This week you will research, complete, and upload to Canvas the Concept Map Download Concept Map for the ‘5 Rights of Delegation’. A deeper understanding of this exemplar will help improve your performance when you complete the scenario for the second time. Read the article “Nurse case study: Wrongful patient delegation to unlicensed assistive personnel”Links to an external site.. On the concept map, define each right, then describe how each right was not followed in the article. Give credit to your sources at the bottom of the template using APA 7th edition format. Nurse Case Study: Wrongful delegation of patient care to unlicensed assistive personnel Our insured was a registered nurse (RN) employed by a home healthcare agency. She was with a patient when she received a telephone call from a certified nursing assistant (CNA) who was employed at the same agency. The CNA was at the home of a mutual patient and reported that her gastrointestinal (GI) tube had come out sometime during the night. The RN informed the CNA that the patient would need to go to the emergency department to have the tube re-inserted as it would be several hours before she could see the patient. The patient’s family didn’t want to take the patient to the emergency department but would instead wait for the RN to see the patient. The CNA informed the RN that she had re-inserted several GI tubes when she was employed at a nursing home, so felt comfortable re-inserting this patient’s tube. The RN agreed to let the CNA insert the tube but advised her to not restart the feedings. Approximately 45 minutes later, the CNA contacted the RN and affirmed that tube was re-inserted without difficulty and proper placement was confirmed. When the nurse arrived at the patient’s home several hours later, she noticed that the patient was receiving tube feeding. When questioned, the daughter confirmed that she resumed the tube feedings shortly after the CNA left and denied being told to wait. The RN noted that the patient was complaining of abdominal pain and reported feeling nauseous. On physical assessment, the patient’s abdomen was distended and positive for pain with abdominal palpation. After stopping the feeding, the nurse called 911 and the patient was transferred to the nearest hospital where she was diagnosed with peritonitis due to the GI tube being accidentally placed in the peritoneal space. The family filed a lawsuit against the RN and the home healthcare agency. The allegations against the RN included: Wrongful delegation of patient care to unlicensed assistive personnel (e.g. CNA); Failure to follow the agency’s policies and procedures on proper delegation, GI tube insertion and supervision of unlicensed assistive personnel. Failure to contact the referring provider and obtain an order to reinsert the GI tube; and Failure to assure that the patient and family had received appropriate communication related to re-inserting the GI tube and holding the GI feedings. Resolution A settlement was reached prior to a lawsuit going to trial. As mandated by state law, the nurse was also reported to the National Practitioner Data Bank (NPDB). The total incurred to defend and settle this case on behalf of our insured nurse exceeded $255,000. Risk Control Recommendations Know your employer’s policies and procedures related to clinical practices and delegation. Unfamiliarity to established policies and protocols is not a defense, especially if a clinician has acknowledged receiving education on such policies and protocols. Prior to delegating tasks, be aware of the knowledge and skills, training, diversity awareness, and experience of the individual to whom you are delegating elements of care. Use good clinical judgement, which includes the complexity of the patient, the availability and competence of the unlicensed assistive personnel, prior to delegating patient care. Monitor implementation of the delegated task, as appropriate, to the overall patient plan of care. Evaluate overall condition of the healthcare consumer and the consumer’s response to the delegated task. Evaluate the unlicensed assistive personnel skills and performance of tasks and provide feedback for improvement if needed. For more information regarding nursing delegation, it is recommended that nursing professionals review the NCSBN and American Nurses Association (ANA) National Guidelines for Nursing Delegation. Contact the risk management department, or the legal department of your organization regarding patient or practice issues. Topics: #Best Practices #Case Study #Nurses Share this article:
In this essay, we will delve into the critical concept of delegation in nursing and its significance in ensuring the well-being of patients. Using a real-world case study, we will explore how adherence to the “5 Rights of Delegation” is crucial in maintaining patient safety. The 5 Rights of Delegation serve as a guide for nurses to make informed decisions when entrusting tasks to other healthcare personnel. However, as we will see in our case study, failing to uphold these principles can result in dire consequences and legal complications.
The first of the 5 Rights of Delegation, “Right Task,” emphasizes the importance of assessing whether a particular task is appropriate for delegation. It requires a careful evaluation of the task’s complexity and the delegatee’s competence. In our case study, the registered nurse (RN) allowed a certified nursing assistant (CNA) to re-insert a gastrointestinal (GI) tube without conducting a proper assessment. The failure to consider the complexity of this task led to a wrongful delegation of the patient’s care.
The “Right Circumstances” involve evaluating the patient’s condition and the context in which delegation occurs. Here, the RN’s failure to assess the patient’s deteriorating condition—manifested by abdominal pain and nausea—prior to delegation was a critical lapse. A lack of consideration for these circumstances led to an inappropriate delegation that exacerbated the patient’s condition.
The “Right Person” principle underscores the need to ensure that the delegatee possesses the necessary competence and training. In this case, despite the CNA’s claim of experience in GI tube re-insertion, the RN did not adequately verify her qualifications and competence. Verifying the delegatee’s qualifications for specific tasks is paramount, especially when it involves critical medical procedures.
The “Right Direction/Communication” principle highlights the importance of effective communication between the delegator and delegatee. It involves providing clear instructions and expectations. In this case, the RN failed to ensure that the patient’s family was informed about the delay in their visit and the proper procedures to follow. This miscommunication resulted in the family resuming tube feedings prematurely, leading to the patient’s condition worsening.
The “Right Supervision/Evaluation” emphasizes the need to monitor the delegatee’s performance and assess the patient’s response. The RN’s lack of supervision and evaluation following the delegation led to the unnoticed incorrect placement of the GI tube, resulting in peritonitis.
In conclusion, the case study demonstrates the profound importance of adhering to the 5 Rights of Delegation in healthcare, particularly in nursing. Failure to uphold these principles can have grave consequences for patients and can lead to legal actions against healthcare professionals and their institutions. Prioritizing patient safety by diligently considering the appropriateness of task delegation, the circumstances, the qualifications of the delegatee, effective communication, and ongoing supervision and evaluation is essential. By doing so, nurses can minimize the risk of wrongful delegation and ensure the provision of high-quality patient care.
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