Legal Issues of the NP Role Nursing 870

Who determines the NP Scope of Practice?

Scope of Practice Role provided by SBON and Certifying Bodies based on education, role (AANP, AACN) http://www.aanp.org/about-aanp Regulated by the State Board of Nursing (The law, regulations, “PA Code”) May be more limiting http://www.pacode.com/secure/data/049/chapter21/subchapCtoc.html (PA Code) Clinical Practice Sites May be more restrictive than the law

NP Licensure Provided by each State Provides the APRN legal scope of practice Recognized roles and titles of APRN Specific criteria for licensure Use certification as entry level competency assessment Licensure considered for public protection NP certification required for APRN license in most states

Legal Aspects of the NP Role Determined by each State Scope of Practice determined by: SBON in most states SBON and SBOM in 3 states (VA, NC, SD) Prescriptive Authority NPs can prescribe independent of physician collaboration in 15 states NPs can prescribe with some degree of physician collaboration in 34 states Limitation of prescribing controlled substances; FL, AL

Legal Aspects : Malpractice The failure of a healthcare professional to exercise such care as would a reasonable prudent healthcare professional under the same or similar circumstances A type of negligence, where a licensed professional fails to provide services as per standards set by the governing body A medical professional performs their job in a way that deviates from the accepted medical standard of care, causing injury or death.

Components of Malpractice Duty Breach of Duty Proximate Cause Damages

Duty Exists when there is a relationship between patient and provider Includes using standards of care accepted by the medical community

Breach of Duty After this duty of care has been established, the provider is required to exercise reasonable care and treat the patient as would other providers doctors in the field, following procedures and actions accepted by peers Violations of standards of care

Proximate Cause The providers actions, or failure to act, results in harm/injury

Damages Permanent or substantial damages occur as a result of the malpractice Placing a value on the harm done to the patient Damages might include lost wages and medical bills May also include general damages, such as pain and suffering

Malpractice in Primary Care Primarily sued for drug errors and misdiagnoses Diagnoses include cancer, MI, meningitis (BMJ Quality and Safety, 2013) Diagnosis errors cause up to 160,000 death annually in the US (BMJ Quality and Safety, 2013)

Malpractice in Primary Care Common chief complaints that are red flags for malpractice The top 3 are: Breast lump, nipple discharge, breast rash or enlarged lymph node in supraclavicular or axillary area Chest pain in an adult Lower abdominal pain Rule out the worst thing first Ruppert, C. Available at: http://www.buppert.com/

NP Malpractice Rates remain low; but is climbing Of all malpractice cases in 2006; 9.6% for NPs Most often for medications, treatment and misdiagnosis Wright, W. Malpractice prevention: What NPs and PAs need to know. Available at: http://nurse-practitioners-and-physician-assistants.advanceweb.com/Web-Extras/Online-Extras/Malpractice-Prevention.aspx

Avoiding Malpractice What can you think of here??

Issues in Prescribing Keep abreast of current therapy CE requirements for State and National certification Provider lack of time Inadequate H&P Pressure from patients Requesting specific medications

Issues in Prescribing Medication confusion Similar names or spelling Failure to anticipate drug interactions CYP 450 interactions

Actions to Avoid Malpractice with Medication Use Write clear prescription Warn patients about potential side effects or adverse reactions Monitor for potential side effects Discontinue medications when no longer needed Use high risk medications for short periods only If hx of suicidal ideations only write for a few days; any meds that can result in lethal OD

Actions to Avoid Malpractice with Medication Use Look up unfamiliar medications Know current standards of care If using a drug off label; document rationale From: C. Buppert JD, Available at www.buppert.com

PA Malpractice In 2012, over 1500 cases of malpractice filed A decrease of 44.8% 135 jury verdicts The Unified Judicial System of Pennsylvania, available at: http://www.pacourts.us/news-and-statistics/research-and-statistics/medical-malpractice-statistics Breakdown by county

Legal Aspects of the NP Role For annual updates to Scope of Practice and Legislation for NP’s : Summary published annually in The Nurse Practitioner at: www.tnpj.com Updated Jan 16, 2016: