Performing Vital Signs Without a Policy

Fiona59 · Mar 31, 2015

I work for an insurance company doing home visits. The state has requested that we take vital signs every 3 months when we visit. My company does not have any type of policy, protocol, or even algorithm in place. I'm concerned about the liability. What rights do we, as RNs, have? Thanks!
Riawahine

How in any way does saying to someone "I'd like to take your vitals" make you worry about liability?

The cuff goes around the arm not the neck.

If the customer wants to keep their insurance they will have their vitals taken. If they decline, chart it and leave.

JustMeRN · Mar 31, 2015

I'm a little confused, why would you need a policy to take vital signs? Do you do an assessment as part of your job? Vitals are a part of a nursing assessment.

Are you more worried about what you are supposed to do with ab normals?

Coffee Nurse, BSN, RN · Mar 31, 2015

An algorithm for vital signs??

CoffeeRTC, BSN, RN · Mar 31, 2015

I'm guessing that the OP wanted to know what to do if she obtains an abnormal value? Like a BP of 200/110 etc?

BrandonLPN, LPN · Mar 31, 2015

I'm guessing that the OP wanted to know what to do if she obtains an abnormal value? Like a BP of 200/110 etc?

Advise her to notify her PCP and/or go to an urgent care?

CrunchRN, ADN, RN · Mar 31, 2015

I think you need some guidelines about what to report and who to report it to. A policy even if it only indicates that you educate the patient to notify their MD. And then you should have somewhere to document that.

allnurses Guide · Mar 31, 2015

I would advise the patient based on the outcomes of said vitals and document the heck out of it.

I do think written guidelines would help protect the nurse, but the scope of practice dictates you to what a prudent nurse would do. That most often would equate to sending the patient to the emergency room or telling them to make an appointment (or even assisting them to do so) with their PCP. You will be judged in a bad situation by what a prudent nurse would do. Document, document, document.

Libby1987 · Mar 31, 2015

OP needs a policy with standard parameters, in home care we have to have them. You can't just decide off the top of your head what values without symptoms need, or don't, action on part of the assessing nurse.

GuEsT78 · Mar 31, 2015

Several posters are right. What's of concern isn't what small set of vital signs she should take, but what should be done if, for instance, a client's blood pressure is dangerously high. Is simply telling that patient sufficient, or should there be some followup to ensure that the proper care is given? If so, who is responsible for that follow up?

Some of the trouble flows from the fact that there are three parties involved. Where do a nurse's personal responsibilities end? After all, her role isn't really as a nurse. If asked, she'd probably say that these people are the insurance company's clients and not her patients.

Making matters worse, it's the state that wants the insurance company she works for to gather these vital signs. That raises questions about the responsibilities of the insurance company and this unnamed state agency. Does anyone have responsibilities beyond entering this data in their databases? If so, what?

Keep in mind that none of the threeâ€”nurse, insurance company or state agencyâ€”are NOT the client/patient's primary caregiver. That's particularly important if those being examined are elderly people in ill-health and perhaps with a confused mental state. Such people could get the impression that they're receiving medical care when that's not actually the case. That's where this becomes a legal tangle.

In short, she is right. This is messy, messy, messy.

I would add that as a nurse she has a right to expect her employer to give her clear answers and unambiguous policies, procedures, etc. to work from. She's not a lawyer and shouldn't be expected to function as one. I would suggest that she stress to her superiors that they need to bring this situation before the company's lawyers. I'm no fan of lawyers, but this is precisely the situation where a lawyer is likely to have a better understanding of what's at stake than an insurance administrator.

For the record, I did do graduate work in medical ethics and dealt with these sorts of issues. This is what happens when someone gets something resembling medical care from someone who isn't actually their care provider.

If disclaimers are to be given to these people, then they need to be very clearly given. For everyone's sake, it shouldn't just be a mere line on a form they sign.

--Michael W. Perry, author of My Nights with Leukemia: Caring for Children with Cancer

GuEsT78 · Mar 31, 2015

I should add that problems can be sins of omission as well as sins of commission.

Giving the appearance of care without actually providing it could lead some people to feel that they've been given a medical checkup when only a few vital signs have been taken. Again, that's a greater problem when the person being checked has mental impairments.

Perhaps this insurance company should approach that state agency and point out what a 'can of worms' the two of them are opening. The insurance company is apparently not collecting this data for its own purposes but for those of the state. Responsibilities should fall on the state.

Riawahine, BSN, MSN · Apr 1, 2015

Hi, I guess I should have explained: we are performing VS as part of an assessment. However, management hasn't given us anything in writing to protect or guide us if the vitals are abnormal. Do we call the doctor and stay in the home until we get him/her on the phone or is simply calling the office and notifying the staff enough? We have to act on abnormal VS, but there is no direction for the nurses in the field to establish a standard of care. We aren't giving meds, but for the grossly abnormal we will call 911. I know in court, they will ask 1-what the standard if care ? And 2-what would a prudent nurse do.