Legal Question

AutumnBreeze · Jul 14, 2012

I agree with you. I would also feel that it is my duty to treat them. This puts you in a very difficult position,in my opinion.

williamd · Jul 15, 2012

The practice of post-hospital phone calls is a good one. The problem lies in trying to give advise and practice over the phone. My advise is to ask people who are having problems to come in and be seen.

bsnanat2 · Jul 15, 2012

I hear what you are saying, but disagree. If a lady in line at Walmart tells me her blood glucose is 300, I am not obligated to treat her. Same if I pass an accident on the freeway... I am not obligated to stop and ID myself as a nurse and provide assistance just because I am a nurse. Not legally obligated anyway. You are following up on a study asking a question. Is a medical assistant who makes these calls obligated to tell a provider that someone's blood glucose is 300? They would be if that person were in the clinic. If it bothers you, tell the person to seek some assistance at the nearest ER or to see their PCP. You probably actually create liability by volunteering to give medical advice over the phone. Research is like traveling to the past....things must be left untouched and without influence. If one were to intervene, there would be no purpose to research. The other major factor that you may not be considering is that all research must go through some type of Institutional Review Board for approval. That IRB makes sure, before, during and after the study that research is collected in a legal and ethical manner.

Bottom line is that this is research which is different from other nursing.

kanzi monkey · Jul 15, 2012

Waiver: (Tongue in cheek) I realize that no one here is qualified to give me actual legal advice. I will not hold anyone here responsible for any advice I may be given. If I make a stupid decision based on stupid advice, I pledge to hold the poster as harmless.
So here's the deal. I work inpatient on a diabetes research study. The NPs and PA manage the diabetes treatment for patients admitted (usually NOT for diabetes) who sign a consent to participate in the study. We do not see the patients for follow up after hospital discharge. Part of the study includes certified nurse educators who contact the patients one week after discharge to ask scripted questions such as confirming the doses of insulins or other meds the patient was prescribed at DC, has the patient had hypoglycemia since DC, has the patient had hyperglycemia since DC, has the patient required ER treatment since DC, etc.
In the past, the NPs and PA were asked to help out with these phone calls, which I tried to do. I quickly realized this put me in a tight spot when a patient had very low or very high glucose at home...I was supposed to just gather data and not advise or treat the patient whatsoever. After that experience I refused to do further follow up calls and explained to the group my thoughts that I am responsible to evaluate and treat patients to the highest level of my license and education, so hearing a patient tell me he has blood sugars of 300+ at home obligates me to at least instruct the patient in adjusting his insulin doses OR to prescribe an additional medication for better control.
Am I right? The question of our doing these phone calls is going to come up in a meeting in the near future and I want to be prepared. I emailed the service department at my liability insurance carrier to ask the question and have not yet received a response.

Are there not safety parameters for these follow up calls? Like, if blood sugars reported 400 call so-and-so doctor or seek emergency treatment? Anyone making the calls could follow these instructions (though "symptoms" may be more nuanced for a non-medical professional).

Also, are you identifying yourself as an NP when you make these calls? Do the patients understand that when they report this information over the phone that they are not going to receive advice or intervention even if they need it?

As far as prescribing an intervention over the phone--that sounds dubious as you are not acting as their care provider and may not know the patient well enough. But if they're having an issue, they should be instructed to seek treatment asap (then be followed up on by their doc).

As far as overhearing a blood sugar report while waiting in line--whatever, ignore it. But if someone actually checks their blood sugar in my vicinity and it's, say, 40, I'd help them out. Mind you, this never happens in Walmart lines :)