Nursing Liability: Critical Issues in the Emergency Department
Sassano, Betty, Risk Management
The care of critically ill patients in the emergency department can be an exciting challenge. Although physicians rather than nurses may be the ones to ultimately decide on the method of care for patients, emergency department nurses can be faced with unique situations not encountered by nurses in other hospital units. These situations may also present potential liability exposures for both the nurses and the hospital if they are not handled properly. Risk managers should encourage emergency department nurses to take basic precautions to prevent liability exposure.
Emergency department nurses working with critically ill patients are often called upon to perform procedures not carried out by nurses on a general medical or surgical unit. This is not inappropriate as long as certain conditions are met. First, nurses should be aware of the procedures that the hospital permits them to perform and cognizant of any hospital protocols associated with the performance of these procedures. Second, there must be documentation that the nurses have the appropriate training and credentials to perform these procedures. Finally, hospitals must make certain that their own policies and procedures do not violate local laws by allowing nurses to perform tasks that are restricted to physicians by law.
A thorough nursing assessment of every patient who enters the emergency department is extremely important. Hospitals should have guidelines to perform the initial evaluation and to prioritize cases so that critically ill patients are identified and treated promptly. In addition to the collection of such data as pulse, respiration and blood pressure, the nurse's assessment of the critically ill patient should include background information from the patient, his or her family, and emergency medical technicians who observed the patient prior to arrival at the hospital. Because patients come to the emergency department from an uncontrolled environment, any information that can be solicited is useful in formulating an accurate assessment of the patient's medical condition. Another precaution that will assist nurses in their care of critically ill patients is to ensure that medications and supplieS, including those necessary for pediatric use, be readily accessible.
MANY EMERGENCY department personnel believe, sometimes erroneously, that because consent is presumed in an emergency, it is not necessary to obtain a consent. to treatment for all persons who are presented for care in the emergency department. While it is generally true that consent is presumed in an emergency, this presumption applies only in emergency situations where a patient is unable to consent and immediate intervention is necessary to prevent what the physician reasonably believes will be serious complications or loss of life. …