Risk management & legal

issues
objectives

 Describe Laws Impacting Health Care

 Differentiate among the Elements of a Risk Management program
 Identify the risks professional nurses face regarding mal-practice and other
torts
 Outline a plan for professional nurses to use to reduce the risks of legal
actions
Law

“law is system of rules created and enforced by social and government

institutions to regulate behaviour of people.”
Purpose and Function of Law
Four principal functions and purposes:
 Establishing standards
 Maintaining order
 Resolving dispute
 Protecting liberties and rights
Why are laws important in healthcare?

Laws are designed to prevent harm to others while protecting the rights of
individuals. As a healthcare worker it is your duty to care and that if you
breach that duty and someone is injured as a result of that breach, there will
be a penalty to pay.
WHO Health Laws

Health law is the area of law concerned with the health of individuals and
populations, the provision of health care and the operation of the health care
system.
Examples of how health laws are used include laws that:
1. advance important health policy goals such as Universal health coverage;
2. establish the basis for organizing, governing and financing a country’s
health system;
3. protect the public and social nature of healthcare;
4. protect public health from communicable diseases or other public health
risks;
Conti…

5. regulate the operation of hospitals, clinics or other health services;

6. control the training and practice standards of health workers;
7. regulate the safety and efficacy of medicines and medical devices;
8. protect patient rights;
9. address non-communicable disease risk factors (e.g. smoking); and
10. Regulate the collection and use of health information.
Laws and The Rules
Administration of the following laws and the rules framed there-under:
 The Public Health (Emergency Provisions) Ordinance, 1944.
 Eye Surgery (Restriction) Ordinance 1960.
 Allopathic System (prevention of misuse) Ordinance, 1962.
 Pakistan Medical and Dental Council Ordinance, 1962.
 Pharmacy Act, 1967.
 The Pakistan Nursing Council Act, 1973.
 Drugs Act, 1976.
 Medical & Dental Degree Ordinance 1982.
 Punjab Health Foundation Act, 1992.
 Punjab Transfusion of Safe Blood Ordinance 1999.
 Mental Health Ordinance for Pakistan 2001.
 Punjab Medical and Health Institutions Act 2003.
 Injured Persons (Medical Aid Act) 2004.
 King Edward Medical University, Lahore Act, 2005
 Human Organ Transplant Ordinance, 2007.
 Pakistan College of Physicians and Surgeons Ordinance, 1962.
 The University of Health Sciences Lahore Ordinance, 2002.
 Fatima Jinnah Medical University, Lahore Act 2015.
Health Care Laws Protecting the Rights of
Patients in pakistan

In Pakistan ,patients has following rights according to law

1. Dignity
2. Announced with name
3. Identification of care giver
4. Experienced staff
5. Knowledge about treatment
6. Confidentiality
7. Refusal
8. Access to facilities
9. Right of legal assistance
 1.Dignity

Patient should be treated with dignity, respect, courtesy and privacy. Health
care is a basic human right and must be given regardless of race, religion, sex,
national origin, age, lifestyle or illness
2.Announce with name:-
Patient should be greeted by name and to receive information on health
services, the routines, policies, and facilities.
3.Identification of care giver:-
Patirnt be able to identify care providers with their name and designation.
 4.Experienced staff

Health care to be provided by qualified and experienced health

5.knowledge about treatment::-
 Receiving necessary health care education and/or counseling enabling to
understand and be informed of the plan for their care, including an
explanation of procedures, medications and treatments ordered
 To have physical access, if physically or visually impaired, to the staff and
to have effective communication with staff regardless of impairment
6. confidentiality
confidentially. Patients are given the opportunity to approve or refuse release
of such information except when required by law.
7.Refusal:-
Patient has a right to refuse any medication, procedure or operation. Or
anything they is understand by hin.
8.Access to facilities

To receive basic nursing care including concern for personal hygiene and
safety, nutrition, activity, rest and comfort according to their needs
To have access to all health care facilities/services when in emergency.
9.Right of legal assistance:-
Patient has a right to take any type of legal assistance to ensure his rights and
safety.
Risk management

 Risk management is the process of identifying, assessing and controlling

threats to an organization's capital and earnings. These threats, or risks,
could stem from a wide variety of sources, including financial uncertainty,
legal liabilities, strategic management errors, accidents and natural
disasters
 important benefits of risk management
include:

 Creates a safe and secure work environment for all staff and customers.
 Increases the stability of business operations while also decreasing legal
liability.
 Provides protection from events that are detrimental to both the company
and the environment.
 Protects all involved people and assets from potential harm.
 Helps establish the organization's insurance needs in order to save on
unnecessary premiums.
The Joint Commission requires all 14 of these
practices.

1. Active quality improvement program

2. .Appropriate use of clinical protocols
3. Clear communication with patients
4. Comprehensive patient medical records
5. .Credentialing of health care professionals
6. Documentation of informed consent
7. Formal patient grievance mechanism
8. .Internal incident reporting system
Conti…

9. Ongoing peer review of patient cases

10. Patient tracking system
11. Privileging of health care professionals
12. Regular patient satisfaction survey
13. Regular staff training on risk management
14. Up-to-date policies and procedures on risk management
Five elements of professional negligence or
malpractice:

 Duty
 Breach of duty
 Foreseeability
 Causation
 Injury or harm
1. DUTY:-
A legally recognized relationship (physician to client, nurse to client) the nurse had
a duty to the client, meaning that the nurse was acting in the capacity of a nurse.
2- BREACH OF DUTY:-
The nurse or physician failed to conform to standard of care, thereby
breaching or failing the existing duty. The nurse did not act as a reasonable,
prudent nurse would have acted in similar circumstances.
3.FORSEEABILTY:-
The ability to reasonably anticipate the potential results of an action, such as
the damage or injury that may happen if one is negligent or breaches a
contract.
4-CAUSATION:
The breach of duty was the direct cause of the loss, damage, or injury. In other
words, the loss, damage, or injury would not have occurred if the nurse had
acted in a reasonable, prudent manner.
5- INJURY OR HARM:
The client suffered some type of loss, damage, or injury.
CONTRIBUTING FACTORS TO INCREASE
MAL-PRACTICE CASES
 Several factors have contributed to the increase in the number of
malpractice cases against nurses.
 DELEGATION. As a result of cost-containment efforts in hospitals and HMOs,
nurses are delegating more of their tasks to unlicensed assistive personnel.
Delegation of some of these tasks may be considered negligence
according to a given facility's standards of care or a state's nurse practice
act.
 EARLY DISCHARGE. Patients are being discharged from hospitals at earlier
stages of recovery and with conditions requiring more acute and intensive
nursing care. 5 Nurses may be sued for not providing care or not making
referrals appropriate to the patient's condition.
 THE NURSING SHORTAGE AND HOSPITAL DOWNSIZING have contributed to
greater workloads for nurses, increasing the likelihood of error.
 ADVANCES IN TECHNOLOGY require nurses to have knowledge of a variety
of technologies' capabilities, limitations, and safety features.
 INCREASED AUTONOMY AND RESPONSIBILITY of hospital nurses in the
exercise of advanced nursing skills have also
NEGLIGENCE ISSUES

 FAILURE TO FOLLOW STANDARDS OF CARE

 FAILURE TO USE EQUIPMENT IN A RESPONSIBLE MANNER
 -FAILURE TO ASSESS AND MONITOR AND FAILURE TO COMMUNICATE
 FAILURE TO DOCUMENT
 FAILURE TO ACT AS A PATIENT ADVOCATE
MOST COMMON REASONSS FOR MEDICAL
MAL-PRACTICE

 Diagnostic error
 Surgical / procedural
 Medical management
 Medical- related
 Patient safety / environment
 Obstetric – related (birth injury)
 Failure in patient monitoring
 Anesthesia - related
A PLAN FOR PROFESSIONAL NURSES TO
REDUCE THE RISKS OF LEGAL ACTIONS

 Malpractice litigation is both professionally and emotionally devastating

and can be financially disastrous. Each nurse can take steps to help reduce
potential liability by using caution and common sense and by maintaining
a heightened awareness of his or her legal responsibilities. The following can
help nurses reduce potential liability.
1. Maintain open, honest, respectful relationships and communication with
patients and family members.
2. - Maintain competence in your specialty area of practice.
3. Know legal principles and incorporate them into everyday practice
4. Practice within the bounds of professional licensure
5. Know your strengths and weaknesses
 OTHER STRATEGIES TO PREVENT
INCIDENTS
 Use effective communication
 Helps decrease risk of bad outcomes
 Attentive listening
 Accurate documentation and reporting
 Professional liability insurance
 Nurses should carry to manage personal financial risk
 https://www.who.int/health-laws/legal-systems/health-laws/en/
 https://onlinelaw.hofstra.edu/blog/5-health-care-laws-protecting-the-rights-
of-patients/
 https://health.punjab.gov.pk/LawsAndRules.aspx
 https://online.norwich.edu/academic-programs/resources/6-business-skills-
for-nurse-leaders
 ELEANOR J.SULLIVAN,( EFECTIVE LEADERSHIP AND MANAGEMENT IN
NURSING), (8TH edition).BOSTON COLUMBUS, (NEW YORK).