Association of Nursing Service

Administrators of the Philippines, Inc.

(ANSAP)

STANDARDS OF PROFESSIONAL
CARE IN INTRAVENOUS THERAPY

Standards of Professional Care in Intravenous Therapy

DESCRIPTION
This module focuses on how the I.V. nurse therapist demonstrates knowledge of
the theory and skill related to the standards of professional care in Intravenous Therapy.

OBJECTIVES
1.
2.
3.
4.
5.
6.
7.
8.
9.

Enhance awareness of the significance of the legal practice of IVT.

Identify the basis of nursing practice of IVT in the Philippines.
Enumerate the types of laws applicable to IVT.
Define the numerous of legal terms used in IVT.
Identify the common errors in administering IVT.
Discuss the general guidelines for avoiding malpractice lawsuits.
Specify the basic patient rights in IVT
Emphasize the importance of the standards of care in IVT
Enumerate most frequent allegations against nurses and preventive tips.

DURATION OF THE TOPIC

Eight (8) hours
PARTICIPANTS
Registered Nurses
COURSE MATERIALS
Whiteboard
Markers
LCD Projector
METHODS/ACTIVITIES
Lecture
Discussion
Interactive Participation
Demonstration
Workshop
CONTENTS

Standards of Professional Care in Intravenous Therapy

As the scope of IV Therapy has become more complex and specialized, nurses
have become more involved in administration procedures formerly performed solely by
physicians and considered medical acts
As a nurse, you have a legal and ethical responsibility to your patients.
By becoming aware of professional standards and laws related to give IVT, the
nurse can provide the best care for the patients and protect oneself legally.
Professional and legal standards are defined by the nursing law and the agency
policies.
A nurse must ask the following questions. Can I legally Administer IV Therapy?
1. Does the Nursing law delegate this function to the nurse?
2. Does the particular institution or agency policy, with the knowledge of the medical
staff, allow the nurse to perform this function?
3. Are the nurses limited in the types of fluids and medications they may administer
by a list of hospital?
4. Is the order written by a licensed physician for a specific patient?
5. Is the nurse qualified by education and experience to administer IVT?

BASES OF NURSING PRACTICE

RA 9173
Code of Ethics
Core Competency Standards (Revolution No. 24 Series 2012)
Standards of Care
Policies of the Institution
Patients of the Institution
Patients Bill of Rights
Legal Prescription of the Physician
EHTICO LEGAL ASPECTS OF NURSING
- Nursing practice is affected by ethical and legal considerations. Laws are
societys formula rules of conduct or action which the members recognize as
enforceable by a controlling authority. Ethics, on the other hand, are set of
moral principles or values that informally govern individuals in a society.
- Everyone has his own personal values or set of personal ethics.
Professionals have their own code of ethics. Nurses are bound not only by
their personal values but also by the rules governing their professional
conduct.
Ethical decision-making is difficult because there are no right or wrong answers.

Standards of Professional Care in Intravenous Therapy

The following are some helpful guidelines for ethical decision making:
1. Know your values. Take some time to determine what you value high enough to
defend.
2. Do not allow your values to be compromised. Giving in to a situation may
temporarily solve the problem but in the long run, this may build disrespect for
yourself, the hospital/agency or the person who asked you to compromise.
3. Be familiar with the code of ethics for nurses. Acting within ethical bounds is
what makes you a professional nurse.
4. Do not allow your nursing ethics to be compromised. Allowing your personal
ethics to be violated leads to disrespect and violation of your professional ethical
standards and adversely affecting professional reputation.
5. Do not force your personal values on others. What works for you may not work
for others.
6. Do not be disappointed when some people fail to meet your expectations.
Values differ among people.
7. Remember that the clients well-being and safety is your ethical responsibility.
2012 NATIONAL NURSING CORE COMPETENCY STANDARDS (2012 NNCCS)
I.

Beginning Nurses Role on Client Care

1. Practices in accordance with legal principles and the code of
ethics in making personal and professional judgment.
2. Utilizes the nursing process in the interdisciplinary care or
clients that empowers the clients and promotes safe quality
care.
3. Maintains complete and up to date recording and reporting
system.
4. Establishes collaborative relationship with colleagues and other
members of the team to enhance nursing and other health care
service.
5. Promotes professional and personal growth and development.

II.

Beginning Nurses Role on Management and Leadership

1. Demonstrate management and leadership skills to provide safe
and quality care.
2. Demonstrate accountability for safe nursing practice.
3. Demonstrate management and leadership skills to deliver health
programs and services effectively to specific client groups in the
community setting.
4. Manages a community/village based health facility/component
of health program or a nursing service.
5. Demonstrate ability to lead and supervise nursing support staff.

Standards of Professional Care in Intravenous Therapy

6. Utilizes appropriate mechanisms for networking, linkage building
and referrals.
III.

Beginning Nurses Role on Research

1. Engages in nursing or health related research with or under the
supervision of an experienced researcher.
2. Evaluates research study/report utilizing guidelines in the
conduct of a written critique.
3. Applies the research process in improving client care in
partnership
with
a
quality
improvement/quality
assurance/nursing audit team.

GENERAL PRINCIPLES
1. The practice of professional nursing has standards of practice setting minimum
levels of acceptable performance for which its practitioners are accountable.
2. Professional nurses are to be guided by the generic standards applicable to all
nurses in all areas of practice as well as by specialty area standards.
3. The authority for the practice of nursing is based on a social contract that
acknowledges rights and responsibilities, along with mechanisms for public
accountability.
4. Various specialty groups have developed their own additional standards
applicable to their own practice areas.
5. Standards and parameters also provide a source of legal protection for the
practicing nurse.
6. Standards and parameters consist of a simple series of steps that would be
application given the same or similar clinical scenario.
7. Standards and parameters should outline the minimum requirements for safe
care and need to be updated as scientific knowledge changes.
8. A deviation from the protocol should be documented in the patients chart with
clear, concise statements of the nurses decisions, actions, and reasons for the
care provided, including any apparent deviation.
9. Informal or volunteer practice must be consistent with the applicable standard of
care.
STANDARDS OF PROFESSIONAL NURSING PRACTICE
Standards of Care
Assessment
Diagnosis
Outcome Identification
Implementation
Evaluation

Standards of Professional Care in Intravenous Therapy

Standards of Professional Performance
Quality of Care
Performance Appraisal
Education
Collegiality
Ethics
Resource Utilization
Research
STATEMENT ON PATIENTS BILL OF RIGHTS
1. The patient has the right to considerate and respectful care.
2. The patient has the right to obtain from the physician complete current
information concerning his diagnosis treatment and prognosis in terms
the patient can be reasonably understand.
3. The patient has the right to receive from his physician information
necessary to give informed consent prior to the start of any procedure
and/or treatment. Where medically significant alternative for care, the
patient has the right to such information to know the name of the
person responsible for the procedure and/or treatment.
4. The patient has the right to refuse treatment to the extent permitted by
law and to be informed of the medical consequences of his action.
5. The patient has the right to every consideration of his privacy
concerning his own medical care program.
6. The patient has the right to expect that all communications and records
pertaining to his care should be treated as confidential.
7. The patient has the right to expect that within its capacity a hospital
must make reasonable response to the request of the patient for
services.
8. The patient has the right to obtain information as to any relationship of
his hospital to other health care and educational institutions as far as
his care is concerned and any professional relationship among
individuals by name who are treating him.
9. The patient has the right to be advised if the hospital propose to
engage in or perform human experimentation affecting his care or
treatment and has the right to refuse the participate.
10. The patient has the right to expect reasonable continuity of care.
11. The patient has the right to examine and receive an explanation of his
bills regardless of sources of payment.
12. The patient has the right to know what hospital rules and regulations
apply to his conduct as a patient.

Standards of Professional Care in Intravenous Therapy

TYPES OF LAW APPLICABLE TO IV THERAPY
Criminal Law
An offense against the public due to harmful effect on the
welfare of society as a whole; conviction results or
fine/imprisonment.
An offense against the legal rights of a private person,
property or corporation, if harm is demonstrated, damages
must be paid to the injured party.
Tort
Private errors by action or omission; negligence which can
result in civil action by the harmed person is an example.
Malpractice
Negligent conduct of a professional; failure to act is a
reasonably prudent manner that results in harm to a person
or property
ELEMENTS OF NURSING MALPRACTICE
1.
2.
3.
4.

The nurse has a duty to the patient.

The nurse failed to perform such duty to his patient
As a consequence of the failure, injury was sustained by the patient.
The failure of the nurse is the proximate cause of the injury sustained by the
patient.

LEGAL TERMINOLOGY
Battery
An intentional touching of a person in harmful or offensive
manner without his consent.
Civil Action
A non-criminal action whereby one seeks to protect, enforce,
or declare a right or address a civil wrong close to him/her.
When the harm occurs, the guilty party may be required to
pay damages to the injured person.
Consent
An expression by a competent adult person of his
fundamental right of self-determination over his person and
property. If the individual is unable to exercise this right,

Standards of Professional Care in Intravenous Therapy

such as minors and an incompetent adult, he is represented
by another who will protect his interest or preserve his basic
rights.
Criminal Action
An action brought by a state or federal law enforcement
agency or by an official agency on behalf of an individual to
protect ones person or property or to protect society in
general. Punishment includes imprisonment, fine or both.
Deposition
A discovery procedure which is an oral question and answer
proceeding, under oath and recorded wherein the attoryneys
seek to find out what the testimony and evidence will be
confronting them in lawsuit. It is an informal proceeding with
lawyers of all parties present.
Interrogatory
Another discovery procedure which is the written equivalent
of a deposition.

COMMON LIABILITIES THAT NURSES MAY INCUR ARE:

Negligence
Negligence is the omission (not doing) or the commission
(doing) of an act that a reasonably sensible person would or
should not do under normal circumstances.

Specific examples of professional negligence are:

Failure to property administer drugs, treatment, medications and failure to
report its adverse reaction.
Failure to exercise reasonable judgment in the performance of duty
Failure to supervise subordinates.
Failure to record and report unusual behavior of patients.
Improper charting
Failure to provide safety measures resulting in the injury of patients
Inability to forecast possible harm to patients, such as, in suicidal or
psychiatric cases or from other elements.
Carelessness in applying hot water bag treatment and other nursing
measures.
Allowing patients easy access to medicine cabinets and sharp
instruments.
Improper handling of equipment
Loss of, or damage to, patients property
Overlooking sponges, needles etc.. inside the abdomen
Escape of patients from the hospital
Leaving the unit without a reliever and proper endorsement

Standards of Professional Care in Intravenous Therapy

Rule of Personal Liability

Every person is liable for his own wrongdoing. No one can
bypass this rule with personal assurance.

Subpoena
The process or paper command by which the person
served must appear at a certain time and give testimony to
the court. It is an order under the seal of the court for which
one can be held for contempt of court for ignoring the
subpoena.
Summons
Notification served upon defendant to appear before the
court.

COMMON ERRORS IN ADMINISTERING I.V. THERAPY

Administration of medication-incorrect dosage, incorrect time of

administration, administration when contraindicated.
Failure in communication (e.g. Charting, Orders)
Use of equipment-error in technique, using defective equipment, allowing
another to act unsafe manner.
Failure to act/follow standards of care.

GENERAL GUIDELINES FOR AVOIDING MALPRACTICE LAWSUITS

According to nurses guide to avoiding Malpractice lawsuits (Springhouse, 1986)
Always questions the following types of orders:

Ambiguous Orders
If you are not sure of the meaning of an order, ask the
prescribing physician and document your actions. Follow
the policy of your facility for clarifying ambiguous orders.

Any order a patient questions

If a patient asks about a medication or I.V. dosage or route,
give him the benefit of the doubt and double check.

Inappropriate Orders
If a patients condition changes, the order that stands may
not be appropriate. If you think that a change is needed,
follow your facility policy in notifying the physician.

Standards of Professional Care in Intravenous Therapy

Telephone Orders
Whenever a doctor gives you an order by telephone, be sure
to document all the details such as time, date, doctors
name, and describe the circumstances that prompted the
call. Read the orders back to the physician to be sure they
have been recorded accurately. Document that the orders
were read back and confirmed by the physician.

Informed Consent
The best way to avoid malpractice lawsuits is to inform your
patient about the procedure. For a consent to be valid three
(3) conditions must be met; patient is capable of giving
consent, necessary information must be given to make an
informed decision, and the patient must not be coerced.
Patients have the right to choose whether they desire
medical care or not.
The patient must be aware of the treatment that would be
given to him/her, the possible complications, danger and
risks that may take place and other alternatives to the
proposed therapy or treatment which may be considered.
The patient has the right to consent or refuse such
treatment.

The general consent taken upon admission is for initial treatment. Special procedures,
such as, surgery, biopsy, spinal puncture, blood transfusion, and x-ray procedures
necessitating the administration of dyes would require another consent.
No consent is necessary for emergency cases where a
patients life is at stake.
However, this should be properly witnessed and the doctor
should make the necessary notation on the chart. It is the
nurses responsibility to obtain such consent.
PATIENTS RIGHT
Touching a patient in a harmful or offensive manner without his consent is called
battery. For example, starting an I.V. in a conscious, coherent adult, without his
approval will make the nurse liable to a battery charge.

STANDARDS OF CARE
Breach of duty can occur in relation to I.V. Therapy when there is:

Delay in administration of medication

Unfamiliarity with drugs

Standards of Professional Care in Intravenous Therapy

Inappropriate route of administration

Failure to qualify orders
Negligence in patient teaching

MOST FREQUENT ALLEGATIONS AGAINST NURSES AND PREVENTIVE TIPS

1. Failure to ensure patient safety
Monitor patient in timely manner
Provide assistance for those patients who require it when
they need to use the lavatory or shower
Keep bedrails raised for patients who are medicated or
confused
Use restraints appropriately

2. Improper Treatment or Performance of Treatment

Question treatments you believe are improper
Use proper techniques when performing procedures
Follow hospital procedures when performing treatments
Seek consultation for treatments beyond your abilities
Update your clinical skills through continuing education
3. Failure to Monitor and to Report
Follow physicians order regarding monitoring of patients
Report any requested information of significant changes in a
patients condition
Perform appropriate and timely nursing assessments
4. Medication Errors and Reactions
Refer to physicians desk reference for any questions on
appropriate dosages, side effects, and reactions
5. Failure to follow hospital procedure
Know hospitals procedures
If you must deviate from a procedure, discuss the incident
with your supervisor and decide on the appropriate action.
Advise the appropriate person of any procedures that need
to be revised.
6. Documentation
Document significant information about your patient
objectively and factually.
Be time specific about the information, such as when you
performed actions, made observations, or performed patient
assessments.
Document legibly, spell correctly, and use only hospitalapproved abbreviations.

Standards of Professional Care in Intravenous Therapy

7. Equipment Use
Learn how to operate equipment in a safe and appropriate
manner.
In teaching patients to use equipment, follow a
predetermined procedure.
Provide home card patients with the telephone number of a
24-hour backup hospital or home care service in case of
emergency.
Have patients demonstrate their competence with equipment
before allowing them to use it.
8. Adverse incidents
When adverse incidents occur, complete the appropriate
documentation and report the incident to the designated
individual.
Dont assume, voice, or record any blame for the incident.
9. Patients with HIV
Participation in testing a patient for HIV without first obtaining
informed consent.
Follow hospital procedures for care of patients with
infectious diseases.
QUALITY ASSURANCE
1. A quality assurance program creates and implements a systematic, deliberate,
and ongoing mechanism for the evaluation and monitoring of professional
nursing practice aimed at performance improvement and adverse event
reduction.
2. The use of quality assurance program effectively reduces the professional
nurses exposure to liability, identifies educational needs, and improves the
documentation of the care provided.
QUALITY ASSURANCE PROGRAMS
May include:
a. Patient satisfaction surveys to assess nurse interactions
b. Peer review
1. Recognize and reward care delivered, lead to higher standards of practice
within a community.
2. Discourage practice beyond the scope of legal authority
c. Audit of clinical records to determine how well established criteria were met by
the care rendered.
d. Utilization review to evaluate the extent to which services or resources were used
as measured against a standard.

Standards of Professional Care in Intravenous Therapy

RISK MANAGEMENT AND QUALITY ASSURANCE
Risk management and quality assurance programs in facilities are implemented
and designed to assure that the standard of care is set to establish desired patient
outcomes. These programs are a way of objectively evaluating the care that is given.
Risk management handles errors while quality assurance seeks the ideal
situation. It is essential, to maintain the quality of care, that standards are set and
monitored for I.V. Therapy.
When error is made, the nurse must report the error via an incident report so that
error trends may be identified and corrected.
When these incidents occur due to negligence, mismanagement, misdiagnosis and of
fortuitous eventsHow do you save yourself from a lawsuit?
Perhaps, the ONLY way is tosay SORRY and PRAY or PAY!!!