Clinical Skills competency in a litigious Environment Harry Basdeo Clinical Consultant RN RM RPN RT RCHN BTech IMM WCC

Why the need ??? Clinical practice management is a area of increasing medico legal risks. The patient profile is changing to incorporate the new age techno savvy patient who is constantly web surfing his or her condition and treatment The emergence of a multi million dollar medico – legal industry is enforcing the implementation of core clinical skills competency at practice level. Rapid migration of nurses back to public sector due to more attractive packages

R 6 million claim

R500 000

CRITICAL QUESTIONS What went wrong???? How did this happen?? Who is responsible?? Doctor/nurse Are the personnel adequately trained?? Blame game Million dollar claims What is the core clinical skills competency of staff at ground level? Agency vs permanent staff ongoing dilemma who is accountable.

Clinical skills competency domains Scientific foundations Leadership attributes Quality management Clinical practice Ethical attributes Independent practitioner Technology competence Policy competency Financial integration

Safe clinical practice Core Clinical governance dictates that risk management reduces the chances of patients being harmed. This will also reduce the risk of complaints or litigation against the nurse /organization Audit is a key tool in effective clinical governance. An ongoing core clinical skills competency programme is imperative to prevent such adverse incidents.

Where are we now? Current iv practices fall to a large extent into the nurses domain including the act of vein cannulation. Currently this process is not well defined by the SANC Scope of Practice R2598 This is placing an increasing burden of litigation on the nurses performing cannulation. Clinical skills competency then become imperative for infusion management

The plan Identify the key personnel who will head up the clinical skills competency programme. The lead role could be rotated between team members. Could be any member of the MDT The leader must have access to all relevant resources to implement a core clinical skills competency programme. Resource allocation to roll out an effective clinical skills competency programme.

Clinical skills competency in infusion management The job description A plan for clinical skills competency in infusion management. In house training on infusion management Infusion nursing standards Training needs assessment Local support database Linking with academic and clinical expertise

Findings in IV sepsis Current cannulation procedures Instutional policy guidelines Internationally recognized guidelines The clinicians vascular practice Nursing /medical personnel cannulation practice Other categories of staff performing vascular access Devices/ accessories /trays

Methods of data Collection Internal wards stats Infection control officers data Inpatient records Laboratory data Ward meetings / handover rounds Patient surveys Significant event audit

Surveillance of hospital acquired bacteraemia

Surveillance of hospital acquired bacteraemia Percentage of Bacteraemia related to CVCs and Peripheral IV by Speciality Surveillance of hospital acquired bacteraemia

Practical issues in implementing CCSC in infusion management Once problems have been identified Swot analysis on IV practices Team meetings Past practice analysis Future planning Implementing research findings Shared best practices

Clinical Skills competency in infusion Management Improvement process must be integrated – Must be part of daily practice. Lessons learned from failure – Implement the “Best Practices” learned from these lessons I.V Clinical Policies must be evidence based – Research must be on going Spread good practice – Forum i.e. ICU and Neonatal/conferences. Implementation across the spectrum in the Hospital

Implementation of Best Practice in infusion Management Identifying areas where increase number of problems in iv management occurs may occur Implementing strategies /mechanisms to prevent or reduce the extent of damages Implementing best and safest products/policies Risk prevention by review, maintenance and training Risk acceptance to identify financial consequences

Recommendations Increase in core clinical skills competency of staff performing vascular access. The team using the Clinical governance approach are monitored and the results published The results showed an increase in clinical skills expertise. Lower IV infection rates Patient and staff satisfaction. Budget allocation for Implementation of a clinical skills programme. Ongoing process for the successful implementation of Core clinical skills competency programme.

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