5.1 Ethical, Legal and Practice Standards Flashcards
This occurs when there is no “right” answer?
Ethical Dilemma
What 3 conditions must be present to be an ethical dilemma?
There is a decision the individual must make, There is a decision the individual must make, and No matter which course of action is taken, an ethical principal is compromised
Case management ethics are demonstrated in the following ways:
Primary obligation is to the client
Respectful relationships with coworkers, employers and other professionals
Recognition that laws, rules, policies, insurance benefits and regulations are sometimes in conflict with ethical principals. In such situations, case managers are bound to address such conflicts to the best of their abilities or to seek appropriate consultation
Awareness of the five basic ethical principals and how they are applied.
What are the 5 basic ethical principles?
Beneficence Non-malfeasance Autonomy Justice Fidelity
What case manager’s role stems from the principle of client autonomy?
Client Advocate
The case manager collaborates with the autonomous client with the goal of fostering and encouraging the clients?
Independence and self-determination
What are the underlying principles of case management?
Placing public interest above one’s own at all times
Respecting rights and inherent dignity of all clients
Maintaining objectivity in relationships with clients
Acting with integrity in dealing with other professionals to facilitate maximum benefit for the client
Maintaining a level of competency that ensures each client will receive services appropriate and consistent for client’s condition and circumstances
Obeying laws and regulations
Board certified case managers are to serve as:
Client advocates
Perform comprehensive assessments to identify needs and offer other options when appropriate
What will board certified case manager’s do prior to termination of case management service?
Document notification of discontinuation to all relevant parties
What assists in clinical management, justifies interventions and expenses, and defends against claims of neglect?
A case manager’s documentation
The following Communication must be documented:
Patient Family Insurer/Payer Vendor Other healthcare providers, both inside and outside the organization
During what phase of the case manager/client relationship do case managers inform their clients that although their conversations are confidential, certain information obtained through the relationship may be disclosed to third parties including payers, service providers, and government authorities?
In the beginning
shared information is
limited to what is necessary and relevant
When storing client records in any form, including written, recorded, computerized, or on other mediums, what must be ensured?
Confidentiality
What does the Health Insurance portability and accountability act (Hippa) cover?
Protected health information that is released, transferred, or divulged outside the agency
When can confidentiality be broken?
When there is a duty to worn
After receiving written authorization from the patient
To comply with a court order
To report suspected neglect/exploitation of child/elder/resident of LTCH
To report births
To report deaths
To report specific diseases as required by public health laws
To report treatment of patients with physical injury that was inflicted by non-accidental means, such as stabbing/gun shot wound
What is the goal of risk management?
To reduce adverse events, decrease malpractice claims, and minimize financial loss
What is root cause analysis?
A tool designed to identify what, how, and why an adverse event occurred by identifying the factors that contributed to the undesired outcome
What steps can a case manager take to reduce the risk of a malpractice lawsuit?
Use only credentialed healthcare providers
Offer the patient several choices for providers
Communicate with the patient and address concerns
Document all communications with patients and others involved in care and decision making
Do not alter records
Use written guidelines when available: if deviating from them, document justification
Document compliance or lack of compliance with treatment plan
Be aware of and comply with professional standards and regulations
How does tort law differ from malpractice law?
Under tort law, a medical professional can be liable if he/she does not obtain informed consent before treating the patient, even if there is no injury or the patient benefited
What criteria must be met for consent to be informed?
Must include discussion of possible side effects, risks, consequences, and benefits of treatment, medication, or procedures including consequences or risks of stoppage of the service
Client must have capacity to make clear, competent decisions
Information must be clear and easy to understand
Information must be given verbally and in writing
Patient must have opportunity for questions and answers
Consent must be self-determined: it cannot be coerced or pressured by the agency or provider of services
Nurse case managers must be licensed
in the state where case management is being provided
