IV Therapy Legal issues

IV Therapy History

• IV therapy became widely used in the 1950s
• Peripheral catheters were introduced around 1960, replacing cutdowns used previously
• Prior to 1960 IV therapy was primarily for surgical clients and those who were ill.

Legal Terms

• Criminal law
• Civil law
• Tort
• Assault
• Battery
• Malpractice
• Rule of Personal Liability
• Observation
• Credentialing process
• Incident Report
• Negligence
• Standards of Practice

Sources of Standards for IV Therapy

Federal

• OSHA: bloodborne pathogens, handling cytotoxic drugs
• DEA: drug enforcement

State Statutes

• Department of Health: licensure
• Board of Nursing: Nurse Practice Act

Private/Professional

• Joint Commission: accreditation standards
• ANA: standards for nursing practice

Institutional Bodies

• Infusion Therapy or Nursing Department: job descriptions, nursing policies, procedures

Refusal to Perform IV Therapy

• If a nurse professionally judges they are not qualified to perform an IV, they may refuse
• Refusal must be justified if it harms the patient
• Failure to perform IV without medical reason may result in liability for consequent harm to the patient

Nursing Practice Law, Rules, and Regulations

Scope of Practice IV Therapy

• LPNs who perform IV must have completed accredited training courses
• Documentation of educational qualifications is necessary and must be accessible

IV Therapy MBON Administrative Code

• LPNs may perform IV therapy acts without further certification, with training and education.
• Examples of permitted acts include maintaining patency, maintaining central catheters, administering IV fluids.
• These acts are limited to specific types of IV fluids and IV access devices.

Board-Approved IV Fluids and Medications

• Specific volume and flow rates are listed for various sodium chloride and dextrose solutions
• Detailed instructions outline allowable combinations and volumes of dextrose and sodium chloride together
• Other electrolyte solutions with particular volume allowances are also listed.

Electrolyte Additives

• Magnesium sulfate and potassium chloride are permitted additions to IV solutions.
• Maximum dosages for each are given per 1000 mL of fluid.
• Specific multivitamin additives are permitted.

Anti-Infective Intravenous Piggyback Medications

• Antibiotics, anti-fungals, and antivirals are administered per pharmaceutical protocol using these intravenous piggyback medications.

Gastrointestinal Intravenous Piggyback Medications

• Specific medications are administered per protocol, such as histamine type 2 receptor blockers, proton pump inhibitors, and antiemetics.

NOT (IV Therapy)

• LPNs cannot initiate, discontinue, or regulate central venous lines.
• LPNs cannot add or administer some medications (e.g., IV medications, intravenous piggyback medications not approved by the Board).
• Other examples are parenteral nutritional agents, blood products, and chemotherapy agents to peripheral lines
• Exceptions apply to pediatric patients and clinics

NOT (includes venipuncture)

• Advanced IV acts are prohibited for certain patient populations.
• Certain conditions require registered nurse supervision instead of LPN supervision for IV care.
• Certain settings, like home care, are prohibited for such procedures.

Communication & the Law

• Documentation guidelines for IV therapy are discussed.

Documentation/Guidelines

• Document patient responses, safety precautions, infusion type, significant lab data, access devices, site condition, and any physical limitations.

Hospital Policies

• Guidelines for flushing intermittent catheters.
• Frequency for changing IV sites and tubing.
• Frequency for changing IV fluids.

Patient/Family Teaching

• The importance of establishing therapeutic connections is emphasized.
• Thorough explanation of IV therapy is necessary.
• Patients should understand expectations about initial or ongoing discomfort and potential reactions requiring reporting.

Delegation of Authority

• No aspects of IV therapy can be delegated to individuals lacking the necessary licensing.
• LPNs certified by the board of nursing are the only authorized personnel for certain aspects of IV therapy starting, access, and fluids/medications.
• Nurse managers must be notified immediately of any observed incompetence with IV therapy.

Legal Perils of Intravenous Therapy

• Potential issues include failure to monitor patient condition, prevention of infection, proper equipment usage, and prevention of injury due to negligence.

Factors That Contribute to IV Infusion Medical Errors

• Illegible orders
• Inaccurate dosages
• Pump malfunction
• Nurse distraction/fatigue
• Math errors converting units
• Staffing inadequacies
• Pharmacy unavailability

Avoiding Intravenous Infusion Errors

• Adhere to the seven rights of medication administration.
• Carefully consider decimals and zeros in calculations.
• Utilize and thoroughly check medication administration records.
• Document actions accurately and report any anomalies.

"I Am Being Sued"

• Recognize indicative behaviors in patients, that may lead to potential litigation.

Signs to Watch Out For

• Habitual complaining, excessive questioning, hostility towards staff, explicit requests from patients

Avoiding Lawsuits

• Adhering to standards of IV therapy practice, and adopting professionalism and respect when dealing with patients are key elements.

Test your understanding of IV therapy with these essential questions suitable for nursing students. This quiz covers historical aspects, regulations, and professional responsibilities related to intravenous therapy. Prepare to deepen your knowledge and ensure compliance with nursing standards.