BASIC ETHICO LEGAL ASPECTS OF IV THERAPY

DUTIES AND RESPONSIBILITIES OF IV THERAPISTS

1. Interpret and carry out the physicians prescriptions for IV therapy. 2. Prepare, initiate and terminate IV therapy based on physicians 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

IV THERAPY AND LEGAL IMPLICATIONS 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.

In giving IV injections, nurses should follow the policies of their agencies. Board of Nursing Resolution No.8 Sec.30 (c) Art.VII or administratively under Sec.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 Practice, SEC.28.Scope of 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.

ETHICAL ISSUES

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.

NURSES AND PEOPLE

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 nursing care.

NURSES AND PRACTICES

Nurses are accountable for their own nursing practice. Nurses maintain or modify standards of practice within the reality of any given situation.

 Nurses are the advocates of the patients. Nurses are aware that their actions have professional, ethical, moral and legal dimensions.

NURSES AND CO-WORKERS

Nurses maintain collaborative working relationships with their co-workers and other members of the health team. They recognize their capabilities and limitations in accepting responsibilities and those of their co-workers when delegating responsibilities to them.

NURSES AND SOCIETY

Nurses are contributing members of society. They assume responsibilities inherent in being members and citizens of the community/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 THE PROFESSION Nurses are expected to be members of professional organizations of nurses. Nurses help to determine and implement desirable standards of nursing practice and nursing education.

 Nurses should initiate and involve themselves in structured and nonstructured research activities within their existing milieu. Nurses should assert the implementation of labor standards and lobby for favorable legislations to improve existing socio-economic conditions of nurses.

CODE OF ETHICS The Nursing Service Administrators of the Philippines

MISSION
Provision of efficient and effective nursing services. Promote quality health care for people as a basic human right. Be responsible for planning, organizing, directing and controlling the programs and activities of the Nursing Service towards optimum quality nursing care.

ARTICLE II
THE ANSAP CREED; CORE VALUES & BELIEFS 1. The nursing profession is a commitment to God and people; 2. The nursing service is responsible and accountable for quality nursing care;

3. The nursing service is a major function in any health care delivery system and deserves a corresponding importance in the organizational structure; 4. A high level of self-discipline and committed leadership are essential factors in the effective management of health care services;

5. The nursing services is most important asset, aside from its clients, are its caring, competent and productive personnel; 6. Competence enhances the publics assurance of quality nursing care, therefore, nursing personnel must be selected and appointed to positions consistent with their qualifications;

7. The client is the reason for the existence of the nursing profession; all efforts should be directed to his care and should consider his uniqueness, personal worth, dignity, and socio-cultural values; 8. The implementation and maintenance of approved standards of nursing practice and nursing administration are bases for effective and efficient nursing service;

9. Nursing service is integral in the quality of education of students; and 10. A unified stand is vital in achieving their objectives through membership in professional organizations, such as the Philippine Nurses Association (PNA), the Association of Nursing Service Administrators of the Philippines (ANSAP), and other specialty groups in nursing.

ARTICLE III
NORMS OF PROFESSIONAL CONDUCT SECTION 1. Dedication to God and people. SECTION 2. Responsibility and accountability for quality nursing service.

SECTION 3. Leadership and Technical Competence. SECTION 4. Responsibility and Accountability for Nursing Practice. SECTION 5. Commitment to the Nursing Profession.

ARTICLE IV
GENERAL PROVISIONS Section 1. Creation of Ethics Committee that shall be responsible to adjudicate violations against the NSA Code of Ethics and adopt such rules and sanctions as the association is authorized to do.

SECTION 2. Legal Force. SECTION 3. Moral Force. SECTION 4. Dissemination.

SECTION 5. Sanctions. SECTION 6. Amendment. SECTION 7. Effectivity

CODE OF GOOD GOVERNANCE FOR THE PROFESSIONS IN THE PHILIPPINES

 E.O. No. 220 - Directing the adoption of the Code of Good Governance for the Professions in the Philippines on June 23, 2003.

General Principle of Professional Conduct

Professionals 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

5. Social and Civic Responsibility 6. Global Competitiveness 7. Equality of All Professions

PROFESSIONAL VALUES

CARING
is the locus of all attributes used to describe NURSING. It is not only the main value of NURSING but the Essence. It is not only a nursing act because to care is human and to be human is caring.

5 Cs of Caring
Compassionate Concern Caring Committed Willingness to perform her responsibilities Confident Assertive Smart Conscientious Honest Competent Knowledgeable Effective/ Efficient

Wholistic Approach

Nurse Practitioner I.V. Nurse Therapist

Ethico legal Responsibility Accountability In Varied Health Setting

Quality care
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 Day Care Center

Educational Setting -Colleges of Nursing Universities -Other colleges & Schools

Home Care Setting -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 Loquitur Three conditions are required to establish a defendants negligence without proving 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 within 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 outpatient clinic for injection. Upon administering the injection to his buttocks, the patient experienced extreme pain. His leg felt weak and he was subsequently paralyzed.

Malpractice
Refers to a negligent act committed in the course of professional performance. Example is the 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 shes 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 or 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 IV 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 about by a state or federal law enforcement agency or by an official agency on behalf of an individual, to protect ones person or property or to protect society in general. Punishment includes imprisonment, fine or both.

 DEPOSITION
a 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.

 INTERROGATORY
another 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.

 STATUTE OF LIMITATIONS
the time limit set by each state legislature in which civil or criminal action can be brought.

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

 SUBPOENA
the 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.

SUMMONS
notification 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 job description, the agencys 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 superiors 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 be informed about the patients 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 Requirements 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 three (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 participants 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 3 years. Violations 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)-hour didactic lecture and a practicum with the following evaluation methods:

1. Written examinations: pre and post tests 2. 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%; and (b) Practicum 50%.

REFERENCES
Association of Nursing Service Administrators of the Philippines, Inc. (ANSAP). 2000. Nursing Standards on Intravenous Practice 7th EDITION. Atty. Rustico T. De Belen, BA, BSN, LLB, MNSA, PhD and Donna Vivian V. De Belen, BSN, RN, CCRN, CRNA, MS Anesthesia. Nursing Law, Jurisprudence & 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.7169 Sec.28. Philippine Nursing Law, Republic Act No. 9173 Section 28 (a), (e). Prescer: Torts, 3rd EDITION.

PRIMER CODE OF ETHICS THE NURSING SERVICE ADMINISTRATORS OF THE PHILIPPINES. Professional 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 . Websters New World Dictionary of the American Language. Cleveland and New York: World Publishing Co.