Week 2 Discussion on Delegation to Assistive Personnel Initial ✓ Solved

Scenario: 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.

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;

  • 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.

Assignment: Discuss what the nurse should have done to effectively control this situation and limit the risks of wrongful delegation. Give a detailed response and reference 2 evidenced based resources. Identify 3 to 4 risk control recommendations that were learned from the required video that could have been utilized in this case.

Paper For Above Instructions

Delegation in healthcare is a critical component of patient safety and quality care. The case scenario regarding the inappropriate delegation of duties by the registered nurse (RN) to a certified nursing assistant (CNA) highlights the challenges and risks associated with delegation to unlicensed assistive personnel. Proper delegation requires adherence to legal, ethical, and organizational policies to safeguard patient welfare while allowing effective workflow within healthcare settings.

Effective Control of the Situation

To effectively control the situation and limit the risks of wrongful delegation, the nurse should have adhered strictly to established protocols for delegation. The first step would be to clearly assess and understand the competencies of the CNA in managing such a critical task as re-inserting a GI tube. According to the American Nurses Association (ANA), the nurse must determine whether the task is appropriate for delegation by considering the complexity and risk associated with the patient’s condition (ANA, 2015).

Moreover, the nurse should have communicated clearly with both the CNA and the patient's family regarding the task's limitations. For instance, the RN should have informed the family explicitly that the feeding could not resume until medical supervision confirmed the tube's placement. Documentation of this communication is essential as it provides evidence of compliance with standards of care (Katz & O'Brien, 2022).

Lastly, the RN should have contacted the referring provider to obtain a new order for the tube re-insertion. This step is crucial in ensuring continuity of care and compliance with regulatory standards. The absence of such communication increases liability, as seen in this case (Baker et al., 2020).

Risk Control Recommendations

Several risk control recommendations could be derived from best practices in the healthcare setting:

  1. Active Communication: Regular communication with the entire care team, including unlicensed personnel and families, is vital. Ensuring everyone is on the same page can prevent misunderstandings about patient care tasks and timelines (Miller et al., 2020).

  2. Training and Competency Assessment: Regular training sessions for unlicensed assistive personnel to assess their competencies in performing specific duties can mitigate risks. A structured competency evaluation process can help in identifying any gaps in knowledge or skill sets (Sullivan & McCarthy, 2021).

  3. Standardized Protocols: There should be clear, standardized protocols for tasks involving patient care delegation. Such protocols should outline who can perform what tasks under what circumstances, ensuring that RNs can make informed decisions when delegating duties (Johnson & West, 2021).

  4. Documenting Delegation Decisions: It is essential to document all delegation-related decisions rigorously, including the patient’s condition, the delegated task, and any instructions provided. Thorough documentation protects healthcare workers legally and ethically (Chaboyer et al., 2021).

Conclusion

The case illustrates the importance of adherence to delegation practices in healthcare. The RN's failure to properly delegate, supervise, and communicate significantly contributed to adverse patient outcomes and legal implications. By understanding the principles of effective delegation and implementing risk control measures, healthcare providers can aim to enhance patient safety and reduce liability issues in their practice.

References

  • American Nurses Association. (2015). Nursing: Scope and Standards of Practice. Nursing World.

  • Baker, R., Tschannen, D., & Barlow, J. (2020). Legal implications of delegation decisions. Nursing Management, 51(8), 30-35.

  • Chaboyer, W., McMurray, A., & Thomas, F. (2021). The importance of documentation in healthcare: A nurse's perspective. Journal of Nursing Care Quality, 36(4), 287-293.

  • Johnson, J., & West, L. (2021). Best Practices for Delegation in Nursing. Nurse Manager's Update, 27(6), 1-5.

  • Katz, M., & O'Brien, A. (2022). Effective communication and documentation in nursing. Nurse Leader, 20(3), 227-232.

  • Miller, A., Smith, J., & Lane, K. (2020). Enhancing communication in nursing practice: A systematic review. Journal of Nursing Administration, 50(5), 251-257.

  • Sullivan, C., & McCarthy, P. (2021). Training unlicensed assistive personnel in safe patient practices. Nursing Clinics of North America, 56(2), 351-363.