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CASE STUDY OF LEGAL ISSUES IN HEALTH CARE

RN Jane is on her second post graduate rotation in a large general medical ward. One of Jane’s 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.

At 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:

The Australian Nursing and Midwifery Council (ANMC) National Competency Standards for Registered Nurses tells us that ‘nurses are personally accountable for the provision of safe and competent care’ and that they are personally responsible for ensuring that the standards of their practice conforms with the legislation set with the objective of enhancing the safety of people in their care (Australian Nursing & Midwifery Council 2008, p. 3 of 10). With this in mind, this essay will discuss how RN Jane and other staff members compromised the health of Mrs. G through acts of negligence and how they fell below the set competency standards in relation to the administration of Pethidine to Mrs. Y. Negligence relates to incidents when a client suffers an injury to self or property as a result of an act or omission which does not meet the expected standard of care (Potter & Perry 2005, p.402). As this essay further discusses negligence and its elements in relation to the case study above, it will be evident that RN Jane and other staff have been negligent in their care of Mrs. G. Professional governance will also be discussed also in relation to the administration of Pethidine to Mrs. Y as there are new guidelines for the medication that should have been applied. Furthermore, the different liabilities will be mentioned as nurses face different consequences and penalties if proven negligent and liable for the harm or injury done to the patient.

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

Negligent conduct is a behavior that results in unintended harm meaning a person can be found negligent even though that person do not purposely want to harm another person (Savage 2007, p. 63). Nurses will be held liable in the tort (civil wrong) of negligence if proven that he or she has failed to exercise the appropriate level of care (Freckelton & Petersen 2007, p.480). Four elements need to be satisfied before an action of negligence can be brought, that (1) there was a duty of care (2) there was an act or omission that fell below the standard expected (3) the act or omission was the direct cause of damage (4) the damage was reasonably foreseeable (Savage 2007, p.64).

Duty of Care

It is a general proposition that when a nurse-patient relationship exists, duty of care also arises (Freckelton & Petersen 2007, p.481). The common law implies a duty of care and if breached can create a civil liability in negligence against the healthcare giver (Kennedy 2008, p.131). The ANMC National Competency Standards for Registered Nurses tells us that nurses are able to fulfill their duty of care when they are able to conform to the following responsibilities: performs nursing interventions in accordance with the set standards of practice, clarifies responsibility for aspects of care with other members of the health team, recognizes the responsibility to prevent harm, and performs nursing interventions following comprehensive and accurate assessments (Australian Nursing & Midwifery Council 2008, p. 3 of 14). In relation to the case, RN Jane and other staff members are to fulfill these responsibilities in order not to breach their duty of care resulting in any harm or injury to their client.

Legally, individual practitioners are not the only ones liable for the client’s well-being. The hospital or institution also owes a duty of care to their patients wherein the hospital must be able to provide a safe environment for their clients and visitors, a competent staff, appropriate record keeping and appropriate and adequately maintained equipment (Savage 2007, p.5). This duty is non-delegable to the employees of the institution and is resultant upon the relationship which exists between the patient and the institution (Daly, Speedy & Jackson 2004, p. 109). Thus, the institution is also liable if a staff member is found to have harmed or injured a client.

Breach of Duty

Failing to meet the standard of care the law requires is called breach of duty (Savage 2007, p.67). In order for a nurse to be held liable for a negligent action the one who sues (plaintiff) must prove that the nurse’s conduct fell below the reasonable conduct set by the law (Daly, Speedy & Jackson 2004, p. 109). In relation to the duties of care mentioned above, RN Jane has clearly breached them and was not able to conform to her responsibilities. She was unable to perform an accurate and comprehensive assessment of Mrs. G as she brought her down to X-ray even when she was very ill. This also tells us that she did not meet the set competency standard as she did not recognize her responsibility to prevent harm (Australian Nursing & Midwifery Council 2008, p. 3 of 14). The staff member also did not recognize their responsibility to prevent harm for they left Mrs. G alone in the X-ray. It is also evident to the situation that she has not clarified her responsibilities of her care to Mrs. G with the other health team members. RN Jane assumed that Mrs. G was still being treated in X-ray as she was having her tea. Her lack of coordination with the other staff members in the X-ray department led to the situation where Mrs. G was unattended without anyone to watch over her care (Australian Nursing & Midwifery Council 2008, p. 11 of 14).

Causation

Another element that needs to be proven in order to prove negligence is causation, meaning the plaintiff must prove that the damage occurred was a direct cause of the act or failure of the one being sued which is the defendant (Savage 2007, p.72). The defendant will only be held liable for the damage done if it is casually linked to the breach of duty (Daly, Speedy & Jackson 2004, p. 110). This is also called a “proximate cause” wherein there is a direct casual link (Cherry & Jacob 2005, p.159). In this case, RN Jane and other staff members breach of duty concerning Mrs. G’s care evidently suggest they are the proximate cause of damage. Their lack of coordination, lack of assessment and poor decision making led to the life threatening condition of the patient.

Damages

The court will only compensate for the damages to the plaintiff if the said damages are recognized by the court such as nervous shock, pure economic loss, physical injury or property damage and the damage must have also been reasonably foreseeable (Cherry & Jacob 2005, p.159). The purpose of legal action is always to recover damages from the injury caused (Potter & Perry p.402). In negligence it does not matter if the defendant did not mean to do the injury or harm to the plaintiff, as long as there are damages resulting to the plaintiff. The law does not recognize situations that occur when an error of judgment, a wrong diagnosis or a mistake as the cause of the damage (Savage 2007, p.67). Even if there is a breach of duty but damages are not established, negligence can not be proven (Daly, Speedy & Jackson 2004, p. 110). RN Jane and other staff members are subject to litigation once the patient claims for the recovery of damages that she has suffered because of the different breach of duties that has occurred. Once a claim is made against RN Jane, according to the Nursing Act 1992 (s.140b) she must give council notice of the judgment or settlement within 30 days and to provide the notice in the form of a statutory declaration.

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.

In each state there is a governing body that is responsible for ensuring that the education and assessment of professionals meet the standards set (Savage 2007, p.96). The Queensland Nursing Council for example is responsible for administering the Nursing Act 1992. The purpose of having professional governing bodies is to protect the public by informing, monitoring and ensuring their professional members satisfy standards (Savage 2007, p.113). It is then the responsibility of the nurse to update themselves on current legislation and to acquire a wide range of knowledge, skills and professional behaviors which are required to effectively manage the comprehensive needs of patients (Daly, Speedy & Jackson 2004, p. 342). The ANMC Competency Standards for Registered Nurses states that nurses should recognize that quality improvement involves ongoing consideration, use and review of practice in relation to practice outcomes, standards and guidelines and new developments (Australian Nursing & Midwifery Council 2008, p. 6 of 14).

Pertaining to the administration of Pethidine 50 mgs to Mrs. Y, it is evident that RN Jane and the other nurse that helped her are not knowledgeable and updated with the current use of the drug. Pethidine is a controlled drug (Schedule 8) which is prescription only medicines that are used for strong pain relief and the use of these medications are restricted because of their dependence forming nature and potential for abuse (Environmental Health Unit 2008, p. 4 of 17). It can be used for the treatment of acute pain for a short time then other options should be considered due to the risk of its potential serious side effects including tremors, twitching, agitation, confusion and (rarely) fitting (Molloy 2002). It should also not be given to patients who are taking monoamine oxidase inhibitors or MAOIs because of the risk of marked hyperpyrexia, muscle rigidity, seizures, respiratory depression, hypertension and possibly coma (NSW Therapeutic Advisory Group 2004, p. 5 of 11). In the case of RN Jane and her colleague, both nurses also should have checked the five rights (patient, drug, route, dose, and frequency) in administering medication in order to be sure that they are administering the drug in a safe manner (Potter & Perry 2005, p. 827). The situation suggests that they did not make a comprehensive assessment of the patient before administering the drug as the history of the patient with Pethidine should have been checked and its drug interactions in relation to its possible side effect to the patient.

The Queensland Hospitals Drugs Advisory Committee (QHDAC) reviewed the need for appropriateness and necessity of use of Pethidine back in 2004 in relation to its adverse side effects and potential for abuse and it was found out that only a selected group of patients particularly managed by anaesthetists and obstetricians has the need for its use. In addition to that, QHDAC recommends that an individual patient approval should be sought from a medical superintendent if other clinicians other than anaesthetists and obstetricians who wished to use Pethidine for patients with specific needs (Queensland Hospitals Drug Advisory Committee 2007, p. 2 of 2). All opioids are capable of producing the same degree of analgesia as compared with Pethidine (Davis 2004, p. 7 of 11). As an advocate of the patient, it is stated in the ANMC Competency Standards that the nurse can question and/or clarify interventions that appear inappropriate with relevant members of the health care team (Australian Nursing & Midwifery Council 2008, p. 5 of 14). In relation to professional governance, if RN Jane and her colleague were aware of these facts about Pethidine, they would have assessed and checked back with the medical officer before giving the drug to Mrs. Y.

CONCLUSION

This essay discussed the different negligent actions of RN Jane and other staff members. The best way to avoid actions in relation to negligence is by maintaining proper standards of care, giving safe health care within their own level of competence, communicating coherently with other members of the health care team, documenting assessments, interventions and evaluations fully, and developing good relationships with clients (Potter & Perry 2005, p. 827). If the plaintiff succeeds in proving negligence, the courts will then assess the state and amount of damages to be compensated by the defendant whether directly or by access to an insurance policy (Staunton, 2003 p.82). Savage tells us that ‘being fearful of legal consequences should become being aware of and thus guided by legal reasoning in relation to practice’ wherein nurses must always be aware that they will be held liable if proven in court to be negligent (Savage 2007, p.113). The ANMC code of Professional Conduct says that nurses should always practice in accordance with the standards of the profession and broader health system (Australian Nursing & Midwifery Council 2008, p. 1 of 10). That is why the different codes for practice and guidelines, standards and regulation of education all combine to provide nurses with a benchmark against which the professional is measured (Savage 2007, p. 98). This is why nurses should be responsible in updating themselves with these so that they would be able to provide safe and competent care to their patients without being fearful of any legal consequences.

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