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Medico-Legal Issues at Triage

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Presentation on the medico-legal aspects of triage in Australian Emergency Departments.

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Medico-Legal Issues at Triage

  1. 1. Medico-Legal Issues& TriageKane Guthrie FCENA
  2. 2. Learning Points• Informed consent• Duty of care• Negligence• Documentation• Confidentiality• Preservation of forensic evidence
  3. 3. The Triage NurseNeeds to be:• Knowledgeable• Skillful• Educated• Professional• Accountable
  4. 4. The Triage NurseUses:– The ATS– Physiological discriminators– Local policies & protocolsNeeds:• Basic understanding of legal principles.
  5. 5. The Risk’s @ Triage• Chaotic environment• Undifferentiated patients• Access block• Shear volume• Stress• Human factors• Patient factors
  6. 6. Getting Consent
  7. 7. ConsentThe 5 elements:1. Must be given voluntarily2. Person need’s legal capacity3. Should be informed4. Must be specific5. Cover whats actually being done
  8. 8. Getting Consent• Implied consent• Verbal consent• Written Consent
  9. 9. Failing to Get Consent• Can mean you have to defend yourself againstbattery charges!
  10. 10. Duty of Care“Once a patient presents to the ED, the triagenurse enters into a health professional-patientrelationship”
  11. 11. Duty of Care“The triage nurse shares responsibility on behalfof the hospital to ensure patients receiveappropriate Ax of their treatment needs.”
  12. 12. What is Duty of Care?• An obligation recognised by law:– Triage nurse is expected to provide samelevel/degree of care– Protect PT from foreseeable harm– Provide reasonable standard of care
  13. 13. What determines the Standard ofCare??• The ATS• CENA Standards• ANMC competencies• Expert opinion
  14. 14. 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
  15. 15. Assessing Capacity• Be of sound mind• Over 16• No drug or alcohol• Have insight• Understand risk• Communicate
  16. 16. The DNW• Ensure capacity• PT’s have the right to leave• If concerned let them know• Invite them back• Measure of ED performance!
  17. 17. Negligence• “Nurses have a responsibility to behave in areasonable manner”
  18. 18. Negligence“Breach from this responsible approach whichresults in harm/injury constitutes negligence”
  19. 19. NegligenceFor 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
  20. 20. Negligence
  21. 21. 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
  22. 22. Confidentiality“Health professionals must maintain anyinformation that has been provided in-confidence to them.”
  23. 23. Confidentiality“ The triage nurse has responsibility to ensurepatient privacy is respected both during triageand in the WR.”
  24. 24. Overriding Confidentiality• Risk to self• Risk to other communityExample:– Child reports abuse!
  25. 25. The Bounce Back• These patient have higher Morbidity &mortality• There giving us a second chance to Dxproperly• Arrange for Snr Clinician to R/V
  26. 26. Questions
  27. 27. Take Home Points• Documentation must be accurate• Duty of care can be a gray area• Know dept’s policy & protocols.
  28. 28. Thank You

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