Medical Legal Flashcards
(116 cards)
1
Q
What are the two types of law that pertain to anesthesia?
A
Criminal and Civil or Tort
2
Q
Define criminal law.
A
Protect society from harm
3
Q
What are the ciminal CRNA concerns?
A
- Fraudulent insurance claims
- Misuse of controlled substances
4
Q
Medication errors are what type of law?
A
Criminally negligent homicide nd gross neglect of an impaired adult
5
Q
Define civil or tort.
A
A civil wrong in which a party is injured dur to the failure of another part to carry out their duties to the injuried party
6
Q
What are the different types of civil or tort?
A
Intentional or Unintentional
7
Q
What are intentional civil or tort classified as?
A
- Assault
- Battery
- False imprisonment
8
Q
Define assault.
A
A threat of bodily harm coupled with an apparent, present ability to cause the harm
9
Q
Define battery
A
Unlawful touching of another person
10
Q
What is a type of false imprisonment unique to anesthesia?
A
can be chemically done
11
Q
What is unintetional civil or tort?
A
Malpractice
12
Q
Define malpractice
A
professional misconduct
13
Q
What are the characteristics of standard of proof with civil or tort?
A
Preponderance of evidence
- Does enough evidence exist to assume negligence occurred?
- Does not require proof beyond a reasonable doubt
14
Q
What is a preponderance of evidence classified as with civil or tort?
A
51% is only needed to be sure that it happened and you caused it
15
Q
What is scope of practice?
A
The basic licensure that allows a nurse to practice in anesthesia is a
registered nursing license
16
Q
What do some states require for APRN?
A
Some states require additional certification
17
Q
What is the requirements of scope of practice from states?
A
These requirements and titles vary from state to state
18
Q
What are components of scope of practice?
A
- Standards of Care
- SBON Nurse Practice Act
- Anesthesia Department or Group
- Malpractice Policy
19
Q
What are the components of standards of care?
A
- AANA Standards of Care
- AANA Office Based
20
Q
What is the characteristics of SBON Nurse Practice Act?
A
APRN requirements
21
Q
What should be reviewed within Anesthesia Department or Group?
A
Policy and Procedure Manual
22
Q
An anesthesia provider should always plan to be __________ for
their conduct and judgements of all their patient’s care.
A
held accountable
23
Q
__________ varies from state to state.
A
Accountability
24
Q
Who is involved in determining lines of responsibility?
A
The hospital is generally responsible for the conduct of everyone performing within its walls and the surgeon was responsible for all events occurring in the operating roo
25
What is vicarious liability?
Concept dates back to ancient times
## Footnote
Respondeat Superior: Let the master answer
26
What are the basic rules stated for directly liability?
An employer is directly liable for the negligent conduct of an employee
when the wrongdoer is acting within the scope of their employment at the time the negligence occurred.
27
What are the basic rules for indirect liability?
This indirect responsibility for an employee’s negligence does NOT excuse
the individual provider
28
What are the current trends regarding liability?
More recent trends consider the technical knowledge required of
each individual involved in the case:
* Surgeon
* Anesthesia
* Nurses
29
What are the more realistica specific obligations for liability?
Each healthcare provider is generally held accountable for their area of
responsibility
30
What is the professional standards of care?
The trend regarding the standard of care is to apply a state or
nationwide standard to all health professionals of a given
discipline and compare a defendant charged with professional
malpractice with reasonably competent peers acting under the
same or similar conditions without regard to geographical
limitations.
31
Why is professional standards of care applied legally?
Courts and legislators are applying this standard because of standardization in
education, training, and advances in communication.
32
What organization regulates CRNA standards of care?
AANA
33
What is the intentions of the AANA standards of care?
1. Assist the profession in evaluating the quality of care provided by it practitioners
2. Provide a common base for practitioners to use in their development of a quality practice
3. Assist the public in understanding what to expect from the practitioner
4. Support and preserve the basic rights of the patient
34
How many standards of care are outlined by the AANA?
14
35
What is AANA Standard I?
Patient's Rights
36
Define AANA Standard I: patient rights.
Interpretation: Respect the patient’s autonomy, dignity, and privacy, and support the patient’s needs and safety
37
Review the code of ethics for the crna.
AANA Standard I: patient rights.
## Footnote
Code of Ethics for the CRNA: https://www.aana.com/docs/default-
source/practice-aana-com-web-documents-(all)/professional-practice- manual/code-of-ethics-for-the-crna.pdf?sfvrsn=d70049b1\_8
38
What is the AANA Standard II?
Preanesthesia Patient Assessment and Evaluation
39
Define the components of AANA Standard II: Preanesthesia Patient Assessment and Evaluation.
* Perform and document or verify documentation of a preanesthesia evaluation of the patient’s general health, allergies, medication history, preexisting conditions, anesthesia history, and any relevant diagnostic tests.
* Perform and document or verify documentation of an anesthesiafocused physical assessment to form the anesthesia plan of care.
40
Review documenting important documents for AANA Standard II: Preanesthesia Patient Assessment and Evaluation.
AANA Standard II: Preanesthesia Patient Assessment and Evaluation.
## Footnote
Documenting Anesthesia Care: https://www.aana.com/docs/default-
source/practice-aana-com-web-documents-(all)/professional-practice- manual/documenting-anesthesia-care.pdf?sfvrsn=ac0049b1\_8
41
What is AANA Standard III?
Plan for Anesthesia Care
42
What is the definition of AANA Standard III: Plan for Anesthesia Care?
* After the patient has had the opportunity to consider anesthesia care options and address his or her concerns, formulate a patient-specific plan for anesthesia care.
* When indicated, the anesthesia care plan can be formulated with members of the healthcare team and the patient’s legal representative (e.g., healthcare proxy, surrogate).
43
What are the important documents pertaining to AANA Standard III: Plan for Anesthesia Care?
* Documenting Anesthesia Care, Practice and Policy Considerations
* Informed Consent for Anesthesia Care, Policy and Practice Considerations:
https://www.aana.com/docs/default-source/practice-aana-com-web- documents-(all)/professional-practice-manual/informed-consent-for- anesthesia-care.pdf?sfvrsn=8a0049b1\_8
44
What is the AANA Standard IV?
Informed Consent for Anesthesia Care and Related Services
45
What is the interpretation of AANA Standard IV: Informed Consent for Anesthesia Care and Related Services?
Obtain and document or verify documentation that the patient or legal representative (e.g., healthcare proxy, surrogate) has given informed consent for planned anesthesia care or related services in accordance with law, accreditation standards, and institutional policy
46
What are the important documents for AANA Standard IV: Informed Consent for Anesthesia Care and Related Services?
* Code of Ethics for the Certified Registered Nurse Anesthetist
* Informed Consent for Anesthesia Care, Policy and Practice Considerations,
* Reconsideration of Advanced Directives, Practice Guidelines and Policy Considerations: https://www.aana.com/docs/default-source/practice-aana-com- web-documents-(all)/professional-practice-manual/reconsideration-of-advanced- directives.pdf?sfvrsn=550049b1\_10
47
What is the AANA Standard V?
Documentation
48
What is the interpretation of AANA Standard V: Documentation?
Communicate anesthesia care data and activities through legible, timely, accurate, and complete documentation in the patient’s healthcare record
49
What are important documents for the AANA Standard V: Documentation?
Documenting Anesthesia Care, Practice and Policy Considerations
50
What is AANA Standard: VI?
Equipment
51
What is the interpretation of AANA Standard VI: Equipment?
* Adhere to manufacturer’s operating instructions and other safety precautions to complete a daily anesthesia equipment check.
* Verify function of anesthesia equipment prior to each anesthetic.
* Operate equipment to minimize the risk of fire, explosion, electrical shock, and equipment malfunction.
52
What is the documentation for AANA Standard VI: Equipment?
Documenting Anesthesia Care, Practice and Policy Considerations
53
What is AANA Standard VII?
Anesthesia Plan Implementation and Management
54
What is the interpretation of AANA Standard VII:Anesthesia Plan Implementation and Management?
* Implement and, if needed, modify the anesthesia plan of care by continuously assessing the patient’s response to the anesthetic and surgical or procedural intervention.
* The CRNA provides anesthesia care until the responsibility has been accepted by another anesthesia professional.
55
What is the documentation for AANA Standard VII:Anesthesia Plan Implementation and Management?
Documenting Anesthesia Care, Practice and Policy Considerations
56
What is AANA Standard VIII?
Patient Positioning
57
What is the interpretation of AANA Standard VIII: Patient positioning?
Collaborate with the surgical or procedure team to position, assess, and monitor proper body alignment. Use protective measures to maintain perfusion and protect pressure points and nerve plexus.
58
What is AANA Standard IX?
Monitoring, Alarms
59
What is the interpretation of AANA Standard IX: Monitoring, Alarms?
* Monitor, evaluate, and document the patient’s physiologic condition as appropriate for the procedure and anesthetic technique.
* When a physiological monitoring device is used, variable pitch and threshold alarms are turned on and audible.
* Document blood pressure, heart rate, and respiration at least every five minutes for all anesthetics.
60
What are the components of AANA Standard IX: Monitoring, Alarms?
* Oxygenation
* Ventilation
* Cardiovascular
* Thermoregulation
* Neuromuscular
61
AANA Standard IX: Define oxygenation
* Continuously monitor oxygenation by clinical observation and pulse oximetry.
* The surgical or procedure team communicates and collaborates to mitigate the risk of fire
62
AANA Standard IX: Define ventilation
* Continuously monitor ventilation by clinical observation and confirmation of continuous expired carbon dioxide during moderate sedation, deep sedation or general anesthesia.
* Verify intubation of the trachea or placement of other artificial airway device by auscultation, chest excursion, and confirmation of expired carbon dioxide.
* Use ventilatory monitors as indicated
63
AANA Standard IX: Define cardiovascular
* Monitor and evaluate circulation to maintain patient’s hemodynamic status.
* Continuously monitor heart rate and cardiovascular status. Use invasive monitoring as appropriate
64
AANA Standard IX: Define thermoregulation
* When clinically significant changes in body temperature are intended, anticipated, or suspected, monitor body temperature.
* Use active measures to facilitate normothermia.
* When malignant hyperthermia (MH) triggering agents are used, monitor temperature and recognize signs and symptoms to immediately initiate appropriate treatment and management of MH
65
AANA Standard IX: Define neuromuscular
When neuromuscular blocking agents are administered, monitor neuromuscular response to assess depth of blockade and degree of recovery.
66
What is the AANA information of mh?
**Malignant Hyperthermia Crisis Preparedness and Treatment, Position Statement**
## Footnote
https://www.aana.com/docs/default-source/practice-aana-
com-web-documents-(all)/professional-practice-manual/malignant-hyperthermia-crisis-preparedness-and-treatment.pdf?sfvrsn=630049b1\_10
67
What is AANA Standard X?
Infection Control and Prevention
68
What is the interpretation of AANA Standard X: Infection Control and Prevention?
Verify and adhere to infection control policies and procedures as established within the practice setting to minimize the risk of infection to patients, the CRNA, and other healthcare providers
69
What are the documentation of AANA Standard X: Infection Control and Prevention?
* Infection Prevention and Control Guidelines for Anesthesia Care:https://www.aana.com/docs/default-source/practice-aana-com-web- documents-(all)/professional-practice-manual/safe-injection-guidelines-for- needle-and-syringe-use.pdf?sfvrsn=5f0049b1\_8
* Safe Injection Guidelines for Needle and Syringe Use:https://www.aana.com/docs/default-source/practice-aana-com-web- documents-(all)/professional-practice-manual/infection-prevention-and- control-guidelines-for-anesthesia-care.pdf?sfvrsn=850049b1\_6
70
What is AANA Standard XI?
Transfer of Care
71
What is the interpretation of AANA Standard XI: Transfer of Care?
* Evaluate the patient’s status and determine when it is appropriate to transfer the responsibility of care to another qualified healthcare provider.
* Communicate the patient’s condition and essential information for continuity of care.
72
What are the documents for AANA Standard XI: Transfer of Care?
**Patient-Centered Perianesthesia Communication, Practice Considerations**
https://www.aana.com/docs/default-source/practice-aana-com-web- documents-(all)/professional-practice-manual/patient-centered- perianesthesia-communication.pdf?sfvrsn=7a0049b1\_6
73
What is AANA Standard XII?
Quality Improvement Process
74
What is the interpretation of AANA Standard XII??
Participate in the ongoing review and evaluation of anesthesia care to assess quality and appropriateness to improve outcomes.
75
What is the AANA Standard XlII?
Wellness
76
What is the interpretation of Standard XlII: Wellness?
Is physically and mentally able to perform duties of the role
77
What is the documents reviews for AANA Standard XlII: Wellness?
* Professional Attributes of the Nurse Anesthetist, Practice Considerations
* Patient Safety: Fatigue, Sleep, and Work Schedule Effects, Practice and Policy Considerations
* Promoting a Culture of Safety and Healthy Work Environment, Practice Considerations
* Addressing Substance Use Disorder for Anesthesia Professionals, Position Statement and Policy Considerations
78
What is the AANA Standard XlV?
A Culture of Safety
79
What is the interpretation of AANA Standard XlV?
Foster a collaborative and cooperative patient care environment through interdisciplinary engagement, open communication, a culture of safety, and supportive leadership.
80
What is the documents of Standard XlV: A Culture of Safety?
* Code of Ethics for the Certified Registered Nurse Anesthetist
* Professional Attributes of the Nurse Anesthetist, Practice Considerations
* Patient-Centered Perianesthesia Communication, Practice Considerations.
81
What are the components of malpractice?
* Duty
* Breach
* Causation
* Damages
82
Define the components of duty.
```
The plaintiff (party that is suing) must establish that a duty flows from the
defendant (person being sued) to the plaintiff.
```
83
Define the components of breach.
* The plaintiff must prove that a breach of the appropriate standard of care has
occurred.
* The most common method of establishing this element of breach is through
expert testimony.
84
Define the components of Causation.
* The plaintiff must introduce information that affords the jury a reason tovconclude that it is more likely than not that the defendant’s conduct caused or contributed to the cause of injury
85
Define the components of damages.
The nature and the extent of injury
86
When is the components of duty established?
**Provider patient relationship**
* Preoperative interview
* Holding area
* Consent signing
87
What are the different types of consent?
* Written
* Implied
* Verbal
88
Define verbal consent.
* As valid as written consent
* Harder to prove
89
Define implied consent.
* Patient is unconscious or unable, for any reason, to give consent
* Presumed that any reasonable and prudent patient would give consent
90
What are the types of breach of duty?
* Error of Commission
* Error of Omission
91
Define error of commission.
Error in performance of an act during the administration of anesthesia
92
Define error of omission.
Failure to perform an act that should have been performed
93
CRNA must act as a reasonably _______ would in
similar circumstances
prudent nurse anesthetist
94
Standards are the _____ for the entire country
SAME
95
What can be used to establish standards?
Expert testimony is used to establish ‘standard of care’
96
What are standards not based on?
Not community-based standards
97
What should the CRNA look at when it is concerned?
* Knowledge of AANA Scope of Practice
* AANA Standards of Care
* Hospital policy and procedure
* State Board of Nursing
98
What are examples of state boards of nursing?
* Boards
* Office practice
* Non-physician presence
99
What is the definition of causation?
Plaintiff (patient) must prove that the damages were caused by the
defendant (provider)
100
What are the common tests for causation?
* but for’ test
* ‘substantial factor’ test
101
Define the ‘but for’ test.
• If the injury would not have occurred but for the action of the anesthesia provider then proximate cause is established
102
Define ‘substantial factor’ test.
if the act of the anesthesia provider was substantial factor in the injury despite other causes the proximate cause is established
103
What is Causation: **Res Ipsa Loquitor**?
**Res Ipsa Loquitor**
## Footnote
• The act speaks for itself
104
What does res ipsa loquitor requires that the injury?
* Is of a kind that typically would not occur in the absence of negligence
* Must be caused by something under the anesthesia provider's exclusive control
* Must not be attributable to any contribution on the part of the patient
105
What are the different kinds of damages?
Plaintiff must prove the negligent activities caused actual harm or
damage:
* Financial
* Physical
* Emotional
106
What are special damages?
Those damages that are the actual result of an injury
* Past and future loss of income
* Medical expenses
* Funeral expenses
107
What are general damages?
* Pain and suffering that are a direct result of injury
* Some states limit the amount of award
108
What are punitive damages?
* Awarded for courts to punish defendants for outrageous conduct
* Rare in medical malpractice cases
109
What is the statute of limitations for malpractice?
Most states = 2 years
110
What is the theory behind statue of limitations?
As time goes on it becomes more difficult to gather evidence for a medical malpractice
case
111
What is the special circumstances of malpractice?
Fraud or concealment of injury
* Negates statute of limitations because of ‘unclean hands’
* Infants and children statute begins on their 18 th birthday
112
What is contributory negligence?
* Many states have replaced contributory negligence (total bar) with a theory of comparative negligence:
113
Contributory negligence: The damage is reduced by the _______ of the plaintiff’s negligence
amount
114
What is the Good Samaritan Statute?
Most states protect providers who provide emergency aid
115
What needs to be aware of the Good Samaritan Statute?
As long as provider renders care in good faith, there is no liability unless gross
negligence occurred
116
The defendant can be responsible for the medical negligence only if the negligent act caused \_\_\_\_\_\_\_
injury or harm.
