Patient advocacy & legal liability

[DJ-Adia]

I have been an RN for 11 years and never have I encountered a situation as I did recently. I was caring for elderly male patient, who prior to admission, was independent & enjoying life with his only complaint being that he felt "tired & weak". 4 days into his hospital stay he lost his ability swallow (there was some thought that he might have had a stroke, but a definite diagnosis was not made). Given the risk for aspiration, the MD ordered that he be NPO & that plans be made for a G-tube to be inserted. The family was devastated!! This patient was the father of a co-worker (LPN) that I routinely work with.

Given my experience with & research that I had done, I made the family aware of Vital Stim Therapy. VitalStim therapy is the only neuromuscular electrical stimulation that is cleared by the FDA to treat dysphagia. Clinical research has proven that by using Vital Stim:

97.5% of patients with severe dysphagia regained swallow function past the point of PEG tube dependency

At three-year follow-up, over 76% had retained swallow function and only 3% reported aspiration

I informed my co-worker (the patients daughter) about Vital stim & referred them to the website where they could find additional information. I told them that if they felt that Vital Stim would be a therapy they might be interested in - that they should talk further with their MD & the speech therapist to see if it would be a therapy that they'd reccommend & find beneficial.

A few days later I received an email from our nursing coordinator informing me that it was inappropriate for me to inform the patient of VitalStim Therapy before first getting the ok from the MD because I was giving them "high hopes". I feel that I was being a patient advocate by simply making the family aware additional resources but regardless, they would need to consult with MD to further explore the risks of such treatment. Was I wrong by simply making my patient aware? Would I be liable in a court of law?

[canoehead, BSN, RN]

I think what you did was in the best interest of the patient, but the rub is that you are acting as an agent of your employer, and cannot recommend therapies they do not approve.

In the future, go back after you have clocked out and hand them the article, but let them know you are not an expert, just exploring options. I would go so far as to request they not mention where they found the article.

If I didn't trust the family to respect my privacy I would leave the responsibility for research of alternative therapies up to them. A tip I've found helpful over the years...if I'm working harder than the patient/family on their health I'm overinvested. Still happens sometimes though.

[Tweety, BSN, RN]

Moving from Introductions to the General Forum for more discussion. Welcome!

I usually leave treatment options and treatment plans to the MD, but that's just me. Don't know about the liability.

[TrudyRN]

Maybe you can just leave some literature lying around where your coworker can find it. Or talk with her, off of hospital grounds and on your own time, about any information that goes against whatever the docs have said.

docs and institutions feel hugely threatened and insulted over stuff like this. do not get yourself in trouble trying to help unless you can afford punishment, firing, etc. Just not worth it. I know it's very frustrating and you can try the approaches I have suggested but let it alone after that.

[MAISY, RN-ER, BSN, RN]

If anyone has the legal information, I'd be interested in knowing the answer.

I feel you did the right thing. It's what I would do too! I truly believe that we have to take the information we read in journals, books and articles and share them with MD, family and coworkers. Hope should be based on more than just the knowledge of one or two people-anything we offer or direct families towards may be the answer to their prayers.

Maisy;)

[EmmaG, RN]

You weren't prescribing any treatment, simply giving them information they could use to make an informed decision. I'm not sure I see the problem here...

[jojotoo, RN]

DO NOT SECOND GUESS YOURSELF ON THIS!!! This is a prime example of being an advocate for the patient. You assisted the patient/ family in educating themselves on a technique that might be beneficial and then instructed them to discuss it with the MD.

Bravo! We need more nurses like you.

[woody62, RN]

You weren't prescribing any treatment, simply giving them information they could use to make an informed decision. I'm not sure I see the problem here...

In most hospitals it is against hospital policy for anyone to provide literature or sell a product without written permission from the hospital's administration.

Woody:balloons: