Clinical observations in health and social care are not just medical routines; they are ethically charged, legally bound practices that hold the key to patient safety and care quality.

In this blog, Dr Richard Dune delves into the complex legal and ethical considerations surrounding clinical observations in UK settings, shedding light on the framework that ensures these practices serve their paramount purpose: safeguarding patient welfare.

The legal framework governing clinical observations

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In the UK, clinical observations are underpinned by a robust legal framework designed to protect both patients and healthcare professionals. This framework includes:

• The Health and Social Care Act 2008 - Sets out standards for care quality and safety.
• The Data Protection Act 2018 - Governs the handling of patient information.
• The Human Rights Act 1998 - Ensures respect for patients' privacy and dignity.

A survey revealed that 70% of healthcare professionals need more training on the legal aspects of clinical observations.

Key definitions

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Clinical observations

Clinical observations relate to monitoring vital signs to assess a patient's health status.

Consent

Consent is the permission given by a patient to undergo any medical intervention.

Confidentiality

Confidentiality is the ethical duty to protect patient information.

Negligence

Negligence is a breach of duty of care leading to patient harm.

Ethical issues in clinical observations

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Consent

Gaining informed consent is not merely a legal requirement but an ethical cornerstone in clinical observations, ensuring patients are active participants in their care.

Confidentiality

Maintaining the confidentiality of the data gathered through clinical observations is paramount, safeguarding patient privacy and trust.

Patient involvement

Ethical practice demands that patients are involved in their care decisions, making clinical observations a shared journey rather than a unilateral process.

The implications of negligence and accountability

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Negligence in clinical observations can lead to misdiagnosis, delayed treatment, and in some cases, irreversible harm. Healthcare professionals are accountable for their actions, with legal implications ranging from professional sanctions to legal proceedings.

Case law examples

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Bolam v Friern Hospital Management Committee (1957)

The Bolam v Friern Hospital Management Committee (1957) case significantly impacted medical negligence law in the UK by introducing the "Bolam Test." This legal standard assesses a healthcare professional's conduct against the practices accepted as proper by a responsible body of medical opinion at the time. The case arose from John Bolam's injury during electroconvulsive therapy, leading to a ruling that highlighted the latitude in professional judgment. A healthcare provider isn't considered negligent if their actions align with practices endorsed by many esteemed peers, even if there's a contrary opinion. This principle underlines the crucial role of peer-reviewed standards in medical practice, shaping how clinical negligence is evaluated to this day.

Montgomery v Lanarkshire Health Board (2015)

The Montgomery v Lanarkshire Health Board (2015) case fundamentally transformed the UK's legal landscape around informed consent. Nadine Montgomery, a diabetic woman of small stature, gave birth to a son who suffered severe brain damage due to complications during delivery. She argued that she was not informed about the significant risk of shoulder dystocia, nor was she offered a cesarean section as an alternative. The Supreme Court's ruling underscored the duty of healthcare professionals to disclose any and all risks that might affect a patient's decision-making process. This case shifted the focus from a professional to a patient-centred standard, emphasising that patients must be aware of material risks and alternatives, thereby significantly changing the dynamics of doctor-patient communication and consent dynamics.

These cases have significantly influenced current practices, embedding patient rights and professional responsibilities at the core of clinical observations.

Legal and ethical best practices

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Thorough documentation

Accurate recording of clinical observations and patient consent is crucial.

Continuous professional development

Accurate recording of clinical observations and patient consent is crucial.Keeping abreast of legal and ethical updates ensures practices are current.

Patient-centred care

Ensuring that care is respectful involves patient input and maintains their dignity.

Recommendations

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To navigate the legal and ethical aspects of clinical observations, healthcare settings should:

• Implement regular training on the legal and ethical dimensions of clinical practice.
• Foster a culture of openness and transparency, encouraging patients to be informed and involved in their care.
• Utilise technology to ensure accurate and secure documentation of clinical observations and consent.

Conclusion

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The landscape of clinical observations in UK health and social care is intricate, marked by a confluence of legal mandates and ethical obligations. By navigating this terrain with knowledge, compassion, and adherence to best practices, healthcare professionals can uphold the highest patient care and safety standards. The journey is complex, but the destination—a healthcare system marked by trust, respect, and excellence—is undoubtedly worth the effort.

Empower yourself and your team with the knowledge and skills to excel in clinical observations' legal and ethical aspects. Explore our comprehensive training courses for healthcare professionals seeking to enhance their competence and confidence in delivering patient-centred care. Enrol now and take a step towards excellence in healthcare practice.