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Ethics and patient safety > Ethics and patient safety > Flashcards

Ethics and patient safety Flashcards

(68 cards)

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1
Q

Name the four exceptions to informed consent

A
  1. Emergency
  2. Waiver by the patient
  3. Patient is incompetent
  4. Therapeutic privilege (unconscious, confused, physician deprives patient from autonomy in interest of health)
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2
Q

When is parental consent not necessary (partial emancipation)

A
  • Sex (contraception, STIs)
  • Drugs (substance abuse)
  • Rock and roll (emergency/trauma)
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3
Q

Examples of when a minor is legally emancipated and does not need parental consent for anything

A
  • Married
  • Self-supporting (more tan 13 years old)
  • Military
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4
Q

Exceptions to confidenciality

A

“The physician’s good judgement SAVED the day”

  • Suicidal/homicidal patients
  • Abuse (children, elderly, or prisoners)
  • protect potential Victims (duty to protect)
  • Epileptic patients and other impaired automobile drivers
  • reportable Diseases (eg, STI, hepatitis, food poisoning)
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5
Q

Name the five R’s to prevent medication errors

A
  • Right drug
  • Right patient
  • Right dose
  • Right route
  • Right time
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6
Q

Most common cause of a hospital acquired UTI

A

Indwelling urethral catheter

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7
Q

Time criteria to diagnose a hospital acquired pneumonia

A

48 hours or more after being admitted

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8
Q

Most common nosocomial infections

A

UTIs

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9
Q

Second most common nosocomial infections

A

Hospital acquired pneumonia

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10
Q

Definition of an unexplained readmission

A

When the patients unexpectantly returns to the hospital in less tan 30 days after being discharged

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11
Q

Name the 3 categories of medical errors

A
  • Diagnostic
  • Treatment
  • Preventive
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12
Q

Name the 3 types of medical errors

A
  • Slips
  • Lapses
  • Mistakes
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13
Q

Define a slip (medical error)

A
  • Actions not carried out as intended or planned (administering something IV instead of SC)
  • Observable
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14
Q

Define a lapse (medical error)

A
  • Missed actions or omissions

* Not observable

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15
Q

Define a mistake (medical error)

A

*When the intended action is wrong

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16
Q

Define an adverse event

A

Harm or injury that result directly from medical care, not from negative outcomes due to the patient’s disease or medical condition

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17
Q

Define a near-miss

A

Errors that occur but do not result in injury or harm to patients because they are caught in time or simply because of luck

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18
Q

Name the 3 types of diagnostic errors

A
  • No-fault errors
  • System-related errors
  • Cognitive errors
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19
Q

Define the cogntive type of diagnostic errorrs

A

Errors that result from a diagnosis that was wrong, missed, or unintentionally delayed due to a clinician error

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20
Q

Name the 3 examples of the cognitive type of diagnostic errors

A
  • Anchoring bias
  • Confirmation bias
  • Availability bias
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21
Q

Define the anchoring bias

A

Wrong diagnosis occurs when a clinician holds on to a particular diagnosis and becomes dismissive to signs and symptoms pointing to another diagnosis

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22
Q

Define a confirmation bias

A

Looking for evidence to support a pre-conveived opinión rather tan looking for evidence that refutes it or provides greater support to an alternative diagnosis

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23
Q

Define an availability bias

A

Tendency to asume a diagnosis based on a recent patient encounter (the most cognitively “available” diagnosis)

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24
Q

Who should do the oficial disclosure of an error

A

The most senior physician responsable for the patient and most familiar with the case

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25
Systematic approach to medical errors that is retrospective in nature (eg, uses interviews and records to identify underlying problems)
Root cause analysis
26
Systematic approach to medical errors that uses fishbone (Ishikawa) diagrams to plot ideas
Root cause analysis
27
Prospective engineering approach which seeks to anticipate and prevent adverse events through safety design
Failure mode effects analysis (FMEA)
28
Name the principles of quality improvement
"STEEEP" * Safe * Timely * Effective * Efficient * Equitable * Patient-centered
29
Name the 4 measures of quality
* Structure * Process * Outcomes * Balancing measures
30
Examples of models of quality improvement
* PDSA * Six sigma * Lean * Flowhcarts
31
Name the steps to reduce variation and improve performance in the six sigma model of quality improvement
"DMAIC" * Define * Measure * Analyze * Improve * Control
32
Model of quality improvement that reduces everything that does not enhance patient outcomes
Lean
33
What would happen if a living will and a person with the medical power of attorney were contradicting themselves
The physician should follow the living will
34
What's the priority of surrogate decision makers
"the spouse ChiPS" * Spouse * adult Children * Parents * Siblings * Other relatives
35
Who is the surrogate decision maker if the patient has no family
A person who cares about and knows the patient's wishes
36
Measures that can be taken in patients who are having difficulty taking medications
* Provide written instructions * Simplify treatment regimens * Use teach-back method (patient repeats to the physician)
37
Can an underage woman request an abortion
Many states require parental notification or consent for minors for an abortion
38
What would be the correct course of action if a serious suicidal patient refuses to stay hospitalized
The patient can be hospitalized involuntarily if he/she refuses
39
What would be the appropiate course of action if a patient is victim of intimate partner violence
Ask if patient is safe and has an emergency plan
40
What would be the appropiate course of action if a colleague presents to work impaired
Report the situation to a local supervisory personnel (designated hospital committee), if there's no answer, alert the state licensing board
41
Level of disease prevention that prevents disease before it occurs
Primary prevention
42
Level of disease prevention that screens early for and manages existing but asymptomatic disease (eg, Pap smear, BP community screening)
Secondary prevention
43
Level of disease prevention that provides treatment to reduce complications from disease that is ongoing or has long-term effects (eg, chemotherapy)
Tertiary prevention
44
Level of disease prevention that focuses on identifying patients at risk of unnecesary treatment to protect them from harm of new interventions
Quaternary prevention
45
Characteristics of a health maintenance organization (insurance plan)
* Patients are restricted to a limited panel of providers who are in the network * Low monthly premiums, copayments, and deductibles * Payment is denied to services that don't follow evidence-based guidelines * Requires referral from primary care physician to see a specialist
46
Characteristics of point of service insurance plan
* Patients can see providers outside of the network, but have higher out-of-pocket costs, deductibles, and copays * Requires referral from a primary care provider to see a specialist
47
Characteristic of preferred provider organization (insurance plan)
* Patients are allowed to see physician inside or outside the network * Higher premium, copays, and deductibles * Does not require referral from a primary care provider to see a specialist
48
Characteristics of exclusive provider organization (insurance plan)
* Patients are limited (except in emergencies) to a network of doctors, specialists, and hospitals * Does not require referral from a primary care provider to see a specialist
49
Describe the capitation payment model
Physicians receive a set amount per patient assigned to them per period of time, regardless of how much the patient uses the healtcare system
50
Patients eligible for Medicare
* More tan 65 years old * Less tan 65 years old with certain disabilities * End-stage renal disease
51
Patients eligible for Medicaid
People with limited income and/or resources (joint federal and state program)
52
Life expectancy criteria to be eligible for hospice care (either in Medicare or Medicaid)
Less tan 6 months
53
Define the principle of double effect
The prioritization of positive effects over negative effects (like in hospice care)
54
Does pregancy make a child emancipated
No, responsibilities for the pregnant minor and her baby fall in the minor's parents
55
Type of euthanasia that a physician can perform
Passive, only if the patient asks for it
56
If a physician thinks treatment is futile but the surrogate insists in continuing treatment, what would be the appropiate course of action
The treatment should continue
57
If a patient is cortically dead but the family insists in continuing treatment, what would be the appropiate course of action
The treatment should stop
58
If an adult refuses to treat a child due to religious beliefs, and the event is not an emergency but still critical, what would be the appropiate course of action
Declare the child a ward of the court, and the court grants permission to treat
59
How long can a physician or a law enforcement oficial detain a patient if he/she is considered to be a danger to themselves or others
Up to 48 hours pending a hearing
60
A physician can detain a child and recommend that he/she is committed to a judge if the child is...
* An immediate danger to self or others * Orphaned or unable to care for their own daily needs * Uncontrollable due to illness, even if parents are seeking for help
61
What is the first thing that should be done after an event that causes harm to the patient
Care for the patient's medical needs
62
Type of error that is not usually needed to be disclosed to the patient but needs to be reported to the system
Near-miss
63
Describe the 3 dimensions of the Triple Aim principle of quality improvement
1. Improve patient experience of care 2. Improve the health of populations 3. Reduce per capita costs of health care
64
What's the use of a Pareto chart
It is used to describe a large proportion of quality problemas caused by a small number of cases
65
Define a "never event"
Particularly shocking medical error that should never occur
66
Most common type of elder abuse
Neglect
67
Define a "sentinel event"
Adverse event resulting in serious or permanent injury to a patient
68
What are the components of malpractice
* Duty * Breach * Harm done * Breach caused the harm

Ethics and patient safety (1 decks)

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