Quality & safety in health care.
The Quality in Australian Health Care Study demonstrated clearly that potentially preventable adverse events occurred in the health system at an alarming rate, often with quite dire consequences for the people receiving health care. Interestingly it has become increasingly apparent that the vast majority of these adverse events are not the exotic incidents and accidents that set the popular media alight. Instead, the majority is made up of commonplace events sadly occurring far too frequently in health and aged care services often involving nurses. These include events such as: medication administration incidents; poor pressure area care; lack of clinical observation or assessment that misses deterioration in a person's condition; or failure to assess and manage a vulnerable person's mobility capacity leading to falls.
The occupational health and safety (OH&S) area of law is a comprehensive codified framework of law designed to protect workers. The OH&S legislation across each Australian jurisdiction sets out clearly the rights and responsibilities of employers and employees, as well as the mechanisms that are required to be in place to reduce the risks of workplace injuries and illness as well as the mechanisms for the ill or injured to seek remedies should they suffer illness or injury at work. A similar codified system exists for people involved in motor vehicle accidents, designed to reduce the complexity of seeking and receiving appropriate compensation for any health care and other needs that come about as a consequence of the injury.
Not so the law relating to the quality and safety of people requiring and receiving care in the health system. Instead there is a complex and confusing array of options for someone who suffers harm from an adverse event in the health system. The legal mechanisms available to people in these situations go across civil litigation (generally the tort of negligence); the administrative law mechanisms of the legislation regulating the professional conduct, performance and health of registered or enrolled health professionals; the Coroners' Courts; the complaints management processes available through the health consumer complaints agencies; and sometimes through the criminal justice system if the event relates to a criminal act such as an assault or even manslaughter.
However, the evidence indicates that taking such action is not necessarily the first choice of people who do come to harm when in the care of the health system. It is often only when a level of frustration is reached when their attempts to deal with the health service directly fail that they will go to complaints bodies or litigation to obtain the remedy they are seeking.
It is not a regular event for nurses or midwives to find themselves in the civil courts defending an action in negligence where a person who was a patient, client or recipient of care or their family are suing for damages because of the harm that has been inflicted while they were in the care of a nurse working in a health service. When it comes to the quality and safety of care provided by health professionals, nurses and midwives have their greatest exposure to the legal system through several of the other judicial processes. While it may be people requiring or receiving nursing or midwifery care that make the complaint, report or notification; employers, colleagues or other witnesses of events may also instigate action against a nurse or a midwife. This may occur if they reach a view that the nurse or midwife's professional conduct, professional performance or poor health (including the effects of drugs or alcohol) affects the quality of care they provide, jeopardising the safety of people requiring or receiving nursing or midwifery care. Increasingly there are mandatory obligations on people to report in these circumstances.
Complaints, reports or notifications about nurses and midwives providing unsafe or substandard nursing or midwifery care are made to nursing and midwifery regulatory authorities (NMRAs) or to the health complaint agency for the jurisdiction. Nurses and midwives may also be required to give evidence in coronial inquests where a person may have died, for example in unexpected, unusual, violent, unnatural, suspicious or other circumstances outlined in the various statutes in each jurisdiction relating to the coronial function.
The regulatory framework for nurses and midwives administered by NMRAs in each jurisdiction have been established specifically to protect the community from substandard care provided by registered and enrolled nurses and midwives. The requirements of educational preparation requirements for entry and re-entry to the professions; the registration, enrolment and special authorisation requirements for nurses, midwives, nurse practitioners and other sections of the professions; as well as the professional conduct, professional performance and health and impairment programs and streams are all in place for that purpose.
We know that things do go wrong for people requiring or receiving nursing and midwifery care in the health system. Ongoing professional development; reporting of incidents, errors and near misses; maintaining one's health; being aware of the conduct and actions of others; open disclosure of errors and incidents to people when they occur; quality documentation of care; and ensuring the lines of communication are open with people receiving care and across the clinical care teams, are all basic but important risk management strategies that will minimise the potential for harm to come to people requiring or receiving care. This will also have the corresponding effect of reducing nurses and midwives' potential exposure to the legal system.
Wilson, M., Runciman, W. and Gibberd, R. 1995. The Quality in Australian Health Care Study. Medical Journal of Australia. 163(9):458-471.
AMANDA ADRIAN IS A REGISTERED NURSE AND A LAWYER AND HAS THIRTY-SEVEN YEARS EXPERIENCE IN THE HEALTH INDUSTRY IN MANAGEMENT, SAFETY AND QUALITY IMPROVEMENT IN NURSING, HEALTH CARE, POLICY DEVELOPMENT AND REVIEW, EDUCATION, LAW, REGULATION, POLICY AND BIOETHICS.
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|Title Annotation:||ethics & legal|
|Publication:||Australian Nursing Journal|
|Date:||Jun 1, 2008|
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