University of Bolton Bsc (hons) Operating Department Practice LEGAL AND ETHICAL ISSUES IN PERIOPERATIVE PRACTISE HLT 4090 Richard Oldfield Lisa Harrison 1811804 (22 May 2019) 2008 Contents Introduction to Legal and Ethical issues in perioperative practice. Pg 3The term Clinical Governance. Pg 3-4Failings within the NHS. Pg 4Legal and Ethical Principles and Guidelines. Pg 4-6Consent. Pg 6-8Conclusion. Pg 8 As a student Operating Department Practitioner (ODP), it is imperative that I understand, can explain, and put into practice Governance within the perioperative setting. What legal frameworks are set to achieve, and why they are put into place within the National Health Service (NHS).
Why as a member of staff I must adhere to these frameworks to protect patients, colleagues, and myself in daily practice. By gaining a valuable understanding of Legal and Ethical principles and Governance guidelines, I can ensure that as a student practitioner I will ensure to deliver the highest standard of care and skill to service users as is practically possible.
By being autonomous and ensuring patient safety is paramount, I will provide an individualised patient centred approach, therefore, minimising risks in all areas of perioperative care and reducing clinical incidents. According to The Department of Health (1998: 33), The term Clinical Governance in the perioperative setting has been implemented, as a system whereby to continuously improve, flourish, and safeguard high standards of care within the NHS. The aim is to achieve excellent care for both the service user, colleagues and staff, by making the NHS accountable for ensuring that their environment will succeed and develop with clinical excellence. (Gottwald, Lansdown 2014)Clinical governance in healthcare is made up of 7 pillars which include clinical audits. A way of assessing where improvements can be made, or if things are going well, also if healthcare is being provided within standards set. (NHS digital 2019). Risk management involves monitoring and minimising any risks to patients and staff and learning from mistakes that have been previously made in the past. This helps to improve care for patients. Examples of this are risk assessments and reporting any incidents. Clinical effectiveness works to provide the best outcome for the patient by using up to date evidence and research from the best sources, for example evidence-based practice with regards treatments. Education and training. This involves work appraisals for staff, courses and lectures to further develop any skills required to be competent. Information and IT, staffing and staff management, and client and carer experience and involvement. Patient and public involvement by way of questionnaires or patient forums. This helps to denote quality of services from a patient perspective. (Dentalnotebook.com). These pillars allow the continual monitoring and daily management, and progression to maintain a high standard of care within the NHS.Numerous failings within the NHS brought about a substantial change in 1999. (The Health Act 1999) (and 2003) When the Health Act made it a legal obligation for trusts to ensure that patients receive a high standard of care. (Publications parliament.uk)Some of these failings included: The Bristol heart scandal. Between 1984-1995. Where the tragic deaths of around 35 children, who died whilst receiving heart surgery at the Bristol Hospital in the early 1990,s. Alan Milburn, the health secretary at that time, outlined the findings and recommendations of the inquiry into the deaths in the House of Commons. Mr Milburn states that, Individual clinicians did not fail ” but children and parents were failed by the NHS. A system that should have saved them. (British journal of nursing 2001).More recently The Mid Staffordshire NHS Foundation Trust. The Healthcare Commission raised some concerns in 2007 about the trust, after it was found to have unusually high mortality rates. This then raised several reports, by different bodies, of which discovered severe and widespread failings in the care received. Barrister Robert Francis QC carried out the enquiry leading on from this. (Francis Report 2013). The enquiry makes a total of 290 individual recommendations. His findings concluded that. The extent of the failure of the system shown in this report, suggests that a fundamental culture change is needed. The system requires changes that can be implemented within systems to create new reforms (National Health Service news).Legal and Ethical principles define how an Operating Department Practitioner governs their clinical activities daily. Without frameworks and guidelines in place, there can be risks to patients, colleagues and ourselves if we do not adhere to stringent guidelines.Many practitioners will be familiar with the expression Duty of care. Legal, professional, and employment issues are the three specific areas in which a duty of care is set, and Practitioners combine in their daily use in Perioperative practice. (Pirie 2012).. Ethical principles have been defined by the British Medical Association (BMA) as, the application of ethical reasoning in decision making. (Herring 2016 p12). Ethics is the way that we behave and act within our role, to be able to treat everyone with the same regard and be empathetic to service users’ values and morals, regardless of our own views(Peate 2016 p25) states that Patient Centred care is healthcare that is respectful of, and responsive to, the preferences, needs and values of individual patients. The four main ethical principles in perioperative practice consist of, Beneficence, Non-maleficence, Autonomy and justice. (BMC medical ethics 2012) Beneficence being the act of doing good and acting in the best way for our patients. Having their best interests underpin our practise. Non-maleficence. As a student operating department practitioner, I have a duty and responsibility to not harm or allow harm to others. Autonomy, being the right to respect another person’s wishes views and beliefs, to enable them to make their own choices. Lastly Justice, how everyone is treated fairly and as equally as possible (Herring 2018).whilst Patient centred care should always be at the forefront of every Operating Department Practitioners daily duties. As an advocate for service users I am required to represent and protect, maintaining the wishes, needs, and confidentiality of patients individualised care.Legal principles safeguards areas of practice which might not consider ethical issues, other than whether the law should not be broken. These have been put in place to ensure and maintain public order, and as a framework of authority. (Dimond, Bridgit 2011)Common law is the constantly changing law with a hierarchy of courts, whereby the judge will assess the case before him and independently decide on action taken in each individual case. For example, if it was the first time a case was heard. Statutory law consists of highlighted acts drafted and set out in the house of commons to ensure that everyone is protected. For example, The Health and Safety at Work Act (1974). This regulates Employers making Employees safe in the workplace. (Dimond 2013).As a student operating department practitioner in the clinical environment, my understanding of the law and ethical values will promote a good awareness and reasoning in every situation I will encounter. As part of maintaining my professional registration, I am accountable for standards of conduct, performance and ethics. if I do not adhere to these procedures and policies in place, then I am in breach of working practice set by our regulatory body. (HPC 2008). This could in turn lead to the loss of a job or ultimately prosecution.Therefore, the National Institute for Health and Care Practitioners (NICE), is in place to support and provide Healthcare practitioners with evidence-based guidelines on a wide variety of conditions. Some of these include, mental health conditions, and cancer care. (Gottwald, Lansdown 2014).Also, the Care Quality Commission (CQC) commence regular visits to trusts as well as independent hospitals. They also regulate the ambulance service and mental health services amongst others. They are an independent regulator, whose role is to inspect review and reflect on policies and procedures, to ensure that they meet the quality standards required. They achieve this by speaking to NHS staff, patients, and experts, to gather any information necessary to use in their reports before publishing. This can be helpful for patients who wish to choose their own individual care. If there is a failure in standards the Care Quality Commission have the power to act accordingly. (Quality Care Commission.org 2019)Consent is an important aspect of medical ethics and international law. Of which consent must be informed. The patient given each step of information with regards to their procedure, including the benefits and risks. By telling them what is exactly involved and if they understand the procedure being undertaken. It must be voluntary, which means solely their decision and not influenced by any other party involved. Capacity meaning the patients can understand the information and use it to make an informed decision and give their consent to the procedure. (National Health Service UK).Within the healthcare sector there are four types of consent forms, these are set out for different purposes. Consent form 1 is a standard consent form for the patient’s own agreement to the treatment, procedure, or investigation being carried out. Consent form 2 constitutes paediatric consent. Where a parent is required to sign on behalf of a child or young person. Parental consent is required. Consent form 3 is the consent form for local procedures in which consciousness is not impaired. Lastly consent form 4 is for adults that are unable to consent to their own treatment or individualised care. They lack the capacity to consent for themselves, but the procedure must be in the patient’s best interests. (Health-ni.gov.uk)Consent can be given verbally or non-verbally. For example, non-verbal could be that a patient nods their head and stretches out their arm when asked if it is ok to retrieve blood or pop a cannula in whilst in the anaesthetic room. Also, in writing, by signing their consent form for surgery. (National health service.uk) As a student perioperative practitioner, I will encounter patients of different beliefs cultures and faiths, this will impact on clinical activities with regards consent and the care they receive. An example of could be a patient who is a Jehovah’s witness. Who since 1945 have refused on religious grounds to accept an allogenic blood transfusion, based on biblical texts. (transfusionguidelines.org). This poses a risk both anaesthetically and throughout surgery to the patient. All UK patients have a legal and ethical right to refuse treatment if they have mental capacity, and to administer blood against a patient’s wishes could lead to criminal or civil proceedings. (Royal College of Surgeons England 2016). Ultimately as an advocate for patient care I must represent the needs of the service user whilst encompassing individualised care and being autonomous to their beliefs.With regards anaesthetic care to the patient in this situation, the consent form will already state the patient’s wishes, as an advanced decision to refuse specified medical treatment form would already have been completed previously by the surgeon. (Royal college of surgeons 2016). The ward staff would be aware of this information after checking the patient in. Morning team brief in theatre would then highlight this whilst discussing individual patient needs with the designated team of staff, consisting of surgeon, anaesthetist, anaesthetic practitioner, and scrub team. Who will then develop the plan for the limitation of blood loss throughout the patients perioperative journey. For example, using tourniquets as and where necessary, the use of cell savage machines to retrieve the patient’s own blood, reprocess through a machine, and give back to the patient intra operatively. Taking care when positioning in the anaesthetic room due to the potential cardiovascular effects that could increase any kind of bleeding risk by altering cardiac output, preload, or peripheral vascular resistance. The patient would be closely monitored by all members of the surgical team throughout the procedure performed, and documentation would be provided thoroughly. The patients care pathway would be documented correctly and concisely including any blood loss sustained during the procedure, along with any other relevant information required for the recovery team involved. (British journal of anaesthesia 2015).In conclusion. By identifying the risks to each individual patient before and throughout their perioperative journey, I, as an autonomous student Operating Department Practitioner can help to assess their individual patient needs accordingly. By communicating effectively these risks with my other staff members and colleagues to outside departments as well as my own. We are working together to minimise any potential issues or incidents that could occur during the service users care. Therefore, ensuring ultimately that patient safety and confidentiality by way of effective communication throughout the perioperative experience is maintained. At the same time by also adhering to legal and ethical principles, policies and guidelines set out for us by the regulatory bodies and being a guardian for patient advocacy. By respecting wishes and beliefs whilst practising safely and responsibly within the boundaries of clinical governance and my own job specification. ReferencesBritish journal of Anaesthesia; Volume115. Issue5.1november2015. [online] Pages676-687. Available from: [accessed17/02/2019].British Journal of Nursing; London. Vol10. Issue14. (2001). [Online]. Proquest Central page 900. [accessed 19/02/2019].British medical Ethics; (2012); [online]. [accessed12/02/2019].Care Quality Commission; Opening the door to change.PDF/3.13MB [online]. [Https://www.cqc.org.uk/sites/default/files/2018224-openingthedoor-report-pdf]. [Accessed 18/02/2019].Dentalnotebook.com; (April 25 2018). [online]. [accessed 17/02/2019].Dimond,B. Legal aspects of health and safety. (2011)(2013). 2nd Edition. Quay, London.Francis Report (2013). [online]. https:assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment data/file/279124/0947.pdf. [accessed 19/02/2019].Gotwald,M. Lansdown,G. Clinical Governance; improving the quality of healthcare for patients and service users. Mcgraw Hill Education, (2014), Proquest Ebook central, [online]. Https://ebookcentral.proquest.com/lib/bolton/detail.action? Doc ID=1758179 [accessed 20/02/2019].Health Ni-Gov.UK. [online]. [accessed 10/02/2019].Herring, J. Medical Law and Ethics. (2016). Oxford University Press. Oxford. 6th Edition.National Health Service Digital. [online]. [accessed 17/02/2019].National Health Service UK. [online]. [accessed 15/02/2019].National Health Service News. [online]. [accessed 5/02/2019].Peate,I. Medical surgical nursing at a glance. John Wiley and sons incorporated. (2015). Proquest Ebook central. [online]. https:ebookcentral.Proquest.com/lib/Bolton/detail.action? doc ID=410772.Pirie,S. (2012). Legal and professional issues for the perioperative practitioner. The journal of perioperative practise. 22 (2), 57-62. Retrieved from Parliament.uk. [online] www.parliament.uk https:publications.parliament.uk/pa/cm 200607/cmselect/cmpubacc/302/30203.htm. [accessed 11/02/2019]Royal College of Surgeons. Advancing Surgical care. [online] [accessed 15/07/2019]Transfusionguidelines.org. JPac(1/JointUnited kingdom (UK) Blood Transfusion and tissue Transplantation Service Professional Advisory Committee. [online]. www.transfusionguidelines.org/transfusion-handbook/…transfusion/12-2-jehovah-s-witness-and-blood-transfusion. [accessed 16/02/2019].