Unit 12: Professional Issues Flashcards
(45 cards)
What is the AANA Code of Ethics?
The AANA. Code of Ethics dictates the principles of conduct and professional integrity that guide the decision-making and behavior of nurse anesthetists. This document speaks to the anesthetist’s responsibilities as a professional, which holds the individuals CRNA accountable for his or her own actions and judgements, regardless of institutional policy of physician orders.
What are practice guidelines?
Practice guidelines are systematically developed statements to assist providers in clinical decision-making that are commonly accepted within the anesthesia community.
Guidelines “should” be adhered to.
What are practice standards?
Practice standards are authoritative statement that describe minimum rules and responsibilities for which anesthetists are held accountable.
Standards “must” be adhered to.
What are position statements?
Position statements express the AANA official positions or beliefs on practice-related topics; they may also define the knowledge, skills, and abilities considered necessary for a nurse anesthetist.
Define autonomy.
Autonomy refers to the patient’s ability to choose without controlling interference by others and without limitations that prevent meaningful choices.
Define nonmaleficence.
Nonmaleficence asserts that a provider has an obligation not to inflict hurt or harm-in other words, the Hippocratic oath primum non nocere (first do not harm).
Define beneficence.
Beneficence in the principle that providers should take action for the benefit of others. This includes both preventing harm and actively helping their patients. Beneficence underpins the fundamental guiding principle of evidence-based interventions-the benefits of the treatment should be demonstrable and must clearly outweigh the risks.
List the 6 elements of informed consent.
-Competence
-Decision-making capacity
-Disclosure of information
-Understanding of disclosed information
-Voluntary consent
-Documentation
What is informed refusal? List one example of this concept in a specific patient population.
A patient has a right to refuse medical treatment or therapy.
A common example is the refusal of blood or blood products by a Jehovah’s Witness. When a recommended therapy is refused, it places an even higher burden on the health care provider to disclose the risks and benefits of both the recommended and any alternative care.
What is an advanced directive?
An advanced directive is a legally binding document that delineates the patient’s wishes regarding healthcare interventions in the case of incapacity and/or delegates the authority to make healthcare decisions to another party.
Advanced directives often include specific provisions that modify aspects of anesthesia management, including intubation, use of antibiotics, blood transfusion, and/or the use of CPR and advanced life support measures. Because many of these measures, when used in conjunction with a procedure/surgery, are temporary, it is recommended that advanced directives be considered before anesthesia is administered.
List the 4 things that must be proven in a lawsuit asserting malpractice.
-Duty
-Breach of duty
-Causation
-Damages
What is res ipsa loquitur?
Res ipsa loquitur (“the thing speaks for itself”) can shift the burden of proof from the plaintiff to the defendant. This can occur if 4 conditions can be established:
1) If the injury would not have occurred in the absence of negligence.
2) The injury was caused by something under the complete control of the defendant (provider).
3) The patient did not contribute in any way to the injury.
4) The evidence for the explanation of events is solely under the control of the provider.
What is the difference between libel and slander?
Libel is the defamation in the written form.
Slander is defamation in the verbal form.
What is the difference between assault and battery?
Assault is the attempt to touch another person.
Battery is touching a person without either expressed or implied consent.
What is vicarious liability? What is another name for this concept?
One person (or entity) may be liable for the actions of another person. For instance, a physician might be held liable for the actions of a PA. This concept typically does not apply to CRNAs working under a physician.
“Respondeat superior” is often used interchangeably with vicarious liability.
What is the Patient Care and Affordable Care Act?
The ACA mandated that all individuals carry health insurance, established standards and requirements for health insurance policies, and launches health care clearinghouses or exchanges to assist people in finding medical insurance. In addition, insurers are no longer permitted to charge more for pre-existing conditions.
What is Emergency in Medical Treatment and Active Labor Act?
Over 30 years ago, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of their ability to pay. This is also known as the “Anti-Patient Dumping” act.
This act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination when a request is made for examination or treatment for emergency medical condition (EMC) regardless of an individual’s ability to pay.
What is the Health Insurance Potability and Accountability Act?
Most health care providers are aware of HIPAA, the federal law that prohibits the disclosure of individually identifiable health information (AKA personal health information, PHI). PHI includes past and present health conditions, treatments, and payments for health care.
Disclosure can occur in any form, including orally, written, or electronically.
Even if you think you’re keeping the patient anonymous, there’s always a risk of HIPAA violation when you post any patient-related stories, data, etc., on social media.
What is the controlled substances act?
We all know that the federal government regulation the manufacture, importation, possession, and distribution of drugs deemed “controlled substances.” The government define what is controlled and what level of restriction carious controlled substances are subject to.
What schedule I drugs are used to provide anesthesia?
By its very definition, a schedule I drug has NO currently accepted medical use. Therefore, we don’t use any schedule I drugs in anesthesiology.
As an aside, the legalization of marijuana at the state level challenges its schedule I designation at the federal level.
What is a schedule II drug? List some examples.
A schedule II drug has a high potential for abuse potentially leading to dependence.
Examples:
-Opioid agonists (fentanyl, morphine, hydromorphone, etc.)
-Cocaine
-Methamphetamine
-Phencyclidine
What is the Health Information Technology for Economic and Clinical Health Act (HITECH)?
This act was intended to create a healthcare information technology infrastructure in order to improve care quality and coordination between providers, i.e., to promote the “meaningful use” of such information.
HITECH is essentially an amendment to HIPAA and applies to the same covered entities, including providers, health plans, and healthcare clearinghouses. HITECH precipitated a massive expansion in the exchange of electronic PHI and widened the scope of privacy and security protections available under HIPAA.
Detail the steps involved with responding to a lawsuit.
DEFENDANT’S INITIAL RESPONSE
1. Notify your insurance carrier immediately.
2. Do NOT discuss the case - not even with other providers who are involved.
3. Do not alter any records.
4. Gather all records of the case (EHR, case notes, critical incident reports, billings, any correspondence about the case).
5. Make notes regarding all aspects of the case (If you write a detailed case note/incident report immediately after the event as recommended, you will have much of this already).
6. Cooperate with your insurer’s attorney.
WORK WITH YOUR ATTORNEY TO WRITE AN INITIAL RESPONSE TO THE SUMMONS
DISCOVERY
-Gathering of facts and clarification of issues that will be brought to trial
WRITTEN INTERROGATORY
-request for factual information and exchange of documents
DEPOSITION
Plaintiff and defense attorneys will question you. This testimony is:
-under oath
-transcribed, and
-may be used as evidence in court
Conversations with your attorney, spouse, personal doctor or therapist, and clergy are not admissable; conversations with friends or peers ARE admissable (hence, rule #2 above).
During deposition, keep your guard up.
-Do not speculate
-Answer only what is asked
-Ask for clarification if question is unclear
SETTLEMENT/TRIAL
What is an emancipated minor?
Emancipated minors are patients younger than 18 years of age who are legally given the rights of an adult by a state court. Although variable by state law, criteria for emancipating a minor may include the fact that they are:
-Married
-A parent or is currently pregnant
-In the military
-Economically independent
