THE ETHICO – LEGAL ASPECTS OF IV THERAPY

Dr Ramona Heidi C PaladDean , College of Nursing – Xavier University

Duties & Responsibilities of IV Therapist

1. Interpret and carry out the physician’s prescriptions for IV therapy.

2. Prepare, initiate and terminate IV therapy based on physician’s written prescription.

3. Perform peripheral venipuncture (all types of needles and cannulas) EXCLUDING the insertion of subclavian and cut down catheter.

4. Determine solution and medication incompatibilities.

5. Administer computed medications, chemotherapeutic drugs, flow rates of solutions, compatible blood/blood components and parenteral nutrition as prescribed by the physician.

6. Assess all adverse reactions related to IV therapy and initiate appropriate nursing interventions.

7. Establish nursing care plan related to IV Therapy.

8. Adhere to established infection control practices.

9. Maintain proper care of IV equipments.

10. Document relevant data in the preparation, administration and termination of all forms of IV therapy

LEGAL BASIS

• R.A. 7164 – The Philippine Nursing Act of 1991 Section 28 states that in administration of IV injections, special training shall be required.

• IV Nursing Standards of Practice developed by the ANSAP should be used.

IV Therapy and Legal Implications

• In giving IV injections, nurses should follow the policies of their agencies.

• Board of Nursing Resolution No.8 Sc. 30 © Art. VII or administratively under Sc. 21 Art. III – states that any registered nurse without training and who administers IV injections to patients shall be held liable, either criminally, administratively or both.

• R.A. 9173 – The Philippine Nursing Act of 2002, Article VI Nursing (a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to . . .

Administration of written presentation for treatment, therapies, oral, topical and parenteral medications . . .

that in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice.

CODE OF ETHICS FOR NURSES IN THE

PHILIPPINES

• ETHICS according to Webster Dictionary, is the study of the standards of conduct

and moral judgment.

Therefore . . .

• NURSING ETHICS is concerned with the principles of right conduct as they apply to the nursing profession.

N U R S E S A N D P E O P L E

• Values, customs and spiritual beliefs held by individuals are to be respected.

• Nurses hold in strict confidence personal information acquired in the process of giving care.

• Nurses are accountable for their own nursing practice.

• Nurses maintain or modify standards of practice within the reality of any given situation.

• Nurses are advocates of the patients.

• Nurses are aware that their actions have professional, ethical, moral and legal dimensions.

N U R S E S A N D P R A C T I C E S

• Nurses maintain collaborative working relationship with their co-workers and other members of the health team.

• They recognize their capabilities and limitation in accepting responsibilities and those of their co-workers when delegating responsibilities to them.

N U R S E S A N D C O - W O R K E R S

• Nurses are contributing members of society. They assume responsibilities inherent in being members and citizen / society in which they live / work.

• Nurses recognize the need for change and initiate, participate, and support activities to meet the health and social needs of the people

NURSES AND SOCIETY

NURSES AND THE PROFESSION• Nurses are expected to be members of

professional organization of nurses.

• Nurses help to determine and implement desirable standards of nursing education

• Nurses should initiate and involve themselves in structured and non-structured research activities within existing milieu.

• Nurses should assert the implementation of labor standards and lobby for favorable legislations to improve existing socio-economic conditions of nurses.

General Principle of Professional Conduct

Professional are required not only to have an ethical commitment, a personal resolve to act ethically, but also have both ethical awareness and ethical competency

Specific Principles of Professional Conduct

1. Service to Others

2. Integrity and Objectivity

3. Professional Competence

4. Solidarity and Teamwork

PROFESSIONAL VALUES

• CARINGIs the focus of all attributesused to describe NURSING. It is not only the main value of NURSING but the Essence. It is not a nursing act because to care is human and to be human is caring

5 Cs of Caring

Compassionate- Concern- Caring

Confident- Assertive

- Smart

Committed- Willingness to perform

her responsibility

Conscientious- Honest

Competent- Knowledgeable

- Effective / Efficient

Wholistic Approach

Nurse PractitionerI.V. Nurse Therapist

Quality Care

Ethico –legalResponsibility – Accountability

In Varied Health Setting

Impact to Health Care Delivery sites

Industrial Setting

- Company Clinics

- Occupation Health Units

Community Setting

- Health Center

- Rural Health units

- Periculture Centers

Hospital and Institutional

Setting- Lying -in- Hospice

Center- Cay Care

Center

Educational Setting

- Colleges of Nursing

Universities- Other

Colleges and Schools

Home Care Settings

- Independent Practitioners

- Self employed

RELATED LAW OFFENSES

• LEGAL ASPECTS AND THE NURSE

The Republic Act 9173 or the Philippine Nursing Act of 2002 is the best guide the nurse can utilize as it defines the scope of nursing practice.

NEGLIGENCE

Commission or Omission of an act, pursuant to a duty, that a reasonably prudent person in the same or similar circumstance would or would not do.

The Doctrine of Res Ipsa Loquitor

Three conditions are required to establish a defendant’s negligence without roving specific conduct:

1. That the injury was of such nature that it would not normally occur unless there was a negligent act on the part of someone;

2. That the injury was caused by an agency with in control of defendant;

3. That the plaintiff himself did not engage in any manner that would tend to bring about the injury.

• EXAMPLE:

A patient came in walking to the put-patient clinic for injection. Upon administering the injection to his buttocks, the patient experienced extreme pain. His legs felt weak and he was subsequently paralyzed.

MALPRACTICE

Refer to a negligent act committed in the course of professional performance

EXAMPLE:

Giving of anesthesia by a nurse or prescribing medicines

INCOMPETENCE

The lack of ability, legal qualifications or fitness to discharge the required duty.

EXAMPLE:

Although a nurse is registered, if she’s not yet an IV therapists, she is not allowed to give IV medications or do the IV insertion

ASSAULT and BATTERY

• ASSAULT is the imminent threat of harmful of offensive bodily contact

• BATTERY is an intentional, un-consented touching of another person.

• It is, therefore, important that before a patient can be touched, examined, treated or subjected to medical /surgical procedures, he must have given a consent to this effect.

EXAMPLE:If a patient refuses an injection and the nurse gives it anyway, the latter can be charged for battery.

LEGAL TERMINOLOGIES THAT ALSO APPLY IN I.V.

THERAPY

CIVIL ACTION

A non-criminal action whereby one seeks to protect , enforce, or declare a right or address a civil wrong close to him or her. When the harm occurs, the guilty party may be required to pay damages to the injured person

CRIMINAL ACTION

An action brought by a state or federal law enforcement agency or by an official agency on behalf of an individual, to protect one’s person or property or to protect society in general. Punishment includes imprisonment, fine or both.

DEPOSITIONA discovery procedure which is an oral question and answer proceeding, under oath and recorded, wherein the attorneys seek to find out what testimony and evidence will be confronting them in a lawsuit. It is an informal proceeding with lawyers of all parties present.

INTERROGATORYAnother discovery procedure which is the written equivalent of a deposition

RULE OF PERSONAL LIABILITY

every person is liable for his own wrongdoing. No one can bypass this rule with personal assurance.

STATUE OF LIMITATIONSthe time limit set by each state legislature in which civil or criminal action can be brought.

TORTa private wrong by act or omission, which can result in a civil action by the harmed person

SUBPOENAthe process or “paper command” by which the person served must appear at a certain time and give testimony to the court. It is an order under the seal of the court for which one can be held for contempt of court for ignoring the subpoena.

SUMMONSnotification served upon defendant to appear before the court

NURSING LIABILITIES AND PREVENTIVE

MEASURES

Points to Observe in Order to Avoid Criminal Liability

1. Be very familiar with the Philippine Nursing Law.

2. Beware of Laws that affect nursing practice.

3. At the start of employment, get a copy of your description, the agency’s rules, regulations and policies.

4. Upgrade your skills and competence.

5. Accept only such responsibility that is within the scope of your employment and your job description.

6. Do not delegate your responsibility to others.

7. Develop good interpersonal relationships with your co-workers, whether they be your supervisors, peers or subordinates.

8. Consult your superior for problems that may be too big for you to handle.

9. Verify Doctors prescriptions that are not clear to you or those that seem to be erroneous.

10.The doctors should bee informed about the patient’s conditions.

11.Keep in mind the value and necessity of keeping complete and accurate recording.

12.Patients are entitled to an informed consent.

STANDARDS OF NURSING INFUSION CARE

Requirements to become an IV Therapist

• Structure Criteria (not included)

1. Entrance Requirements Level of academic preparation

a BSN graduate, RN, with a current license from the PRC

Behavioral characteristics: Honesty, Reliability, Initiative, Flexibility and Judgment.

Demonstrates Communication and technical skills.

2. Completion Requirement 3 days Basic IV Therapy Training

Program must have successfully participated

3. Renewal / Revalidation of an IV Therapy Card The IV Therapy Card is renewable

every 3 years Attendance to IV related Updates

equivalent to 24 CEU

4. Loss of the IV Therapy Nurse Card

Presenting an affidavit of loss

Submitting Certificate of Training.

Photocopy of the official list of participant of the IV therapy training attended

5. Cancellation of the IV Card PRC license is not renewed.

Any violation of Nursing Law 9173.

IV Card is not renewed for more than 5 years.

Violation in the Standards of IV Therapy practice

PROCESS CRITERIA (not included)

The IV Therapy Program consists of discussions of concepts in IV therapy and demonstration of skills in access-related situations. It has a twenty – four (24 hr) didactic lecture and a practicum with the following evaluation methods

1. Written examinations: pre and post tests2. Completion of the required number of actual

cases for each of the following competencies:– Initiating and maintaining peripheral IV infusion (3

cases)– Administering IV drugs (3 cases)– Administering and maintaining blood and blood

components (2 cases).

The participants will be rated as follows:(a) Didactic – 50%;(b) Practicum – 50%

REFERENCES• Association of Nursing Service Administration

of the Philippines, Inc. (ANSAP). 2000. Nursing Standards on Intravenous Practice 7th Edition.

• Atty. Rustico T. De Belen, BA, BSN, LLB, MSA, PhD and Donna Vivian V. De Belen, BSN, RN,CCRN, CRNA, MS Anesthesia. Nursing Law, Jurisprudence and Professional Ethics 1st EDITION.

• Lesnik, M.J. and Anderson, B. Nursing Practice and the Law. 2nd Edition with revisions. Philadelphia: J.B. Lippincott.

• Pallock: Torts, 14th EDITION.• Philippine Nursing Act of 1991, Republic Act

No. 9173 Section 28 (a), (e).• Prescer: Torts, 3rd EDITION

• PRIMER CODE OF ETHICS THE NURSING SERVICE ADMINSTRATORS OF THE PHILIPPINES.

• Professionals Regulation Commission, Board of Nursing Resolution No. 8.

• Professional Regulation Commission Board of Nursing Souvenir Program Oath taking as Professionals of the Successful Examinees June 6 & 7, 2004 Nurse Licensure Examination.

• Venzon, Lydia M. R.N., M.A., FPCHA. 2003. Professional Nursing in the Philippines 9th EDITION.

• Webster’s New World Dictionary of the American Language. Cleveland and new York: World Publishing Co.