Good Afternoon, Colleagues
At our Institution, we are getting ready to unveil an educational blitz on using "ouchless" medications for peripheral IV insertion. We are wanting to be able to demonstrate on each other, both the technique and the effectiveness of buffered lidocaine. Before we go about doing this I wanted to be sure their were no legal ramifications. So, I ran it by our Risk Management dept who directed us to Occupational Health who directed us to Education. They recommended we pose the question on a list serve. So, here it is:
Have you had any experience, outside of nursing school, where employees used themselves or their co-workers to learn an IV module?
If yes, please provide details and did you have them sign a consent or release of liability?
I appreciate your input and expertise.
Thank you.
Sara Owens, RN, BSN, CPN, CRNI
In California the Board of Licensed Practical Nursing (aka vocational nursing)
REQUIRES LVN'S who seek the privilege to practice IV therapy - must complete a 30 hour board compliant / approved course which includes a 6 hour clinical component.
For the State certification the LVN s are required to successfully complete 3 piv insertions.
As an instructor, my students most often stuck each other. I had an informal consent (to CYA)
The board does not mention consent... It would behoove your employing organization to determine what their policy is on the matter.
I DID NOT INSTRUCT USE OF BUFFERED LIDOCAIN, so I can not comment on that
This is not a practice I subscribe to for routine PIV insertion. I had no orders and no budget for this.
Ann Zonderman, BSN, JD, CRNI
As a certified specialist in both infusion nursing and nursing professional development, I would urge you NOT to allow any invasive procedure on a healthy volunteer. In fact, this is written in the Infusion Nursing Standards of Practice from INS, #6 Competence and Competency Validation, page S11.
There are several reasons for this standard. First is the high risk to the healthy person. I know we think of short peripheral catheter insertion as carrying no or minimal risk, however this is just not true. Many years ago, I found a picture online of a nursing student who developed an axillo-subclavian thrombosis due to fellow students practicing venipuncture on him. Also many years ago, I heard of a lawsuit about this issue, although I do not know the outcome of that suit.
The second reason is that this is essentially the same as any other simulation lab using anatomical models but using a human instead. This lab setting can never duplicate the clinical setting. In the real clinical setting, there will be decisions to make based on real patient assessments, and the patient's response to what you are doing. This can not be duplicated in the lab setting. Please review the INS standard on competency assessment as this is the legal standard to which you and your colleagues will be held accountable and rethink this process.
Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn's comments bring up an interesting dilemma. In California it is a law (see California Board of Vocational Nursing and Psychiatric Technicians scope of practice) that LVN's must successfully insert 3 PIV in the IV course they attend. The courses are not usually in a clinical environment that would allow for an actual patient/ resident experience.
Volunteers can be students or the student's designee. (occasionally a family member).
We have a law vs a the INS standards. This would definitely be interesting to debate.
Ann
Ann Zonderman, BSN, JD, CRNI
Ann rasies some interesting points. I would guess that the CA law was written long before the risk of using healthy volunteers was recognized. Also, the states that require LPNs to have this post-gradur ate course on IV therapy usually include requirements for supervised clinical practice along with a very specific course content outline and even the number of hours spent in this course. Each state is very different on this and many other issues. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861