In determining whether a duty of care has arisen it must be demonstrated that it was foreseeable the act or omission in question could have resulted in injury of the patient’ (ed. Kennedy 2008, p. 132). The National Competency Standards for the Registered Nurses also gives guidelines in which the nurses need to fulfill the duty of care in such a way that the nurse must have the responsibility to recognize situations to prevent harm and to properly recognize aspects of healthcare that needs to be endorsed to other members of the health team (Australian Nurses & Midwifery Council 2006, p. 3 of 14).

However, the RN Jane is not only the one liable for the duty of care to the patient but the institution as well. The relationship that exists between the hospital and the institution explains the concept of non-delegable duty (Daly, Speedy & Jackson 2004, p. 109). The hospital owes responsibilities for the safety of the patient such as provision of competent staffs, appropriate documentation and record keeping and proper maintenance of equipments (Savage 2007, p. 63).

Breach of duty of care

Once the duty of care has been established, the second element that needs to be proven by the plaintiff is that the duty of care was violated by healthcare team if the breach fell below the expected standard of skills required for the profession (Kennedy 2008, p. 133). Breach of duty ‘refers to failure on the defendant to meet the standard of care that the law requires’ (MacFarlane 2000, p. 107). In the competency standard domain that discusses professional and ethical framework of assessing consequences of various outcomes of decision making (Australian Nurses & Midwifery Council 2006, p. 5 of 14), RN Jane’s decision to bring the patient to the X-ray department in an unstable condition was detrimental to the health of Mrs. G especially without proper assessment and attendance by a nurse. Furthermore, RN Jane violated the statement from the competency standards in preventing harm since Mrs. G was left unattended in the corridors (Australian Nurses & Midwifery Council 2006, p. 3 of 14). There was also poor communication between RN Jane and the other health services involved which contravenes the statement from the competency standards that the nurse must collaborate with the interdisciplinary healthcare team in providing quality nursing care where in the case, poor endorsement was involved regarding the serious condition of the client (Australian Nurses & Midwifery Council 2006, p. 13 of 14).

Damages resulting

The plaintiff must establish that she suffered damage for the court to award compensation (Daly, Speedy & Jackson 2004, p. 109). Damages in the negligence context refer to three types of specific damages in which physical damages refer to the obvious physical injuries which are easily identified; financial damages refer to the financial loss of the client due to the negligent conduct of the nurse and psychological damages which are now highly recognized by the court refers to the nervous shock and emotional distress the situation has caused to the client and her significant others (Staunton & Chiarella 2003, p. 73). In the case of RN Jane, the breach of duty caused the client to be physically more unstable requiring emergency attention which also caused for the family to carry more financial burden other than the actual reason of hospital confinement and even psychological distress for the client and the family as well especially for Mrs. G’s sister who was shocked and furious of the occurrence.

Causation

The greater burden of the plaintiff is proving the fourth limb of negligence which is the breach of duty of care led to the cause of the injury (ed. Kennedy 2008, p. 134). There must be a direct relationship between the nurse’s breach of duty of care and the client’s injury or damage for the plaintiff to be awarded the amount deemed appropriate by the court (Staunton & Chiarella 2003, p. 76). There is causal relationship when the harm was done to the client and no intervening event is responsible for the injury other than the nurse and the other healthcare team members. RN Jane has an independent duty to prevent harm (Cherry & Jacob 2005, p. 159) and by sending the client to the X-ray department without proper assessment, detailed endorsement and appropriate supervision, the client was caused injury.

If all points above are found to be proven then the action of negligence becomes successful and the plaintiff will be awarded by the court with reasonable amount to cover the damages. In light of the situation, RN Jane must follow through the Nursing Act 1992 (sec.140b) stating that if a registered nurse is claimed to be alleged with a negligence case, she must notify the Queensland Nursing Council of the judgment within 30 days (Queensland Nursing Council 2006, p. 1 of 3).

2. with reference to professional governance, describe the activities that relate to the administration of the Pethidine to Mrs. Y. How would investigators analyze these activities.

Healthcare trends continually change overtime and nurses would have the need to blend in their clinical knowledge and skills to keep up with the healthcare changes. In light of this, nurses are called out to adhere to the state’s governing body that ensures the educational updates and assessment of healthcare professionals to meet the set standards (Savage 2007, p. 96). The National Standards of Competency for Registered Nurses states that nurses are accountable and responsible in the development of his learning and professional practice in accordance with the health needs of different clients, changes in the healthcare system and to maintain current knowledge base in the nursing field and integrate it to practice (Australian Nurses & Midwifery Council 2006, p. 2 of 14). This includes procedural practices, administration of medications and evidenced base nursing researches. The professional governing bodies’ goal is to promote public safety by making sure that the healthcare professionals meet the specific standards through proper distribution of information (Savage 2007, p. 113). However, it is still within the prerogative the registered nurses to keep themselves informed in regards with the updates and changes of the healthcare system.

In relation to the case of RN Jane and her colleague’s administration of Pethidine 50 mg to Mrs. Y, both registered nurses were poorly updated in regards to new information regarding the said drug. Pethidine is a Schedule 8 Drug or Controlled Drug which is prescription only and used mainly for strong pain relief but is highly restricted because of its dependence and abuse forming nature (Environmental Health Unit 2008, p. 7 of 17). Serious adverse effects such as tremor, twitching, agitation, confusion and seizures (Molloy 2002) led for the Drug Usage Advisory Committee to recommend to the Queensland Hospitals Drug Advisory Committee back in September 2004 to review the appropriateness of Pethidine use and the feedback resulted that the use of the said drug should be discouraged (Queensland Hospitals Drug Advisory Committee 2007, p. 2 of 2). It is also recommended that other clinicians besides obstetricians and anesthetists order Pethidine for specific needs, the local medical superintendent should be notified for approval of the individual patient approval such as instances of true allergy to opioids (Queensland Hospitals Drug Advisory Committee 2007, p. 2 of 2). RN Jane and her colleagues should have consulted the medical superintendent regarding the order of Pethidine to Mrs. Y. Furthermore, the use of Pethidine in wards and in the emergency department has been discouraged effective since the first of December 2004 (Queensland Hospitals Drug Advisory Committee 2007, p. 2 of 2) which should have been familiar to RN Jane and the other nurses in order to have suggested to the prescribing physician to use an alternative pain medication.

RN Jane should have assessed Mrs. Y further when she was distressed at 5:55 pm and should have relayed her findings to the medical officer to confirm the administration of Pethidine. RN Jane also demonstrated poor assessment skills in terms of asking the patient of previous drug and food intake that could have an interaction with Pethidine such as MAOIs (Molloy 2002) which may have caused complications. The National Competency Standards for Registered Nurses states that the nurse should be able to question and clarify orders that are unclear or maybe questionable in which such intervention may lead to compromise the care (Australian Nurses & Midwifery Council 2006, pp. 3-4 of 14). The investigators may analyze that RN Jane could have questioned the clinician and suggested to have used another type of opioid less dangerous than Pethidine. In addition, medication orders should be complete meaning that it should include the right patient, drug, dosage, route and frequency which was vague in the case (Queensland Nursing Council 2005, p. 2 of 3).

The doctor may have ordered the medication but the nurse has an independent duty to clarify the order. Guidelines on reducing medication errors and provision of the professional governing bodies of updates on researches and modifications regarding Pethidine should be known by RN Jane and her colleagues. The professional bodies are present to make aware the nurses of new information provided for the practice that protects them legally and protects the public as well.

CONCLUSION

This essay provided fundamental points of negligence and the elements that are needed to be proven for a successful action to make RN Jane and the health team involved to be liable or to be held responsible for their actions. Success of proving negligent claims award the plaintiff compensation for the injury caused (Savage 2007, p. 76). In failure of keeping responsibilities of safe healthcare, the Queensland Nursing Act 1992 (s.116) states that the nurse may reprimand or caution the nurse, remove or suspend the nurse from the register, limit the nurse’s practice or restrict certain professional activities. Healthcare professionals are part of the group usually anxious about liabilities over the likelihood of their actions that may cause harm to another person or property. However, this anxiety may be reduced when the nurse adheres to the standards set within the nursing practice (Funnel, Koutokidis & Lawrence 2005, p. 231) such as proper communication with the client and the healthcare team, proper documentation and record-keeping and practicing safe health care.

Nurses are also called out to adhere to the professional governing bodies whose proficiency and knowledge should be utilized in relation to information, guidelines and research that enables the nurses to be updated on the currency and trends of the nursing practice (Savage 2007, p. 113). The case gave an example in regards with new updates in Pethidine administration in which RN Jane and her colleagues were unaware of. Professional governing bodies continuously update their information sheets and websites to protect the public and give the best care possible. Professional governance can enhance client and staff management that allows the nurses to broaden their education and training for health service developments (McSherry & Pearce 2007, pp. 91-92).

By maintaining good professional governance and adhering to the legalities of the practice, the registered nurse can be more legally secured since he or she is able to practice in a safe manner that would not harm their clients and would protect them from future liabilities.