324 Safety, Legal & Ethics Flashcards
what entities exist for the purpose of ensuring and enhancing pt safety?
TJC, ISMP, CMS, AHRQ, QSEN
The Joint Commission (TJC) does what?
Is a regulatory body for hospital and health care agency accreditation
The Quality and Safety Education for Nurses (QSEN) is what?
A project that prepares nurses for the future with the knowledge, skills and attitudes necessary to continuously improve the quality and safety of the health care systems within which they work
the Agency for Healthcare Research and Quality (AHRQ) does what?
identifies elements that are essential key features represented in a culture safety
how often does TJC reevaluate patient safety goals?
every 12 months
what are common sources that contain lead?
homes built before 1978, water pipes that contain lead, older toys or jewelry, ceramic dishes, candies imported from other countries, stained glass and air/soil near airports
poisoning symptoms can resemble symptoms of which other disorders?
brain attack, seizure, alcohol intoxication, hypoglycemia and delirium
using the QSEN competencies as a framework, nurses are accountable for:
delivery of patient-center care, engagement in teamwork and collaboration, implementation of evidence based practice, engagement in the quality improvement process, informatics, safety
what are common conditions that place patients at higher risk for falls?
incontinence, unsteady gait, cognitive changes, visual or hearing difficulties
what are common environmental conditions that place patients at higher risk for falls?
use of medical equipment (IVs/IV poles, tubes, drains), wet floors, clutter
What are the 7 factors evaluated in the Johns Hopkins Fall Risk Assessment (JHRAT)?
age, fall hx, elimination / bowel & bladder concerns, medications, pt care equipment that tethers, mobility, cognition
what are the three different levels of risk in the JHRAT?
low (score of 0-5), moderate (6-13), and high risk (+13)
where can the JHRAT be used?
homes or acute care environment
what are the 6 weighted fall risk items that the Morse Fall Scale (MFS) assesses?
hx of falls, existence of secondary diagnosis, use of ambulatory aids, receiving IV therapy or the presence of heparin lock, gait/transferring (normal, weak, impaired), mental status
what are the 3 different risk levels of the MFS?
low risk (<25), moderate risk (25-45), high risk (>45)
where is the MFS used?
acute and long term care, nationally and internationally
what are the 8 risk factors used in the Hendrich II fall risk model?
confusion/disorientation/impulsivity, symptomatic depression, altered elimination, dizziness/vertigo, male gender, any administered anti-epileptics, any administered benzodiazepines, “get up & go test” aka rising from a chair
how is the Hendrich II model scored
an item is assigned a 0 if it does not apply to the pt and if it does it is scored on a weighted scale. If the pt scores 5 or higher, the pt is considered at high risk for falls
where is the hendrich model used?
acute care settings
RACE - R
rescue all patients in immediate danger
RACE - A
activate the manual pull station or fire alarm and call 911
RACE - C
contain the fire by closing doors, confining the fire, and preventing the spread of smoke
RACE - E
extinguish the fire, if possible, after all patients are removed from the area
in a fire prevention plan, how often should smoke alarm batteries be changed?
every 6 months
scope of nursing practice
defines nursing and reflects the values of the nursing profession (defined by the American Nurses Association + otherss)
nurse practice act
state laws related to licensure (compact licensure)
Patient Protection & Affordable Care Act (Obama care)
1) consumer rights and protections
2) affordable health care coverage
3) increased access to care
4) quality of care that meets the need of patients
*the ability to get insurance
Patient Bill of Rights
protection for people with pre existing conditions
HIPAA
establishes patient rights regarding privacy of their health care info and records. Allowed patients the right to their own medical records and limits who has access to the chhart
what is protected health information
name, address, DOB, SS#, photos, fingerprints, medical record, telephone #, fax, driver license #, email/URL/IP address, admit/discharge date, any other unique ID# (if 2 or more are on something then it is PHI)
Patient Self Determination Act
requires health care institutions to provide written information to patients concerning their rights to make decisions about their care, including the right to refuse treatment and to formulate an advanced directive
advanced directives
at minimum, must note response to respiratory and cardiac arrest and a copy of the pt’s durable power of attorney. Used when a person doesn’t have the capacity to make decisions
durable power of attorney
the person who will make decisions for you if you become incapacitated
living will
-a type of aan AD, give more info about end of life preferences
-can include info about DNR, enteral feedings, & other decisions about end of life care
-pt must have decision making capacity to make a living will
EMTALA
when a person presents to an emergency department, they have to be treated (does not matter if they have insurance, if they are a prisoner, or illegal, ect)
Americans w/ disabilities Act (ADA)
protects the rights of people with physical or mental disabilities
Mental health parity and addiction equity: require health insurance companies to provide coverage for mental health and substance use treatment (does not need to be in full)
Omnibus Budget Reconciliation Act
centered on protection of older adults, particularly in nursing homes (lots of talk of chemical and physical restraints)
Good Samaritan Laws
limit liability and offer legal immunity if a nurse helps at the scene of an accident
The Uniform Determination of Death Act
determines actual death
Public Health Laws
laws affect individuals, populations and communities that are intended to improve the health of people (ex: mandatory vaccines)
value
a deeply held belief about the worth of an idea, attitude, custom, or object that affects choices and behaviors
values clarification
ethical dilemmas almost always occur in the presence of conflicting values, to resolve ethical dilemmas, one needs to distinguish among values, facts and opinions
ethical dilemma
when two opposing courses of action can be justified by ethical principles
moral distress
instead of competing options for action, the nurse feels the need to take a specific action while believing that action to be wrong
main causes of ethical dilemmas
social media, quality of life, care at the end of life, access to health care
professional nursing code of ethics
includes advocacy, responsibility, accountability and confidentiality
national patient safety goals (TJC)
1) identify patients correctly
2) improve staff communication
3) use medicines safely
4) prevent infections
5) use alarms safely
6) patient safety risk
7) prevent surgical mistakes
how can we prevent falls
fall risk assessments, call light, fall risk alert signs/wrist bands, hourly rounding, orientation & cognitive assessments, bed in low and locked position
seizure precautions
rescue equipment at bedside, pad side rails, IV access, bed low & locked, remove unnecessary items, teach caregivers/family
5 rights of delegation
right task, right circumstance, right person, right direction/communication, right supervision
what cannot be delegated
*assessments, *teaching, *evaluation, new admits/discharges/transfers, pt w/ potential problems
what are appropriate tasks to delegate
routine tasks & skills, tasks in job description, routine care, care to stable pt w/ predictable outcomes
the rights of medication administration - expanded 5
right assessment, right documentation, right evaluation, right to refuse treatment, right to patient education
the rights of medication administration - original 5
right medication, right dose, right time or frequency, right patient, right route
the National Center for Health Statistics (NCHS) does what?
tracks statistics of health and categorizes injuries as intentional or unintentional
