Urinary Catheterisation and The Law
Karen Ayers RN, BSc Hons
Nurse Specialist Continence Care
Bradford and Airedale teaching PCT
Objectives
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Legal issues with catheterisation
Accountability
Consent
Roles and responsibilities
Clinical Governance
Documentation
Vicarious liability
Skills for Health CC02
• You need to apply:
• Legislation, policy and good practice
• K1. a working knowledge of the current European and National legislation,
national guidelines, organisational policies and protocols in accordance
with clinical/corporate governance which affect your work practice in
relation to inserting and securing urethral catheters
• K2. a working knowledge of the importance of working within your sphere
of competence and when to seek advice if faced with situations outside of
your sphere of competence
• K3. a working knowledge of the importance of documentation, the data
protection act, care of records and disclosure of information with consent
from the individual and your employer and the legal and professional
consequences of poor practice
What the law says
• Nurses and support workers have a duty of care to patients.
• Inexperience is no defence to a claim of negligence.
• When things go wrong, you are judged against the standard
that would reasonably be expected from an ordinarily
competent practitioner.
• There is no excuse for getting basics wrong, such as poor
handwriting in a patient record or failing to read relevant
patient notes.
• Employers must ensure staff are trained and supervised to
provide care to a legal standard.
Accountability
• Public - through criminal law
• Employer - Contract of
Employment
• Patient - Civil Law, duty of care,
Common law of negligence
• Qualified Nurses - NMC Code of
Conduct
Delegation
• Qualified Nurses are professionally accountable for
any duties delegated to the HCSW
• It is crucial that HCSW is appropriately supervised
and competent to carry out the task.
• HCSW must have written evidence of competence in
catheterisation from Employer
• HCSW must recognise any limitations when
considering to undertake a delegated catheter
change
Consent
Nurses are accountable for ensuring that
patients have given consent for any
treatment they are going to receive.
Catheterisation without clinical justification
and consent can represent assault, battery
and /or negligence
12 key points on consent: the law in
England
(Dh 2001)
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Before you examine, treat or care for competent adult patients
you must obtain their consent
Adults are assumed to be competent unless demonstrated
otherwise
Patients may be competent to make some health care
decisions even if not competent to make others
Giving and obtaining consent is not usually a one – off event,
it is a process. You should always check before caring /
treating a patient.
5. Children aged 16 and 17 are presumed to be competent to consent.
Younger children who fully understand can also consent.
6. The person treating the patient should seek consent from the patient.
7. Sufficient information should be given i.e. benefits and risks, and
alternative treatments. If inadequate information is given the consent
may not be valid
8. Consent must be given voluntarily, not under duress from health
professionals, family of friends
9. Consent can be written, oral or non verbal. A signature does not prove
the consent to be valid
10. Competent adults are entitled to refuse treatment, even when it would
clearly benefit their health. Only exception is in case of patients
detained under the mental health act with a mental disorder.
11. No – one can give consent on behalf of an incompetent adult.
However treatment can be given if it is in the patients best interests.
12. If an incompetent patient has indicated in the past, while competent
that they would refuse treatment in certain circumstances (an
“advance refusal”) this must be adhered to.
More detail can be found in the DH publication “Reference guide to
consent for examination or treatment” www.doh.gov.uk/consent
What does consent really mean if you
are a patient?
• You have a choice
• You must have enough information to enable
you to make a decision
• You can say no or ask for more information
• You must be acting under your own free will
• You must be able to give your consent
Consent – what you have a right to expect
A guide for adults, DH 2001
What is Vicarious Liability?
• The employing organisation is liable for “systematic
errors”, e.g. fault in the system, or inadequate staff
training
• If employee acting in connection with employment
when patient harmed, employer is vicariously liable
for the employees actions
• This needs to be understood by employers when
inviting staff to change their roles
• Onus is on the employer to ensure staff adequately
trained
Patient Education
• Procedure explained
• Catheter care education
• Patient / Carer able to care
for catheter
• Hygiene / hand washing
• Avoiding Constipation
• Signs of complications blockage, UTI.
Product Liability
• Catheters and drainage equipment must
be used as instructed by manufacturers,
otherwise the nurse may be liable.
• Manufacturers are required to ensure that
products conform to British Standards
1695 (1990)
• Check packaging and expiry date
• Store according to manufacturers
instructions
Principles of Documentation
The law assumes that if the work was
not documented it was not done.
Frank-Stromborg and Christensen 2001; NMC 2005
Nursing records -A legal document
• Society is becoming more litigious
• Patients are encouraged to complain about the care they
receive
• Any court can request nursing documentation be presented
to a court of law.
• Analysis of nursing records demonstrates if the Nurse has
understood and honoured their duty of care (RCN 2003, NMC
2005)
NMC Guidance for Record Keeping
• Be factual, consistent and accurate
• Document soon after an event has occurred
• Write clearly. Alterations to be dated, timed and signed so
original entry can be read clearly
• Be accurately dated, timed, signed with signature printed
on first entry
• Not include abbreviations, jargon, meaningless phrases,
irrelevant speculation and offensive subjective statements
• Be readable on any photocopier
Documentation
• Reason for catheterisation
• Date and time insertion
• Type of catheter- ch, length, material, balloon size,
batch no, manufacturer
• Cleansing solution, lubricant, anaesthetic agents
• Any problems encountered
• Date for reassessment, planned change
• Signature
So what can go wrong?
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False passage
Bleeding
Urethral trauma
UTI
Septicaemia
Death
CATHETERS CAN KILL!!!
Nurse Gets Struck Off For Cruelty
A former nurse at a Nursing Home in Bradpole has
been struck off the nursing register for her conduct
including bending a 97-year-old lady's leg, until it
cracked, whilst inserting a catheter. The former
nurse did not attend the hearing saying that she had
retired from nursing for personal reasons.
•A 75 year old lady with advanced dementia was admitted to
an acute medical ward following a collapse.
•Her daughter, a Nurse was horrified when she noticed that her
mother had been catheterised for no apparent reason other than
management of incontinence.
•After discussion with the staff the catheter was removed.
•Symptoms of a UTI were observed the following day.
•Antibiotic therapy was commenced.
•However the lady died 7 days later.
•The cause of death?
Septicaemia secondary to UTI
Questions to be asked about this case
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Why was the catheter put in?
Whose decision was it?
Was it in the patients best interests?
How was informed consent obtained?
Case scenario for discussion
You are asked to visit an elderly gentleman to replace
his long term indwelling catheter.
The qualified Nurse has prescribed catheters and asks
you to take them to the house.
The catheterisation is uncomplicated and you leave the
patient comfortable.
7 weeks later it comes to light that the you inserted a
short term catheter (14 days).
Who is to blame for this error : You, the qualified Nurse
or both of you?
So ….in a nutshell, you should
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Always act in the patients best interest
Recognise your own limitations
Regularly update your knowledge
Adhere to local policy
Always obtain informed consent
Use catheter equipment appropriately
Report any concerns to a qualified Nurse
Document the necessary details correctly
Don’t be afraid to challenge practice if you are in
doubt