Author: Emma Monger, MIPS Claims Specialist
Most practitioners will be aware that the risk of skin staining is one of the complications of iron infusions. Staining can occur when there is extravasation into surrounding tissues. Although iron staining claims usually cost less than other litigated claims, we are witnessing a growth in their frequency. In this article, we consider some of the ways to protect yourself against iron staining litigation.
What should you do to prepare yourself before embarking on iron infusion treatment?
First, clear and well-documented consent processes will be most valuable. It is good to keep a template consent form for iron infusions and to specifically draw patients’ attention to the risk of iron staining. A signed and dated consent form that refers to the risk of iron staining will provide a better defence than a note in the record that simply states “patient consented”. Be alert to patients who may place more importance on the appearance of their skin, such as athletes, young people, people who prefer short sleeves and people whose income relies on their appearance.
Second, patients undergoing iron infusions should ideally be supervised throughout. However, this is not feasible for many practitioners. As such, regular checks by a practitioner and/or nurse are important. This should include visually inspecting the skin for evidence of extravasation and asking the patient about any symptoms of extravasation, which include:
- Discomfort
- Burning
- Stinging or pain
- Swelling
- Erythema
- Itching
- Leaking at the site
- Alteration of the flow rate or the alarming of an infusion pump
If any of the above symptoms are present or the patient reports a symptom, it is best to stop the infusion and assess the site. If there is evidence of extravasation, you may discuss ceasing the infusion or trying another site for infusion.
Other ways to minimise the risk of extravasation include:
- using an appropriately sized cannula
- not making multiple attempts to insert a cannula into the same site
- securing the cannula to minimise movement and explain to the patient not to move
- not applying pressure to the site e.g. compression with a bandage
- supervising the infusion for extravasation symptoms.
In conclusion, the best ways to protect yourself against an iron staining claim is to have a rigorous consent process with focus on the risk of staining and to ensure close monitoring of the infusion so that symptoms of extravasation can be immediately managed. Call MIPS if you have any questions regarding iron infusions and how to best safeguard your practice against potential claims.
Disclaimer:
Medical Indemnity Protection Society ABN 64 007 067 281 | AFSL 301912
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