Legal and Ethical Issues – Guidance from NMC

1. Legal and Ethical Issues – Guidance from NMC Cervical Screening QARC Training School October 2012

2. Legal & Ethical Issues Accountability Confidentiality Consent Record keeping Protocols

3. Accountability For your own clinical practice/professional conduct To the patient To the NMC for actions and omissions To your employer

4. The role of the nurse The nurse’s role is to educate and facilitate within this area of health care and to provide information and support for women: it is not to provide a diagnosis or to imply that the nurse can in any way define whether a woman may or may not have cervical cancer

5. Confidentiality You must respect people’s right to confidentiality. You must ensure people are informed about how and why information is shared by those providing their care. You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practicing. NMC The Code, Points: 5,6 and 7. 1st May 2008 Updated May 2012

6. Consent The patient must understand – What & why Nature of treatment Risks Consequences of refusal Options available Incompetent adults

7. Consent cont… Consent should be obtained by the nurse carrying out the test / examination Consent should be informed or it is not valid Women should be made aware of the associated risks & benefits of screening These risks & benefits should be given in an information leaflet Consent can be withdrawn at any time during the procedure Consent does not have to be written – self referral by the patient shows implied consent

8. Record keeping Records should be factual and not include unnecessary abbreviations, jargon, meaningless phases or irrelevant speculation. You should use your professional judgement to decide what is relevant and what should be recorded. You have a duty to communicate fully and effectively with your colleagues, ensuring they have all the information they need about the people in your care. The principles of good record keeping apply to all types of records, regardless of how they are held. NMC Record Keeping, A Guidance for Nurses April 2010.

9. Records should be Factual Accurate and relevant Abbreviations Legible Dated and timed Signed Alterations & additions made correctly Computer records

10. What do I write in the notes / on thecomputer / labforms ? Remember – If is not written down, then it did not happen! Remember – Your Sample Taker (ST) number is unique to you – please do not share with anybody else – you are accountable for your practice!

11. Protocols Give clear guidance as to why, when, where and by whom a procedure will be carried out are a draft of terms signed by all parties involved in the care of the patient a procedure is the how : a guideline to the practical implementation of a task Protocols therefore guide procedures

12. Reducing the risk - 3 questions to ask? Do I have AUTHORITY? Does the law allow me to do this? Do I have ABILITY? Am I competent and up to date? Do I have AGREEMENT? Have I my employer’s permission and the patient’s consent? From: Legal and Ethical Issues- Bridgit Dimond. 2005.

13. CASE FOR DISCUSSION The practice had a clinic run by the practice nurse. Mrs Brown had never been to the clinic before but she had regular cervical sampling taken by her GP. Mrs Brown had noticed an offensive PV discharge but knowing that she was attending for her cervical screening, decided to leave it until her appointment. Mrs Brown told the nurse that she had a smelly discharge that she was worried about. The nurse informed Mrs Brown that she would need to take some swabs to see if the patient needed any treatment prior to her sample being taken. The nurse did not discuss with the patient the possible reasons for the vaginal discharge or treatment options. Nor did she discuss with her the reason why she could not undertake the cervical sample at this appointment and the possibilities of passing on infections and precautions that she needed to take – i.e. condom use and antibiotic treatment. How would you have handled this situation? Was it the correct way?

14. CASE FOR DISCUSSION A 27 year old single woman attended her surgery following an invitation for routine cervical sampling. Two weeks after the routine examination the GP received the following letter. Dear Doctor, On Nov 29th I attended your surgery for a cervical sample as I had received an invitation letter. This was done by your nurse. She gave no explanation of why this was being done. She did not ask me any questions about my personal life. Until I spoke to a friend of mine I did not realise that I did not need a cervical sampling at all as I have never had a sexual relationship with anyone. The test itself was very painful and I think that the nurse should have found out more about me before doing it. I will not be coming back for another test. What are the main issues raised here?

15. CASE FOR DISCUSSION Mrs Jones was 29 and her youngest child was three. She was generally good about doing the things she was meant to do, like having cervical sampling and going to the dentist, so when she received her reminder for her 3 yearly sample she went ahead and had it done. She was advised that if she had not received a result letter in 2 weeks to contact the surgery. She rang 2 weeks later as the nurse suggested. The receptionist said that the results had not come back yet and she should try again in a few days. When they did come back they showed mild dyskaryosis and suggested that the smear was repeated in 6/12. The results were filed. Mrs Jones tried phoning again several times but the line was always busy. She decided that if there was bad news the surgery would ring her. After about 18/12 Mrs Jones went to see her GP because she had intermenstrual bleeding and an unpleasant discharge. The GP found her cervix to be abnormal and immediately referred to gynae. She was found to have inoperable ca. cervix from which she died at the age of 31. Could this happen in your practice? What responsibility did the patient have?