B71P02 - Foundations in EBP

1. B71P02 - Foundations in EBP • Introduction to Healthcare Law and EBP

2. 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……

3. 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.

4. 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’

5. 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.

6. 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

7. 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

8. 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

9. Law and consent • See Open Learn – Learning Space at: http://openlearn.open.ac.uk/mod/resource/view.php?id=189908 • See NMC Guidance at: http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=4710

10. 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 likelyto be involved in civil actions. • Patients may sue them for compensation for either: • Battery, or: • negligence.

11. 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.

12. 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

13. 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

14. 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.

15. Health and Safety Law • HASAW Act 1974 • RIDDOR (1995) • COSHH (1989, 1996) • Manual Handling Regulations (1993) • Puwer (1998) • Loler (1998)

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

17. 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

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