Question

• In your own words, define the term delegation.

• Discuss the Five (5) Rights of Delegation.

• Who is involved in delegation? Is the delegator accountable for the tasks that he/she delegates? Explain your answer.

• One of the most important responsibilities of a nurse is to ensure patients' safety. Discuss two (2) interventions that a nurse must implement to ensure patient safety in an acute care setting.

• From your readings, discuss the guidelines for chemical and physical restraints.

Answer 1

Delegation:Delegation is the assignment of authority to another person to carry out specific activities. It is the process of distributing and entrusting work to another person.

Five Rights of delegation :

Right task.
Right circumstance.
Right person.
Right supervision.
Right direction and communication.

Right task
o The activity is within the delegatee job description.
o The activity is included as part of the established written policies and procedures.
2. Right circumstance
o The patient’s health condition is stable.
o The delegatee must notify the licensed nurse if the patient’s condition changes; the
licensed nurse will then reassess the situation and determine if the delegation is
appropriate.
3. Right person
o The delegatee has the appropriate skills and knowledge to provide care.
o This is determined by licensed nurse, the employer and the delegatee.
4. Right directions and communication
o Specific instructions should be given for the delegated activity to the delegatee.
o Clarifying questions should be answered.
o Data collection, reporting and time frame should be determined and agreed upon.
o Decisions or modifications can’t be made without consulting with the delegator.
5. Right supervision and evaluation
o Monitoring, follow up and evaluation are the responsibility of the delegator.
o Completion of documentation must also be confirmed.

Delegation involves a delegator and delegatee.

Delegatee: One who is delegated a nursing responsibility. A delegatee may be an RN, LPN/VN or
AP.
• Delegator: One who delegates a nursing responsibility. A delegator may be an APRN, RN, or
LPN/VN.

Yes the delegator is accountable for the tasks he delegates.

Accountability within the nursing context refers to nursing professionals’ legal liability for their actions related to patient care. During delegation, delegators transfer responsibility and authority for completing a task to the delegatee; however, the delegator always maintains accountability for the task's completion. The registered nurse is always accountable for the overall outcome of delegated tasks based on each state's nurse practice act provisions.

Important responsibilities of a nurse to ensure patient's safety:

Nurses play a critically important role in ensuring patient safety by monitoring patients for clinical deterioration, detecting errors and near misses, understanding care processes and weaknesses inherent in some systems, and performing countless other tasks to ensure patients receive high-quality care.

Identify “wrong site, wrong procedure, wrong patient” errors. High quality hospitals view nurses as the physician's partner in avoiding errors such as these. ...
Catch medication mistakes.
Educate patients about their medications.
Reduce patient falls.
Monitor patients for deterioration.

Interventions a nurse must implement to ensure patients safety in acute care setting are:
Use monitoring technology. ...
Make sure patients understand their treatment. ...
Verify all medical procedures. ...
Follow proper handwashing procedures. ...
Promote a team atmosphere.

Guidelines for physical and chemical restraints are:

(1) A physician or licensed practitioner must see and evaluate the patient within 1
hour of initiating intervention.
(2) restraint can only be used when clinically justified and after consid-
eration of alternative treatment options.
(3)restraints must have time-limited orders: 4 hours for adults (older
than 17 years), 2 hours for adolescents (9–17 years), 1 hour for patients younger
than 9 years.
(4) Patients must have continuous monitoring with periodic evaluation with the
intent to discontinue intervention at the earliest possible time.
(5) A face-to-face reevaluation must be performed before each renewal of initial
time-limited orders.
(6) Clinical leadership (ie, the medical director) must be notified after 12 hours of
continuous seclusion or restraint and every 24 hours thereafter.
(7) With the patient’s informed consent, family should be notified promptly when
seclusion or restraint is initiated.
(8) Debriefing with patient and staff should be performed after intervention has been
discontinued.