IV Therapy Legal Issues PDF

History IV therapy has only been widely used since the 1950s The first peripheral catheter was introduced around 1960 —prior to that, cutdown’s were performed IV therapy was reserved for surgical clients and those who were dehydrated Legal Terms Criminal law Rule of Personal Liability Civil law...

History IV therapy has only been widely used since the 1950s The first peripheral catheter was introduced around 1960 —prior to that, cutdown’s were performed IV therapy was reserved for surgical clients and those who were dehydrated Legal Terms Criminal law Rule of Personal Liability Civil law Observation Tort Credentialing process Assault Incident Report Battery Negligence Malpractice Standards of Practice Sources of Standards for IV Therapy Federal ◦ OSHA—bloodborne pathogens, handling cytotoxic drugs ◦ DEA—drug enforcement State Statues ◦ Department of Health—licensure ◦ Board of Nursing—Nurse Practice Act Sources of Standards for IV Therapy Private/professional ◦ Joint Commission—accreditation standards ◦ ANA—standards of nursing practice Institutional bodies ◦ Infusion Therapy or Nursing Department—job descriptions, nursing policies and procedures Refusal to Perform IV Therapy  If professional judgment is that he or she is not qualified  Harmful to patient or patient refuses **Failure to do so without medical reason may result in liability for any consequential harm to patient. Nursing Practice Law, Rules, and Regulations Rule 2.4 Scope of Practice IV Therapy A. The LPN performing IV therapy must have successfully completed education and training provided by an IV therapy integrated accredited nursing program or Board approved IV therapy course. B. Evidence of education and training must be documented via official transcript and accessible for audit purposes. C. The LPN who endorses a license and has successfully completed an IV therapy training program through an IV therapy integrated accredited nursing program in another jurisdiction must complete a Board-approved IV therapy delineation course before performing acts of IV therapy. IV Therapy MBON Administrative Code (Includes Venipuncture) D. The LPN who has received the appropriate education and training may perform the following acts of IV therapy without an additional Board certification: 1) Maintain patency of a peripheral intermittent vascular access device using a nontherapeutic dose of a flush solution. 2) Maintain the peripherally inserted central catheter and central venous infusion of Board-approved IV fluids by checking the flow rate and changing the site dressing. 3) Initiate the administration of Board-approved IV fluids and medications via a peripheral route. The peripheral route does not include midline, central venous catheters, midclavicular catheters, or peripherally inserted central catheters. E. Board-approved IV fluids and medications are as follows: Sodium Chloride Solutions NaCl 0.225% (1/4 NS) 20 ml to 150 ml per hour NaCl 0.45% (½ NS) 20 ml to 150 ml per hour NaCl 0.9% (NS) 20 ml to 150 ml per hour Dextrose Solutions dextrose in water 5% (D5W) 20 ml to 150 ml per hour Solutions with a Combination of Dextrose and Sodium Chloride 5% dextrose and NaCl 0.225% (D5 1/4 NS) 20 ml to 150 ml per hour 5% dextrose and NaCl 0.45% (D5 ½ NS) 20 ml to 150 ml per hour 5% dextrose and NaCl 0.9% (D5 NS) 20 ml to 150 ml per hour Electrolyte Solutions 5% dextrose and Lactated Ringer’s (D5LR) 20 ml to 150 ml per hour Lactated Ringer’s Or Ringer’s lactate (LR or RL) 20 ml to 150 ml per hour Electrolyte Additives Magnesium Sulfate mixed in 1000ml solution ◦ Maximum dose 2 grams to 5 grams per 1000 ml of fluid Potassium Chloride mixed in 1000ml solution ◦ Maximum 40 mEq per 1000 ml of fluid Vitamin Additives Multivitamin additive (MVI or banana bag) for peripheral infusion only; not associated with total parenteral nutrition (TPN) ◦ 20 ml to 150 ml per hour Thiamine 200 mg to 500 mg daily Anti-Infective Intravenous Piggyback Medication Classifications Antibiotics Per pharmaceutical protocol Anti-Fungal Per pharmaceutical protocol Anti-Viral Per pharmaceutical protocol Gastrointestinal Intravenous Piggyback Medication Classifications Histamine type 2 receptor blockers Per pharmaceutical protocol Proton pump inhibitors Per pharmaceutical protocol Antiemetic Per pharmaceutical protocol NOT F. The LPN performing IV therapy may NOT: 1) Initiate, regulate, add or administer medications to or discontinue a central venous line; 2) Administer or add the following to a peripheral venous line: (a) IV push or bolus medications; (b) Intravenous piggyback medications other than those approved by the Board. (c) Parenteral nutritional agents other than vitamins; (d) Blood, blood components, plasma, plasma expanders; (e) Chemotherapeutic agents. NOT (includes venipuncture) 3) Perform any advanced acts of IV therapy listed in Part 2830, Chapter 2, Rule 2.4 D. with patients under two (2) years of age; 4) Perform any advanced acts of IV therapy listed in Part 2830, Chapter 2, Rule 2.4 D. with pediatric patients age two (2) years and older, unless: (a) The patient is on a dedicated unit for pediatric patients; and (b) A registered nurse is present on the pediatric patient care unit where IV therapy is being administered and is readily available to respond as needed. G. Unless otherwise specified in these regulations, the LPN may perform IV therapy if the supervisor is physically on the premises where the patient is having nursing care provided. The physician or dentist may provide supervision in the medical or dental office. In all other settings, supervision and delegation must be by a registered nurse. H. IV therapy as listed in Part 2830, Chapter 2, Rule 2.4 may not be performed by the LPN in the home setting. Communicati on & The Law DOCUMENTATION AND REPORTING Documentation/ Guidelines Patient response Safety precautions Type of infusion Significant lab data I&O Types of venous access devices Condition of access site and dressing Physical restrictions on client R/T IV therapy Hospital Policies Flush Intermittent catheters q 8 hours Change site and tubing every 72 hours IV fluids must be changed every 24 hours Patient/Family Teaching Fosters a therapeutic relationship Explain necessity for IV therapy Include expectations of discomfort from starting IV or from medications Explain expected outcomes, possible side effects, and reactions that need to be reported Delegation of Authority No aspect of IV therapy may delegated to unlicensed personnel Only PN students and LPNs who are IV certified by the board of nursing may initiate an IV access and administer allowed fluids/medications by IV route If you witness a nurse display incompetence with IV therapy, you have a legal obligation to report your observations to your nurse manager immediately Legal Perils of IV Therapy Failure to monitor and assess clinical status Failure to prevent infection Failure to use equipment properly Failure to protect the patient from avoidable injury Factors that Contribute to IV Infusion Medical Errors Illegible orders Incorrect dose ordered Pump programming errors Distracted or fatigued nurse Math errors converting mcg/kg/min to mL/hr Inadequate staffing for double check Pharmacy not available 24 hours Avoiding Errors Seven rights of IV therapy administration Use decimal and zeroes carefully Three checks of medication administration Document and report “I Am Being Sued” CLUES Signs to Watch Out For Habitual complaining Questioning everything Open expressions of hostility toward staff Asking for staff names Taking notes of discussions with health care team members Exhibiting combative, noncompliant, uncooperative behaviors Requesting the chart prior to discharge Avoiding Lawsuits Follow standards of practice for IV therapy Maintain a calm, polite, professional attitude Make every effort to meet the client’s needs