1) Discuss legal issues regarding EBP and Clinical guidelines.
Clinical practice guidelines are recommendations that have been created to assist clinicians and advanced practice practitioners in patient health care diagnosis, treatment and plan of care (White, 2021). Ideally clinical practice guidelines are based off best practices and evidence based practice, however at times clinicians must sometimes deviate from those clinical practice guidelines because they may not be appropriate or provide the best possible outcome for the patient. Clinical practice guidelines are helpful in the sense that it can support clinical reasoning and evidence, but it can be used for cases in malpractice and negligence if actions from clinicians deviate from it in certain states (White, 2021). The aforementioned would mean clinicians could be held liable for not following certain clinical practice guidelines, since they are setting a certain standard of care and action, however what if those guidelines are not appropriate for the patient or that specific guideline is not the most current practice? Clinical practice guidelines may have uncertain authority, for example, national academies, state and federal agencies, hospital systems and even patient advocacy groups now create guidelines, some of which can contradict each other, others even have conflicts of interest undermining their authority (Ruhl & Siegal, 2017). Fear of litigation in not using clinical practice guidelines could force clinicians to use clinical practice guidelines that they may not agree with, may not be most up to date, may not be in the patients best interest, nor the best possible treatment or guideline that would provide the best outcome for that specific patient or clinical situation. Adherence to clinical practice guidelines is not feasible for every patient, as such its adherence should not be used as the sole factor to establish liability and malpractice claims, instead it should be considered in conjunction with primary science customary science, clinical experience and expert opinion regarding specific facts of each particular case (Taylor, 2014).
Ruhl, D. S., & Siegal, G. (2017). Medical malpractice implications of clinical practice guidelines. OtolaryngologyHead and Neck Surgery, 157(2), 175177. https://doi.org/10.1177/0194599817707943
Taylor, C. (2014). The use of clinical practice guidelines in determining standard of care. Journal of Legal Medicine, 35(2), 273290. https://doi.org/10.1080/01947648.2014.913460
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2021). Chapter 18: Creating a Culture That Promotes Translation. In Legal Issues in Translation (3rd ed., pp. 347351). essay, Springer Publishing Company, LLC.
2) Telehealth or telemedicine practice has become a popular treatment modality among nurse practitioners in the post-COVID19 pandemic era. Telehealth is defined as the use of digital communication based technologies to evaluate, diagnose and provide treatment management remotely (Mayo Clinic, 2022). According to the The American Telemedicine Association (ATA) (2021) telehealth claim lines increased 2980% nationally from September 2019 to September 2020. Moreover, Patients with chronic illnesses report a 77% increase in the use of telehealth (The American Telemedicine Association, 2021).
There are legal issues concerning the use of evidence-based guidelines and clinical guidelines when providing telehealth medicine by advanced nurse practitioners. First, the risk of liability issues in telehealth practice increases with a lack of adherence to telehealth practice guidelines (CBGs) (Balestra, 2018). For instance, Horton and colleagues (2020) present clinical practice guidelines for the evaluation and diagnosis of ocular diabetic-retinopathy via telehealth and based on recommendations published by ATA. Practice guidelines include principles of retinal examination, ethical issues in telehealth practice involving patient confidentiality, clinical accuracy of diagnosis, and adoption of clinical diagnostic tools such as the International Clinical Diabetic Retinopathy Scale (Horton et al., 2020).
In addition, to clinical practice adherence, the authors emphasize the fundamental importance of having network and software security protocols to protect patient confidentiality and identification of image (Horton et al., 2020). A breach in patient data signifies a violation against the Health Insurance Portability and Accountability Act and security requirements. The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 as federal law which mandates protection against the unauthorized disclosure of patient information (Centers for Disease Control and Prevention, 2022). The legal consequences resulting from a HIPPA violation vary based on the nature of the violation, whether action was taken to correct the violation, and harm caused to the patient (HIPAA Journal, 2022). Civil penalties range between one-hundred dollar fines to twenty-five thousand dollars (HIPAA Journal, 2022). Furthermore, criminal penalties may exceed fifty thousand dollars in addition to plaintiff restitution. In conclusion, when providing telehealth services it is imperative for the advanced nurse practitioner to remain licensed in states participating in the enhanced Nurse Licensure Compact (eNLC), and remain adherent to clinical practice guidelines based on specialty. Including the adherence to ethical standards, state and federal law regulations.
Balestra, M. (2018). Telehealth and legal implications for nurse practitioners. The Journal for Nurse Practitioners, 33-39.
Centers for Disease Control and Prevention. (2022). Public Health Professionals Gateway. Retrieved from Health Insurance Portability and Accountability Act of 1996 (HIPAA): https://www.cdc.gov/phlp/publications/topic/hipaa….
HIPAA Journal. (2022). HIPAA Rules and Regulations. Retrieved from What Happens if You Break HIPAA Rules?: https://www.hipaajournal.com/what-happens-if-you-b…
Horton, M., Brady, C., Abramoff, M., Barker , G., & Chiang, M. (2020). Practice guidelines for ocular telehealth-diabetic retinopathy, third edition. Telemedicine and E-Health, 495-543.
Mayo Clinic. (2022). Telehealth: Technology meets health care. Washington DC: Mayo Clinic Staff. Retrieved from Health Information: https://www.mayoclinic.org/healthy-lifestyle/consu…
3) Reply to prof. “Great post. Thank you
Do clinical guidelines always set “standard of care”?