Legal Implications in the Care of Orthopedic Patients: Serious Complications.

To help reduce potentially devastating outcomes from spinal complications and venous thromboembolism, it is essential for the bedside nurse to have a comprehensive understanding of risk factors and assessments. The orthopedic nurse carries a responsibility for accurately assessing, documenting, and mobilizing the team when abnormal changes occur. Nurses act as patient advocates. The bedside nurse must communicate with the physician. If a patient or family sues the health care team, after a careful screening of the case for merit, the legal process begins. A health care provider should never give in to the temptation to alter medical records.

Caracterização das ações de enfermagem ao paciente ortopédico em um hospital público / Characterizing nursing actions in a public hospital towards orthopedic patients

O objetivo deste estudo foi caracterizar as ações ao paciente com disfunções musculoesqueléticas prestada pelos profissionais de enfermagem atuante na ortopedia, num Hospital do município de Caxias-Ma. O trabalho segue uma abordagem quantitativa com caráter descritivo, os dados foram coletados por meio da observação dos procedimentos executados com a aplicação de um check list, e através de uma entrevista estruturada com questões fechadas referentes à atuação da enfermagem os critérios de seleção dos sujeitos foram: ser profissional de enfermagem atuante na ortopedia, ser da escala definitiva do setor e aceitar participar da pesquisa. Os resultados mostraram que as ações de enfermagem ao paciente ortopédico em sua maioria são de delegação e supervisão do ortopedista, o enfermeiro raramente participa deste processo. Conclui-se que existe a necessidade de uma atualização dos profissionais que compõe a ortopedia tendo em vista as lacunas existentes frente aos diversos aspectos que regem a enfermagem traumato-ortopédica.

Preventing lawsuits by noting and acting on key aspects in a patient's condition.

Nurses are often concerned about committing a wrong action that will result in a lawsuit. In reality, it is often omissions, failing to consistently and thoroughly perform the basic acts of nursing, that result in lawsuits. These include timely adequate assessments, following up on test or treatment results, and persistently notifying someone (up the chain of command, as necessary) when there is a significant abnormality. Red flags for concern include more severe pain than expected for the patient's condition, a sudden change in mental status, and a deteriorating trend. Institutional policies for standardized communication techniques and rapid response back-up assistance can be beneficial.

Assistants-at-surgery: recognition of the role of the registered nurse.

In the Omnibus Budget Reconciliation Act of 1989 (OBRA '89), Congress directed the Physician Payment Review Commission (PPRC or "the Commission") to make recommendations on payment policies for assistants-at-surgery, including physicians, physician assistants (PAs) and registered nurses (RNs). The National Association of Orthopaedic Nurses (NAON), via the Government Relations Committee and Executive Board, participated in the public hearing on this issue and submitted testimony on the role of the RN first assistant during orthopaedic surgery. In its 1991 report to Congress, the Commission recommended that inappropriate utilization of assistants-at-surgery could be reduced by implementing "profiling"--a variety of techniques to examine the use of assistants. PPRC failed to comment on policies related to non-physician providers, determining that this was a coverage issue, not a payment issue and thus outside the scope of their jurisdiction. However, as global surgical payment policy is further defined by the Health Care Financing Administration (HCFA) and Congress, consideration will again be given to incorporating payment for assistants-at-surgery into a comprehensive fee schedule. Recognition of the registered nurse as an assistant-at-surgery will continue to be a primary goal of NAON.