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

2. 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

3. R 6 million claim

4. R

5. 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.

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

7. 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.

8. 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

9. 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.

10. 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

11. 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

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

13. Surveillance of hospital acquired bacteraemia

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

15. 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

16. 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

17. 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

18. 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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