Medico-Legal Issues at Triage
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Presentation on the medico-legal aspects of triage in Australian Emergency Departments.
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Medico-Legal Issues at Triage
- 1. Medico-Legal Issues & Triage Kane Guthrie FCENA
- 2. Learning Points • Informed consent • Duty of care • Negligence • Documentation • Confidentiality • Preservation of forensic evidence
- 3. The Triage Nurse Needs to be: • Knowledgeable • Skillful • Educated • Professional • Accountable
- 4. The Triage Nurse Uses: – The ATS – Physiological discriminators – Local policies & protocols Needs: • Basic understanding of legal principles.
- 5. The Risk’s @ Triage • Chaotic environment • Undifferentiated patients • Access block • Shear volume • Stress • Human factors • Patient factors
- 7. Consent The 5 elements: 1. Must be given voluntarily 2. Person need’s legal capacity 3. Should be informed 4. Must be specific 5. Cover what's actually being done
- 8. Getting Consent • Implied consent • Verbal consent • Written Consent
- 9. Failing to Get Consent • Can mean you have to defend yourself against battery charges!
- 10. Duty of Care “Once a patient presents to the ED, the triage nurse enters into a health professional-patient relationship”
- 11. Duty of Care “The triage nurse shares responsibility on behalf of the hospital to ensure patients receive appropriate Ax of their treatment needs.”
- 12. What is Duty of Care? • An obligation recognised by law: – Triage nurse is expected to provide same level/degree of care – Protect PT from foreseeable harm – Provide reasonable standard of care
- 13. What determines the Standard of Care?? • The ATS • CENA Standards • ANMC competencies • Expert opinion
- 14. Against their will! • Detaining PT’s against their will: Needs to be: – Risk to self – Risk to community • Principle of necessity under common law. • Arrange senior clinician review
- 15. Assessing Capacity • Be of sound mind • Over 16 • No drug or alcohol • Have insight • Understand risk • Communicate
- 16. The DNW • Ensure capacity • PT’s have the right to leave • If concerned let them know • Invite them back • Measure of ED performance!
- 17. Negligence • “Nurses have a responsibility to behave in a reasonable manner”
- 18. Negligence “Breach from this responsible approach which results in harm/injury constitutes negligence”
- 19. Negligence For negligence to be proven: – Duty to meet standard of care – Breach of the duty to meet standard of care – Breach of duty which causes foreseeable harm – Causing actual harm & injury – Causing loss
- 20. Negligence
- 21. Documentation Requirements • Date & time • Name of triage nurse • Chief complaint/presenting problem • Limited relevant Hx • Relevant Ax findings • Initial triage category • Area allocated • Tx initiated @ triage
- 22. Confidentiality “Health professionals must maintain any information that has been provided in- confidence to them.”
- 23. Confidentiality “ The triage nurse has responsibility to ensure patient privacy is respected both during triage and in the WR.”
- 24. Overriding Confidentiality • Risk to self • Risk to other community Example: – Child reports abuse!
- 25. The Bounce Back • These patient have higher Morbidity & mortality • There giving us a second chance to Dx properly • Arrange for Snr Clinician to R/V
- 26. Questions
- 27. Take Home Points • Documentation must be accurate • Duty of care can be a gray area • Know dept’s policy & protocols.
- 28. Thank You