LPN-CLPN-C

Unit One

Legal Aspects of IV Therapy

Scope of Practice R/T IV Scope of Practice R/T IV TherapyTherapy

LPN-C = An LPN who has had additional education and has passed an examination to obtain certification in an advanced role permitting him/her to provide limited services in intravenous therapy.

LPN-C is the licensed titleAn LPN can ONLY practice IV therapy under the LPN-C scope in the state of certification

Scope of Practice Scope of Practice (cont’d)(cont’d)

Application requirements for a certificate to practice as an LPN-C are as follows:◦Current license to practice as an LPN in the state of Nebraska

◦Successful completion of an approved certification course within one year of certification application

◦Submission of proof of certification course completion

◦Satisfactory passing of board approved exam for certification: 80% out of 100 multiple choice questions (results within 30 days)

Licensed Practical Nurse-Licensed Practical Nurse-CertifiedCertified

ActActPurpose:

◦To provide a means by which licensed practical nurses-certified (LPN-C) may perform certain activities related to intravenous therapy

◦To provide for the approval of certification courses to prepare licensed practical nurses-certified (LPN-C)

◦To ensure the health and safety of the general public

Scope and Authority of Scope and Authority of the Practice of LPN-C in the Practice of LPN-C in the State of Nebraska the State of Nebraska Title 172, Chapter 102Title 172, Chapter 102

Perform limited IV therapy interventions under the direction of an RN or licensed practitioner.

Observe, initiate, monitor, discontinue, maintain, regulate, adjust, document, assess, plan, intervene, and evaluate with regard to IV treatment.

Provide IV interventions only when there is a licensed practitioner or RN assessing the patient at least once every 24 hours ( or more frequently with significant change in therapy or condition).

IV therapy is the responsibility IV therapy is the responsibility of the RN as ordered by the of the RN as ordered by the licensed practitioner:licensed practitioner:The RN must perform a physical

assessment prior to initial IV insertion.The RN need not be on premises in

order for the LPN-C to perform directed activities EXCEPT:◦ Initial venipuncture for a peripheral line◦ Central line activities

The RN must be present at least once in 24 hours.

The RN must be present more than once in 24 hours in cases of a significant change in therapy or client condition.

LPN-C IV ActivitiesLPN-C IV Activities(*Refer to LPN/LPN-C (*Refer to LPN/LPN-C Comparison Chart)Comparison Chart)

Expanded scope of practiceLPN license AND certification as an

LPN-C requiredApproved certification courseExaminationGeneral and direct supervisionAssessment by RN or licensed

practitioner required every 24 hours (or more frequently when change in client’s condition or IV therapy occurs)

LPN-C ActivitiesLPN-C ActivitiesAdult PatientsAdult Patients

(*Direct Supervision)(*Direct Supervision)Initial venipuncture to upper extremity

(with use of 3-inch device or less)◦ NOTE: RN MUST PERFORM FACE-TO-FACE

ASSESSMENT OF PATIENT PRIOR TO IV INSERTION

Infuse IV fluids and administer medications through a continuous flow central line◦ NOTE: INFUSING FLUIDS AND ADMINISTERING

MEDICATIONS THROUGH AN INTERMITTENT CENTRAL LINE IS NOT PERMITTED

Administer the initial dose of an approved medication

May add 500cc Dextrose 10% as a meal replacement

LPN-C ActivitiesLPN-C ActivitiesAdult PatientsAdult Patients

(*Under Direction)(*Under Direction)Venipuncture to upper extremity

(with use of 3-inch device or less)Infuse IV fluids and administer

medications through an intermittent OR continuous flow peripheral line

Calculate and regulate rate of flowAdminister approved medications via

push OR piggybackReinsert, convert and flush peripheral

intermittent devicesFlush peripheral lock with heparin or

saline solutionAdd pain medication solutions to a

PCA pump

LPN-C ActivitiesLPN-C ActivitiesPatient-Controlled Analgesia Patient-Controlled Analgesia

(PCA)(PCA)Pain medication MUST be

◦Prepared by a pharmacist or physician

◦Prepared by the RN◦Commercially prepared

All ordered settings and medications for PCA MUST be◦Checked by the RN◦Signed on the PCA infusion sheet

LPN-C ActivitiesLPN-C ActivitiesPediatric PatientsPediatric Patients(*Under Direction)(*Under Direction)

Pediatric Patient = one who is both younger than 18 years of age AND under 35 KG

Administer pain medications by PCA◦ Only if medication is commercially prepared or

prepared by physician, pharmacist, or RN◦ Always checked by RN after PCA pump has been

set per order and before infusion is started◦ RN must sign the PCA infusion sheet

Flush intermittent peripheral deviceMay NOT calculate the rate of IV fluid

infusionsMay NOT perform venipuncture

Medications that are Medications that are NOTNOT approved forapproved forLPN-C administration are as LPN-C administration are as follows:follows:BloodBlood productsAntineoplastic agentsOxytocics

◦Pitocin◦Ergotrate◦Methergine◦Syntocinon

Anti-arrhythmicsHyperalimentation

IV administration by the LPN-C IV administration by the LPN-C of approved medications by of approved medications by approved methods shall be approved methods shall be those for which nursing those for which nursing interventions are routine and interventions are routine and predictable in nature related to predictable in nature related to individual responses and individual responses and adverse reactions.adverse reactions.The RN must consider:Adverse consequencesHow adverse consequences are manifested

How adverse consequences are measured

What intervention is requiredHow intervention is applied

LPN-C RenewalLPN-C Renewal

Certification as an LPN-C must be renewed along with LPN license

Must complete 5 hours of IV-related continuing education; these hours can be included in the 20 hours required for LPN renewal

Renewal of LPN license and certification is due on or before October 31st during odd-numbered years

Clinical Competencies for Clinical Competencies for HLTH1210HLTH1210

The LPN must demonstrate the ability to:

Select administration site◦ Hands◦ Forearms◦ Antecubitus◦ Upper arm

Assemble equipment and set up flow control administration devices◦ Gravity◦ Pump(s)

Clinical Competencies Clinical Competencies (cont’d)(cont’d)Perform at least 3 venipunctures in

the lab and/or clinical area under the direct supervision of faculty◦ Selection of appropriate site◦ Preparation of site◦ Selection of appropriate type/size of

catheter◦ Completing the venipuncture◦ Securing the device

Problem-solve non-functioning peripheral IV lines

Convert and flush a peripheral intermittent infusion device◦ Drawing up correct irrigant

Clinical Competencies Clinical Competencies (cont’d)(cont’d)

Add a fluid to a functioning central venous line

Change central line tubing and sterile dressings at insertion site

Document the insertion of a peripheral IV

Document the administration of select fluids

Document the administration of acceptable medications

Add a fluid and/or medication to an infusion pump◦ Change tubing◦ Reset administration parameters

Pathway to achieving and Pathway to achieving and demonstrating competence in demonstrating competence in

IV therapyIV therapyStudy the professional and legal

implications of expanded practice and accountability

↓Undertake study relating to IV therapy,

obtaining knowledge, skills, and evidence for practice

↓Undergo a period of supervision from

faculty who is experienced in IV therapy↓

Demonstrate competence

It is essential for the LPN to It is essential for the LPN to develop a knowledge base in develop a knowledge base in the following areas:the following areas:1. Accountability2. Circulatory anatomy and

physiology3. Fluid and electrolyte balance4. Techniques and equipment

used for IV therapy administration5. Pharmacology6. Administration of fluids7. Risk management relating to IV

therapy8. Possible effects of treatment on

the patient physically, socially, and psychologically

Elements of CompetenceElements of Competence

Describes the rationale for administration of medications via IV

Describes the risks associated with IV medication administration

Demonstrates knowledge of medications routinely administered by IV in the clinical area

Describes the signs and symptoms exhibited if a medication reaction occurs

Describes and takes appropriate action in the event of a medication reaction

Correctly calculates doses, volumes, and rates of medications to be given by IV

Elements of Competence Elements of Competence (cont’d)(cont’d)

Demonstrates appropriate techniques and actions in preparation of medications for IV administration

Demonstrates SAFE practice in the administration of prescribed IV medications

Demonstrates appropriate techniques in the administration of IV medications by bolus or infusions-over-time

Demonstrates health promoting practices in caring for IV access and medication administration

Describes how to act appropriately in the event of a drug error or adverse incident associated with administration of IV medications

Elements of Competence Elements of Competence (cont’d)(cont’d)

Demonstrates awareness of professional accountability

Demonstrates knowledge of available resources related to medication information, local policy, and current evidence for practice

The Five Rights of The Five Rights of Medication Medication

AdministrationAdministrationRight patient

Right medication

Right dose

Right route

Right time

The Three Checks of The Three Checks of Medication Medication

AdministrationAdministration1. Read the label of the

medication as it is removed from the shelf, unit dose cart, refrigerator, or dispensing system

2. Read the label of the medication when comparing it with the MAR

3. Read the medication label again before administering the medication to the patient

Medication Verification (cont’d)Medication Verification (cont’d)

LOOK at the label for verification of the medication name, dosage, route, and expiration date

CHECK the medication itself, NOT just the pharmacy label

Be overly cautious with regards to dose, proper dilution, and administration rate

Watch decimal pointsBe aware of the unit

◦ Is the medication dispensed in mcg or mg?

◦ What is ordered in comparison?

Infusion Nurses Society Infusion Nurses Society (INS)(INS)

(781) 440-9408(781) 440-9408www.ins1.orgwww.ins1.orgRecognized globally as an authority in

infusion therapyPlaces the highest priority on the care

and safety of patients receiving infusion therapy

Dedicated to exceeding the public’s expectations of excellence by setting the standard for infusion care

Developed standards of practice backed by evidence-based research

Supports professional certification

The INS’s Infusion The INS’s Infusion Nursing Standards of Nursing Standards of

PracticePracticeThe Standards of Practice have undergone an extensive review process by INS nurses, pharmacists, physician, legal advisors, healthcare clinicians, and manufacturers of infusion therapy products

Defines the accountability of nursing in the participation and delivery of specialized nursing care

Provides measurable components in establishing nursing competencies, performance improvement criteria, and identification and evaluation of patient outcomes

INS Standards of Practice INS Standards of Practice (cont’d)(cont’d)

Used as a framework for the development of organizational infusion-based policies and procedures applicable for all practice settings and all patient populations

The Infusion Nurses Society’s Infusion Nursing Standards of Practice include nursing practice, patient care, documentation, infection control and safety compliance, infusion equipment, site selection and device placement, access devices, site care and maintenance, infusion-related complications, nursing interventions, nonvascular access devices, and infusion therapies

Legal Aspects of IV Legal Aspects of IV Therapy AdministrationTherapy Administration

Legal aspects of IV therapy administration are important as your role as LPN is expanding

With the increase in responsibility comes an increase in liability

You have a duty to care for the patient without exceeding the scope of your LPN Certification

Knowledge of the standards of practice within the bounds of the LPN Certification is critical to malpractice prevention

Over 85% of hospitalized patients will receive IV therapy

Legal Aspects (cont’d)Legal Aspects (cont’d)Of the 180 million IV’s inserted,

150 million are peripheral IV’sTherefore, there are 150 million

opportunities for the nurses who insert peripheral lines to become involved in litigation

Most lawsuits involve cases of infiltration and phlebitis that juries feel could have been prevented

Liability IssuesLiability IssuesInfiltration = the leakage of IV solution

or medication into surrounding tissueThe nurse is responsible for selecting

the appropriate device, needle gauge, venipuncture technique, and venipuncture site

If an infiltration occurs, the priority concerns include:◦ What was the solution that infiltrated?◦ Could the vesicant cause tissue necrosis?◦ How much of the solution infiltrated?◦ How soon was the infiltration discovered?◦ Was the patient injured by the infiltrate?◦ What injury occurred (i.e. nerve

compression, tissue loss, disfigurement, loss of function)?

Causes of Legal Action inCauses of Legal Action inNursing PracticeNursing Practice

The two most common causes of legal action in nursing practice are◦ Unprofessional practice = failure to conform

to minimal standards◦ Professional malpractice (civil action) =

professional misconduct or unreasonable lack of skill that results in harm

Professional nursing practice is measured based on what a reasonable and prudent nurse would do

Measuring tools include the Nurse Practice Act, institutional policy and procedures, the Nurse’s Code of Ethics, and HIPAA

Nurse Practice ActNurse Practice ActDetermines the scope of

professional nursing practice in a particular state

Establishes guidelines whereby the nurse can perform skills or services

Describes rules and regulations that provide guidance

Establishes educational, examination, and behavioral standards for nurses that protect the public

Enforces these requirements

Institutional Policy and Institutional Policy and ProceduresProcedures

KNOW the specific policy and procedures related to LPN-C functions in your facility

Code of EthicsCode of EthicsStatement of values developed by

the American Nurses Association (ANA) to provide guidance to the nurse and protection for the client and family

Code of Ethics (cont’d)Code of Ethics (cont’d)Correlates with the Patient’s Bill of

RightsConsists of ethical principles that

dictate nursing action:◦ Autonomy = the right to independence◦ Beneficence = doing good for patients◦ Nonmaleficence = doing no harm to patients◦ Veracity = truthfulness◦ Fidelity = an obligation to be faithful◦ Justice = an obligation to be fair to all people

In decision-making, the nurse’s choices and actions should ideally reflect three criteria:◦ They should be best-practice clinically◦ They should be within the legal scope of

policies, procedures, and practice acts◦ They should be the right things to do morally

Dilemmas of AutonomyDilemmas of AutonomyInvolves freedom to take action for

self and make decisions that will impact own welfare◦ Ability to determine personal goals◦ Complete understanding of choice◦ Freedom to implement plan or choice

Dilemmas of autonomy are often related to beneficence issues◦ Occurs when individuals other than the

patient must determine, or attempt to determine, what’s best for the patient

Dilemmas of BeneficenceDilemmas of Beneficence

Involves acting in the best interest of others, such as through patient advocacy◦ To contribute to the well-being of others◦ To promote good◦ To prevent harm◦ To remove harm

Dilemmas of beneficence occur when health care providers, the patient, and/or family members disagree about what course of action is in the patient’s best interest

Dilemmas of Dilemmas of NonmaleficenceNonmaleficence

Involves the avoidance of intentional or unintentional harm

Related to the principle of beneficenceOften involves the nurse’s responsibility

to “blow the whistle” if another is seen as compromising the patient’s safety

The nurse is charged with protecting those that cannot protect themselves, such as the mentally challenged, the unconscious, the weak, and the debilitated

Discourages experimental health research that may have a negative outcome

Prohibits the performance of unnecessary procedures used as learning experiences

Dilemmas of VeracityDilemmas of VeracityVeracity = truthfulnessPatients may not be given

information about health care treatment or outcomes if the information would cause further harm to the patient

Not telling the patient the truth may show lack of respect for others and untrustworthiness of the person telling the lies or omitting the truth

Dilemmas of FidelityDilemmas of FidelityEmbodies the nurse’s duty to be

loyal, faithful, and keep promisesDilemma occurs when the nurse is

forced to be loyal and accountable to two opposing interests

One situation may be a conflict between duties and loyalties to the patient and the economic needs of the employer --◦ Example: The nurse is forced to

discharge a patient from outpatient care because the patient can no longer pay for services

Dilemmas of JusticeDilemmas of Justice

Encompasses the nurse’s duty to be fair and equitable, and provide access and appropriate care to all patients

Begs the question, “Who is entitled to these goods and services?”, when dividing limited health care services

One example may be an organ procurement system

Moral DilemmasMoral DilemmasMoral dilemmas occur when one must

make choices that are complicated by uncertainty, psychological pressures, and personal emotions

In health care, choices must often be made quickly, further complicating the dilemma

Ethics, the law, and best practice do not always agree -- ◦ Example: A patient verbalizes to the nurse

that she does not want to have surgery, but has given consent because her husband insisted. Since this is not a valid consent via informed consent protocol, the nurse contacts the physician even though the surgery is in the patient’s best interests.

The Health Insurance The Health Insurance Portability and Portability and

Accountability Act (HIPPA)Accountability Act (HIPPA)Protects the patient’s privacy, confidentiality, and security of medical information

ONLY those who need to know patient information for the care of the patient, and those authorized by the patient to have access to his or her medical information, can lawfully enter a patient’s medical record

Take care when faxing patient informationHealth care facilities must demonstrate that

their computer systems are trustworthy enough to be used in court (i.e. software automatically records entries with time, date, and author; when an error is corrected, the software preserves both original and corrected versions)

The Patient’s Bill of RightsThe Patient’s Bill of RightsGuarantees certain rights and

privileges to every patientThe nurse shall be an advocate for

the patient’s rightsThe Bill of Rights should be given

to each patient upon admission to a health care facility

Areas Most at Risk for Areas Most at Risk for MalpracticeMalpracticeA study of 747 malpractice claims in which

nursing negligence (i.e. failure to adhere to a standard of care) led to a settlement was conducted in 1997

Of the 747 cases, 219 resulted in death76 of these deaths were related to

inadequate communication to the physician46 were caused by inadequate assessmentMedication errors led to 42 deaths17 resulted from inadequate nursing

intervention21 deaths were caused by inadequate care7 deaths were due to an unsafe

environment 7 were related to inadequate infection

control3 deaths were caused by the improper use

of equipment and products

Most Common Causes of Most Common Causes of LawsuitsLawsuits

*All involved failure to maintain a standard *All involved failure to maintain a standard of practiceof practice

1. Medication and treatment errors2. Lack of observation and timely

reporting on the patient3. Defective technology or

equipment4. Infections caused or worsened by

poor nursing care5. Poor communication of important

information6. Failure to intervene to protect the

patient from poor medical care

Factors Impacting Practice Factors Impacting Practice StandardsStandards

1. Certain knowledge and skills are essential to nursing practice

2. In court, it is difficult to argue the 5 rights of safe drug administration

3. The public is better informed than they used to be

4. When accidents or injuries occur, the public expects accountability

5. Patients are more acutely ill on admission to the hospital and more invasive treatments are required, which can lead to more accidents

6. Nursing shortage and cost containment increases nurse-to-patient ratios

Legal TermsLegal TermsTort = a wrong committed by an act or

an omissionThere are two types of torts –

◦ Intentional: Assault, battery, restraints as a form of false imprisonment, slander, and breach of confidentiality

◦ Unintentional: NegligenceAssault = the unjustifiable attempt or

threat to touch a person without consent that results in fear of immediately harmful or threatening contact (actual contact need not occur)

Battery = the unlawful, harmful, or unwarranted touching of another, or the carrying out of threatened physical harm, REGARDLESS of the intent or outcome

Legal Terms (cont’d)Legal Terms (cont’d)Invasion of privacy is an intentional

tort that may involve◦ Releasing private information about a

patient to a third party◦ Allowing unauthorized persons to read

a patient’s medical records◦ Allowing unauthorized persons to

observe a procedure◦ Taking pictures of a patient without his

or her consentSlander = making false statements

about a patient that cause damage to the patient’s reputation

Legal Terms (cont’d)Legal Terms (cont’d)Negligence = failure to do something

that a reasonable person would do, or doing something that a reasonable and prudent person would not do

Malpractice = a type of negligence◦ Committed by a professional person◦ Any professional misconduct,

unreasonable lack of professional skill, or nonadherence to the acceptable standard of care that causes injury to the patient

◦ The nurse may be held liable for not following the organization’s policy and procedures

MalpracticeMalpracticeIn a malpractice case, four components

are required to prove liability –◦ That there existed a duty to act◦ That there was a failure to carry out that

duty◦ That harm or injury occurred◦ That the injury resulted from the breach of

dutySpecial legal doctrines apply to cases

involving subordinate-superior relationships

Respondeat superior (Italian for “let the master answer”) = if an employee is found negligent, the employer must accept responsibility if the employee was acting within scope of practice

LiabilityLiabilityEach person is liable for his/her own

wrongdoingsNurses are liable in carrying out

physician’s ordersNurses have a legal and professional

responsibility to be knowledgeable regarding IV fluids, medications that are administered, and techniques for initiating and maintaining infusion devices

Risk factors for malpractice suits include infiltration, nerve injury, extravasations, fractured central venous catheters, administration of the wrong medication, and failure to document appropriately

Liability (cont’d)Liability (cont’d)Most lawsuits related to IV therapy

involve infiltration and phlebitis◦ Infiltration = the leakage of IV solution

or medication into surrounding tissue. This is 100% a nursing responsibility

◦ Phlebitis = inflammation of the vein wall; often a precursor to sepsis

Informed ConsentInformed ConsentIf a surgeon performed surgery without

the patient’s consent, the patient could sue for battery, which is legally defined as one person touching another without consent.

A physician can be sued for negligent nondisclosure if the patient did not obtain enough information to enable an informed decision.

Informed consent must be obtained before central line IV insertions

Responsibility to obtain informed consent rests on the physician

The nurse’s signature only acknowledges that this is the right patient for the procedure

Risk Management forRisk Management forInfusion TherapyInfusion Therapy

Know venous anatomy and physiologyKnow appropriate vein selectionUse infusion equipment appropriatelyClarify unclear ordersRefuse to follow orders that you know

are not within the scope of safe nursing practice

Know the infusion indications, side effects, and special considerations for IV medications

Administer medications and/or infusions at the proper rate and within the ordered intervals

Risk Management (cont’d)Risk Management (cont’d)Assess the patient and monitor the IV

site for complicationsUse proper IV care and maintenanceNotify physician promptly of IV

complicationsKnow and give appropriate treatments

for complicationsProvide proper patient educationDocument all aspects of IV therapy,

including patient educationFollow your institution’s

policy/proceduresAbide by Nebraska’s Nurse Practice Act

and standards of IV practiceKeep current in research R/T IV therapy

IV Therapy DocumentationIV Therapy DocumentationIn an IV-related lawsuit, nursing skill

would be considered secondary to accurate, appropriate, and concise documentation

Document ONLY firsthand information◦ What you observed◦ What the patient said or did◦ What you said or did

Use the word “observed” instead of “noted”, as noted could describe an item that was written in the medical record

Write “No IV-related complications observed” instead of “site is normal” to document your assessment of a complication-free venous access site

Documentation (cont’d)Documentation (cont’d)Give details about complications

◦ Nursing interventions◦ Physician orders◦ Patient’s comments regarding the

complication◦ Patient’s response to treatment

Do NOT document opinionsDo NOT chart “patient tolerated

procedure well”, as the court may view this statement as an opinion and ask how you reached such a conclusion; instead, chart the patient’s own words in quotation marks (i.e. “That wasn’t so bad…”)

What DO You Chart?What DO You Chart?Date and time of insertion of venous access device

Specific vein chosenGauge and length of infusion device

Brand and style of infusion deviceThe solution that is being infusedThe method of solution infusion

◦Gravity◦Pump (include name and model of pump)

Any comments the patient has made concerning how the infusion site feels

Legal TestimonyLegal TestimonyAt the legal deposition and in court,

you will be asked difficult questionsYou may be asked vein anatomy and

physiology, reasons for choosing certain veins, insertion techniques, etc.

You need to make sure you portray yourself as a professional

Use scientific terms to name veins and identify insertion sites◦ Saying “I started the IV in the patient’s left

hand” may imply that you inserted the cannula into the tissue of the hand instead of a vein.

◦ It is better to say “I inserted the IV catheter in the dorsal metacarpal vein of the patient’s left hand.”

Legal Testimony (cont’d)Legal Testimony (cont’d)Do not say “I always use that catheter

size”, as this does not sound professional. It would be better to say “I chose the smallest catheter size available to promote hemodilution of the infusate and blood flow around the catheter, and to prevent trauma to the wall of the vein” as this demonstrates scientific rationale

Do not mention an incident report in the patient record, as the plaintiff’s attorney may attempt to have the document admitted as evidence

Never include opinions, accusations, excuses, or suggestions in an incident report, as they are subjective, and can be used against you

Legal Testimony (cont’d)Legal Testimony (cont’d)Other questions you may be asked

in a legal situation include:◦ What was the anatomic location of the

catheter tip?◦ What standards did you follow to

monitor the venous access device for complications?

◦ How did you determine that the device was functioning properly?

◦ When did you recognize the signs and symptoms of the complication?

◦ What nursing actions did you take when you recognized the problem?

Legal Case StudiesLegal Case StudiesStaph infection at the IV site was blamed

for a premature delivery; the plaintiff was awarded $8.6 million in a 1992 Florida case

In Ohio, a nurse failed to clamp an IV pump regulating the flow of an antibiotic through a central line to a child; this resulted in the delivery of nearly 7 times the prescribed dosage of gentamycin, causing the child to become totally deaf

In Pennsylvania, an emergency department nurse placed an IV line that infiltrated the patient’s hand, resulting in reflex sympathetic dystrophy; the patient could not return to work, and was awarded $702,000 in damages

Legal Case Studies Legal Case Studies (cont’d)(cont’d)

Several recent lawsuits have involved allegations that the nurse struck a patient’s radial nerve during insertion of an IV line; this can cause compartment syndrome and requires emergency fasciotomy and skin grafts. Uncorrected compartment syndrome can progress to gangrene and amputation of the fingers.

A New York case involving finger amputation related to radial nerve damage resulted in a $40 million jury verdict (this was later reduced to $5 million)

Legal Case Studies Legal Case Studies (cont’d)(cont’d)

When monitoring an IV line, listening to your patient is just as important as monitoring the infusion site, IV pump, and tubing

In the case of Frank versus Hillsborough County Hospital in Tampa, Florida, the patient’s frequent complaints of pain were ignored; the patient suffered permanent nerve damage and later obtained an award of almost $60,000

Malpractice InsuranceMalpractice InsuranceYour employer may have liability coverage

that covers the individual nurseBy obtaining your own malpractice

insurance policy, your best interest will be upheld rather than that of your employer

“Occurrence coverage” is the best type of policy because it covers any negligent act committed during the policy period regardless of when it is reported◦ Important for cases with minors, who have the

right to sue until the age of majorityMake sure your policy covers your nursing

roleAnnual rates are higher for “high-risk”

nursing

Malpractice Insurance Malpractice Insurance (cont’d)(cont’d)Ensure your policy covers the

following options:◦ Misuse of equipment◦ Error in reporting or recording care◦ Failure to properly teach patients◦ Errors in administering medications◦ Mistakes made while providing emergency

care outside the employment setting◦ Coverage for a case in which your

employer sues youKnow the exclusions to your policyKnow that no insurance policy will

cover you for acts outside your scope of practice or licensure

Malpractice Insurance Malpractice Insurance (cont’d)(cont’d)

Make sure your policy allows you to chose your own lawyer

Some policies allow the nurse to consent to settlement while others do not; this is important for future professional employment opportunities

Court costs, legal fees, and reimbursement for your lost earnings may all be covered in an individual malpractice insurance policy

Nebraska State Division of Insurance can review the insurance company’s background, history, and financial stability