LPN- IV Therapy and the LAW
LPN IV
CLASS:
Day 1
HOUSEKEEPING DUTIES!
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Course Requirements
Evaluations
Schedule
Content Outline
Clinical
Homework
Book
Legal issues related to IV therapy
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Objectives for this unit
are to outline the
LPN,s role,
accountability, and
responsibility relative
to IV therapy in terms
of law, board rules,
role of the directing
professional, health
care setting and
institutional policy
Sources of law- four primary
sources in the United States
Constitution- formal set of rules for
gov,t and individual rights
 Statutes- Federal state and local laws,
laws dealing with malpractice
 Administrative law- Board of Nursing
 Common- court made law (malpractice)
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Legal terms
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Criminal law
Civil law
Tort- private wrong by act of omission
Malpractice- is the form of negligence in which any
professional misconduct, unreasonable lack of
skill, or non adherence to the acceptable standard
of care causes injury to a patient
Rule of personal liability- every person is liable for
own wrong doing cannot say that it is ok because
the doctor told me so – you are responsible to
know and know your scope of practice
Malpractice
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Must establish that nurse had a duty to patient
A breach of standards of care or failure to carry out that
duty must be proven
The patient must suffer actual harm or injury
There must be a causal relationship between the
breach of duty and the injury suffered
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If an act of malpractice does not create harm, legal action
cannot be initiated
Coercion of a rational adult for placement of IV constitutes
assault and battery
Breach of Duty
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Failure to observe
Failure to intervene or react
Verbal rather than written orders
Know your scope of practice
Medication errors are an area where nurses
face criminal charges what is common cause?
LAWS THAT GOVERN LPN
PRACTICE
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Ohio Revised Code: what is it?
Ohio Board of Nursing Rules: What makes it
different from ORC?
Accountability to the law
Standards of Practice
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Ohio Board of Nursing
Infusion Nursing Society
Ohio Revised Code
(ORC)
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Laws that are made and approved by the
government of the State of Ohio
Laws are adopted by official state offices
such as Ohio Board of Nursing
Ohio Board of Nursing Rules
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Ohio Board of Nursing (OBN) is a
government agency
Must abide by the ORC laws
Adopts them as rules to be followed
OBN rules can be found on the website
Specific rules for LPN IV Therapy – see
handout
Accountability
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As nurses, when we accept a license from
the state, we agree to follow what the laws
of the Ohio Revised Code and rules of the
Ohio Board of Rules say we will follow!
Standards of Practice VS
Standards of Care
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Standards of Practice govern how we as
nurses practice the art of nursing.
Standards of Care govern how we provide
care to our patients such as policies on
starting IVs.
Standards of Practice for LPNs in
the State of Ohio
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Ohio Board of Nursing: 4723-4-04
Maintain knowledge
Demonstrate competence
Provide nursing care according to education
Nursing care does not involve a function or
procedure which is prohibited by the law
Implement regimens in a timely manner
Will clarify prescribed regimen when unsure
Standards of Practice for LPNs
in the State of Ohio
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Report changes in a timely manner
Maintain confidentiality
Not disclose patient information unless it
will have an adverse affect on their
treatment or progress
Will evaluate others according to
established criteria such as standards of
care/practice
But I did not Know
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This excuse will never hold up in a court of law
As a licensed professional you are held
accountable to know your states nurse practice
act and your scope of practice.
But I was told to or asked to will not hold up.
Board of nursing is responsible for protecting
the public from harm.
INFUSION NURSING SOCETY (INS)
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In the INS Scope of Practice:
Knowledge of A & P
Infusion treatment modalities
Participation in the patient’s plan of care
Knowledge of infusion therapies
Knowledge of psycho/social aspects
Collaborate with other team members
Breach of duty
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The nurse does not want to breach
standard of practice or violate
employer’s policies
Five examples of Breach of duty
related to IV therapy
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Delay in administration of medication
Unfamiliarity with the drug
Inappropriate route of administration
Failure to qualify orders
Negligence in patient teaching
What can any LPN do with IVs
(4723.171)?
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Verify the type of
peripheral IV solution
being administered
Examine peripheral
infusion site and extremity
for infiltration
Regulate peripheral IV
according to prescribed
flow rate
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Discontinue a
peripheral IV device
Perform routine
dressing changes at
insertion site for:
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Peripheral IV
Arterial line
PICC
CVP subclavian infusion
What can no LPN do… period!
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Blood and Blood
components
TPN
Cancer therapeutic
medication
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chemotherapy
anti-neoplastics
Investigational or
experimental
medications
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Discontinue:
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CVP
PICC
art line
any line other than
peripheral
IV Medications other than
antibiotics for those
trained.
IV push/bolus medications
WHAT CAN AN “AUTHORIZED”
LPN DO?
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Initiate IV therapy in
hand, forearm or
antecubital on an adult(18
and older)
Maintain accepted IVs in
CVP or PICC lines
Prepare or reconstitute an
antibiotic medication
Verify blood products
with an RN
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Initiate an IV of:
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D 5W
Normal Saline
Lactated Ringers
0.45% NaCl
0.25 % NaCl
Sterile Water
What can we do cont.
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Hang subsequent
containers of
accepted IV solutions
containing vitamins or
electrolytes
Initiate and/or
maintain IV piggyback
of an antibiotic
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Inject normal saline or
Heparin in an
intermittent infusion
devise or heparin lock
Change tubing on IV
that terminates in a
peripheral vein
What does your policy say?
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Review your policy and see if it meets the
requirements of the law.
If not, what does it need to add?
Who are you going to tell?
Role of the RN in delegation
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What is delegation?
LPN can’t delegate IV
medication
administration
Before an RN can
delegate the following
must be done:
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Assess patient
condition
Assess type of care
Assess complexity
Training and skill of
person delegating to
Resource availability to
perform safely
RISK MANAGEMENT
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What is risk management?
Why and how do we ask for informed
consent?
Why is documentation important with risk
management?
What is Risk Management
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INS describes the process as:
“ a process that identifies, analyzes, treats
and evaluates real and potential hazards.”
A risk management program collects and
analyzes data to find trends and to help
improve practices to increase patient
satisfaction and decrease complications and
adverse patient outcomes.
Risk Management, cont.
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Looks at areas of actual or high risk
Looks at customer satisfaction
Works with PI and EOC to provide safest
environment
Educates
Helps facilities complies with federal and
state mandates
INFORMED CONSENT
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Proactive strategy because it provides
patients with information needed to make
and informed decision
Medication Errors
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New systemwide policy
Non-punitive
Anonymous reporting
Investigation into the processes not the
person
DOCUMENTATION
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Needs to be timely, accurate and complete
Objective
Legible
Use only accepted abbreviations
Don’t use criticism or complaints
Every entry dated and timed
No vacant space
10 Steps to Medication Safety
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Know the patient
Know the drugs
Communicate clearly
Beware of look-alike
and sound-alike drugs
Restrict and
standardize drug
storage, distribution
and stock meds
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Assess drug delivery
devices and maintain
competence
Watch the environment
Educate self
Encourage patient
participation
Target process not person
OCCUPATION RISKS
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Physical hazards
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needle stick injuries
abrasions
contusions
chemical exposure
latex allergies
Biological Hazards
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Bloodborne pathogens:
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OHSA regulations
Exposures
Wearing gloves
Using safety devices
The most effective way of preventing the spread
of disease is...