Liability of RN who accompanies a patient during a transport to another facility

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    Hi, I am a labor and delivery nurse in a small community hospital. We occasionally transport patients in perterm labor to a nearby tertiary facility if she can be stablized. One of the labor and delivery nurses is required to accompany the patient on the ambulance to the other hospital. Here is my question: what is my liability if something should happen (i.e. the patient delivers the baby, etc.) while enroute? There is no written hospital policy regarding my duties while on the ambulance and therefore I am never exactly sure what to do regarding assessment, charting, etc. and what my responsibility is versus the EMT. Most of the patients are on magnesium sulfate therapy while enroute and we bring calcium gluconate with us in case of the patient starts experiencing symptoms of magnesium toxicity. We also take a fetal doppler monitor with us but we have no orders that set forth how often we should be monitoring the fetal heart rate. I am going to talk to my manager sometime in the next few days about this issue, but I would appreciate any comments any of you might have regarding this issue. The more I think about it and the more research I do, the more worried I become. Thanks.
    lindarn likes this.
  2. 10 Comments so far...

  3. 2
    You need to get written protocols to follow...if anything happens I would guess you would probably be hung out to dry. Our Children's hospital has an ICN transport team and they follow strict protocols. I think you are right to be worried...
    lindarn and caliotter3 like this.
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    I agree that you are right to be worried.
    You need a documentation system.
    You need physician orders and/or a protocol for monitoring.
    You need to know which physician to contact if there are problems en route (your physician or the accepting hospital's).
    You bring calcium gluconate, but have no order "coverage" for administering it?

    Honestly, I think I'd refuse to go on another transport without a policy in place. Policies guide your actions AND cover your butt.
    lindarn and caliotter3 like this.
  5. 1
    Quote from shsteer
    Hi, I am a labor and delivery nurse in a small community hospital. We occasionally transport patients in perterm labor to a nearby tertiary facility if she can be stablized. One of the labor and delivery nurses is required to accompany the patient on the ambulance to the other hospital. Here is my question: what is my liability if something should happen (i.e. the patient delivers the baby, etc.) while enroute? There is no written hospital policy regarding my duties while on the ambulance and therefore I am never exactly sure what to do regarding assessment, charting, etc. and what my responsibility is versus the EMT. Most of the patients are on magnesium sulfate therapy while enroute and we bring calcium gluconate with us in case of the patient starts experiencing symptoms of magnesium toxicity. We also take a fetal doppler monitor with us but we have no orders that set forth how often we should be monitoring the fetal heart rate. I am going to talk to my manager sometime in the next few days about this issue, but I would appreciate any comments any of you might have regarding this issue. The more I think about it and the more research I do, the more worried I become. Thanks.
    Are you transporting ALS with a Paramedic. You should be because the patient has an IV and requires close monitoring and possible advanced airway if the baby is born and need life saving intervention. Technically the patient is the responsibility of the paramedic, however, if you are with an EMT....it can get sticky because that makes you the most responsible on board and that makes you responsible for mother and baby in the event of delivery. Are you traveling with adjunct airway for baby? What I see here is the transport rig being inadequate, even though the chances are small the chances are still there, for the resuscitation of the premie and that put you squarely in the hot seat. Personally I think these Mom's should go by ALS with a paramedic who can care for the patient and the premie in the event that something happends. In that senario you are only responsible for the MgSO4 drip and treatment of toxic issues....which you still would need orders and documantation policies.

    YOu need transport monitoring paper work for vitals as well as interventions and treatment if any. YOu need standing orders to cover you on transport for the administration of the calcium and what parameters/circumstances it should be given. You need to know who you contact if complications occur enroute. You have a right to be concerned. I think you need to contact other hospitals outside your area to see how they transport pregnant moms in pre-term labor.
    lindarn likes this.
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    I agree with all of the above, also are you monitoring your pt with the Q-15 min vitals etc/per your mag gtt policy? ( What are you policies for the monitoring of this patient)? I agree YOU ARE SMART TO QUESTION THIS PRACTICE! EVEN WISER, TO REFUSE! IT UNTIL YOU HAVE A WRITEN PROTOCOL, POLICY ,AND PROCDURES, that your Hospital and all the treating physicals and Admin have signed off on. You may offer to help your boss/DON write one up. Look at other hosptials/Mediflight ( Level 1 Nurserys ask them who they use for tranport and talk to them) that are in your area that face the same problem and ask them for assistace in coming up with a plan for y'all. 10 years ago, I faced this same problem when lived in a rural area, and no one thinks about things until they become a problem. Things are different in Rural Nursing. But it doesn't mean it can't be 'CHANGED' for the better. And this can be fixed rather easy, it's just a matter of putting a plan on papper. It's going to take time, and getting crative, using resources, and looking up laws for your state, and then asking other hospitals/anbulance (compareable to your area) services how they are handaling these issues; This is going to your first step. Good Luck!
    sparklie.lady and lindarn like this.
  7. 1
    we quit this role years ago for same reasons. EMT's are adequately trained for transport. I agree with above recommendations
    lindarn likes this.
  8. 1
    Quote from classicdame
    EMT's are adequately trained for transport. I agree with above recommendations
    Not if the patient has MgSO4 running. Depending on the state it could be in a paramedic's scope of practice. Also, if you are transporting a patient to a higher level of care there are laws governing who can do the transfer. Basically they say you must provide the same level of care during the transport as the patient was receiving prior to transfer. You cannot drop down a level so a BLS rig would not be allowed.
    lindarn likes this.
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    I would think if you are punched in and doing it, you will be covered by the facility insurance. With that being said, never trust them. Get your own insurance. But I agree with OPs... there should be protocols and other things in writing.
    lindarn likes this.
  10. 0
    I agree with much of the above. Paramedics may be able to monitor a MgSO4 drip, however, this very easily could be out of their scope. Check with your local EMS agency about that. Almost certainly monitoring such a drip is out of any EMT scope. They're not educated about medications added to drips. They don't know how to titrate those drips and don't know about signs of mag toxicity. Certainly they won't have a protocol allowing them to administer the Calcium gluconate.

    Since you are assigned to do transport, you will have some coverage by your facility, however, you should have your facility develop some kind of standing order for transport or on your unit should the MD not be able to attend. If you do not have a standing order for fetal monitoring, delivery, mag and calcium gluconate administration/monitoring, at least ensure that orders for that are a part of the transported patient's orders.

    Definitely contact other hospitals and find out what they do for transport.

    Also, if I'm transporting from one hospital to another and an RN accompanies the patient, I consider that patient to be the RN's, not mine... especially if there are drips or procedures that need to be done that are out of my scope of practice.
  11. 1
    Quote from PsychNurseWannaBe
    I would think if you are punched in and doing it, you will be covered by the facility insurance. With that being said, never trust them. Get your own insurance. But I agree with OPs... there should be protocols and other things in writing.
    This is true until the feces hit the fan. If the patient starts going sour and you administer that calcium gluconate without an order and have a bad outcome you most definitely will be charged with practicing medicine without a license. I guarantee the hospital is going to cover their own butt by saying you did it by your own choice. They will likely go so far as to say they never told you to take the med with you. If the baby delivers and has a bad outcome they will say you are trained in NRP and you must have made a mistake. They have tons of lawyers and a big bank account on their side. What do you have? I think your facility is playing fast and loose with your license. If your patient needs transported they should be accompanied by a transport team trained in HROB and equipped to handle whatever emergency might arise while in transit. You need a medical control physician, a way to contact him/her, standards of care, protocols, job description with scope of practice and additional training including actual experience directing the resuscitating infants and sick moms. Not to mention proper monitoring equipment and, I'm sorry, but a fetal doppler just doesn't cut it. Whoever thought this was a good idea needs their head examined. I bet the risk management department would have a fit if they knew what was going on.
    Esme12 likes this.


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