Medico-Legal Issues & Triage

Kane Guthrie FCENA

Learning Points

• Informed consent• Duty of care• Negligence• Documentation• Confidentiality• Preservation of forensic evidence

The Triage Nurse

Needs to be:

• Knowledgeable• Skillful• Educated• Professional• Accountable

The Triage Nurse

Uses:– The ATS– Physiological discriminators– Local policies & protocols

Needs:• Basic understanding of legal principles.

The Risk’s @ Triage

• Chaotic environment• Undifferentiated patients• Access block• Shear volume• Stress• Human factors• Patient factors

Getting Consent

Consent

The 5 elements:

1. Must be given voluntarily2. Person need’s legal capacity3. Should be informed4. Must be specific5. Cover what's actually being done

Getting Consent

• Implied consent

• Verbal consent

• Written Consent

Failing to Get Consent

• Can mean you have to defend yourself against battery charges!

Duty of Care

“Once a patient presents to the ED, the triage nurse enters into a health professional-patient

relationship”

Duty of Care

“The triage nurse shares responsibility on behalf of the hospital to ensure patients receive appropriate Ax of their treatment needs.”

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

What determines the Standard of Care??

• The ATS• CENA Standards• ANMC competencies • Expert opinion

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

Assessing Capacity

• Be of sound mind• Over 16• No drug or alcohol• Have insight• Understand risk• Communicate

The DNW

• Ensure capacity• PT’s have the right to leave• If concerned let them know• Invite them back• Measure of ED performance!

Negligence

• “Nurses have a responsibility to behave in a reasonable manner”

Negligence

“Breach from this responsible approach which results in harm/injury constitutes negligence”

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

Negligence

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

Confidentiality

“Health professionals must maintain any information that has been provided in-

confidence to them.”

Confidentiality

“ The triage nurse has responsibility to ensure patient privacy is respected both during triage

and in the WR.”

Overriding Confidentiality

• Risk to self• Risk to other community

Example:– Child reports abuse!

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

Questions

Take Home Points

• Documentation must be accurate• Duty of care can be a gray area• Know dept’s policy & protocols.

Thank You