B71P02 - Foundations in EBP

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B71P02 - Foundations in EBP

• Introduction to Healthcare Law and EBP

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Achievement of practice outcomes and portfolio
work

• Outcome 1.4.1
• Identify key issues in relevant legislation
  relating to mental health, children, data
  protection, moving and handling, health and
  safety etc

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Law and Evidence Based Practice

• EBP is about
• ...doing the right thing for patients
• using guidelines, information, research,
  clinical experience, and patient wishes/
  experiences in order to ensure best practice
• making sure practice is up to date
• being able to account for your actions
• So how are EBP and the law connected?
• Well....in 2 main ways. The first considers the
  use of law as evidence for practice whilst the
  second considers how the absence of evidence may
  result in an infringement of the law.

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1) The law as evidence

• There are laws governing specific areas of health
  care practice e.g. Manual Handling Regulations
  (1993), The Medicines Act (1968), The Mental
  Capacity Act (2005)
• So doing the right thing for patients might
  mean following the details of these laws
• You can justify or explain your actions by saying
  that you are following the law
• The law is the evidence

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1) The law as evidence

• You must always act lawfully, whether those
  laws relate to your professional practice or
  personal life (NMC Code of Conduct, 2008)
• You must adhere to the laws of the country in
  which you are practising (NMC Code of Conduct,
  2008)
• There is thus a professional obligation to act
  lawfully at all times.

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2) EBP and breaking the law

• If nurses do not use up to date information,
  research, evidence to support their practice then
  they may be carrying out substandard or dangerous
  practice
• Substandard or dangerous practice could have
  legal implications for example the nurse could
  be sued by the patient for the damages caused by
  negligence

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A Claim for Negligence

• For this to be successful the claimant must
  establish a number of facts
• 1) A duty of care existed
• 2) There was a breach in the standard of care
• 3) Reasonably foreseeable harm was caused
• 4) There was a clear chain of causation between
  the negligent act and the harm

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Vicarious liability means your employer might
be sued for your mistakes

• Employers are responsible for the actions /
  faults of their employees
• To be successful claimants have to establish that
  an employee had been negligent and
• that the person was actually employed
• that the employee was acting in the course of
  their employment

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Law and consent

• See Open Learn Learning Space at
  http//openlearn.open.ac.uk/mod/resource/view.php?
  id189908
• See NMC Guidance at
• http//www.nmc-uk.org/aFrameDisplay.aspx?DocumentI
  D4710

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Law and consent

• The basic rule underpinning law and consent
• competent adults have a right to determine what
  is done to their bodies.
• People who break this rule (for instance by
  assaulting others) are sometimes prosecuted under
  the criminal law.
• Health care professionals are rarely prosecuted
  under criminal law but if they touch patients
  without consent they are more likely to be
  involved in civil actions.
• Patients may sue them for compensation for
  either
• Battery, or
• negligence.

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Law and consent

• Battery and Consent
• Battery is any physical contact without consent.
  It need not be violent the wrong lies not in any
  injury caused but in the contact itself.

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Law and consent

• Negligence and consent
• A patient agrees to care / treatment but has not
  been given all the information about the
  advantages / disadvantages / risks of the care /
  treatment
• The care / treatment was carried out skilfully
  there were no errors or mistakes
• .but the patient is unlucky and suffers from
  one of the known side effects / risks.
• She may be able to sue for negligence because
  she was not fully informed about the risks
• In this case the negligence is in the information
  giving not in the care / treatment itself

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Law and consent

• Every adult must be presumed to have mental
  capacity to consent or refuse treatment (or care)
  unless they are
• Unable to take in or retain information provided
  about their treatment or care
• Unable to understand the information provided
• Unable to weigh up the information as part of the
  decision making process

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The law and consent

• To be valid consent must
• Be given by a competent person
• Be given voluntarily
• Be informed
• Another person cannot give consent for an adult
  patient who has the capacity to consent.

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Health and Safety Law

• HASAW Act 1974
• RIDDOR (1995)
• COSHH (1989, 1996)
• Manual Handling Regulations (1993)
• Puwer (1998)
• Loler (1998)

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Medicines

• Medicines Act 1968
• Misuse of Drugs Act 1971
• Misuse of Drugs Regulations 1985

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Human Rights Act (1998)

• Article 2(1) - Right to life
• Article 3 - Right not to be subjected to inhuman
  or degrading behaviour
• Article 5 - Right to liberty and security
• Article 8 - Right to respect for private and
  family life

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Reference

• Dimond, B. (2008) Legal Aspects of Nursing.
  London Longman.