Apex: Professional issues Flashcards
A CRNA in meddle management submits a written complaint to the state board about several other CRNAs that are false and defamatory. Which AANA document could be applied to this situation?
A. Code of ethics
B. Practice guidelines
C. Practice standards
D. Position statements
What is the specific act committed by the CRNA in this question called?
A. Code of ethics
Libel
What are authoritative statements that describe minimum rules and responsiblities for which anesthetits are held accountable?
Practice Standards
*nationwide expected behaviors
*they MUST be adhered to (guidelines SHOULD be adhered to)
what are systematically developed statements to assist proividers in clinical decision making that are comonly accepted within the anesthesia community?
Practice guidelines
*SHOULD be adhered to… but not required
What dictates the principles of conduct and professional integrity that guide the decision-making and** behavior **or nurse anesthetists.
AANA code of ethics
The use of unnecessary invasive preop testing is most likely to put the provider in violation of the principle of:
A. respect for autonomy
B. nonmaleficence
C. beneficence
D. justice
B. nonmaleficence
obligation not to do harm (intentially or unintentialy)
Hippocratic oath - primum non nocere (first do no harm)
What refers to the patients ability to choose without controlling interference by others, and without limitations that prevent meaningtul choices?
Autonomy
What ethical principal is associated with informed consent?
Autonomy
primum non nocere
what does it mean
which principle is it associated with
first do no harm
hippocratic oath
nonmaleficence
Which principle is often applied to the appropriate use of** diagnostic testing** with the inherent risk of false-positive or false-negative results?
nonmalfience
hippocratic oath- primum non nocere
durty to do no harm
preop testing
What is beneficence?
states that providers should** act for the benefit of others**
preventing harm and actively helpipng their patients
*underpns evidence-based interventions
benefits outweigh risks
ahhhhh beneficence = benifits lol
Which ethical principle guides evidence-based interventions
Beneficence
benefits should be demonstratable and clearly outweigh risks
What is distributive justice?
that people under similar circumstances and conditions should be treated alike
giving higher quality care to the CEO of the hospital puts the provider in violation of what principle?
justice
T/F: the ethical principles support the position that medical mistakes must be disclosed to the patient
True
Informed consent for anesthesia should include a discussion of which topics? (select 2)
-Description of the recommended type of anesthetic
-Agreement to undergo the scheduled surgery/procedure
-Risks and benefits of each type of appropriate anesthetic
-pt’s preferences, questions and fears
-Risks and benefits of each type of appropriate anesthetic
-pt’s preferences, questions and fears
6 elements of informed consent
- competence
- decision making capacity
- disclosure of information
- understanding of disclosed information
- voluntary consent
- documentation
What does competence mean?
the patient has the leagal aurthority to consent
What describes the pts ability to decide about specific anesthetia care
Decision-making capcity
competence is that the pt has LEGAL AURTHORITY to consent - like 18yo , or emanicpated minor, ect
Pt got versed before anesthesia consent was signed- whoops. Now what?
proivder may need to arrange a legal, ethical, or psych consult to determine CAPACITY
capacity = ability to DECIDE , decision making CAPACITY
How do you get informed consent on an incapacitated patient?
someone must be delegated as the legal decision maker
in accordance with state law and institutional policy
T/F- the risks of not recieivng anesthetic care is part of the minimum requirements for conset
True
- nature and purpose of proposed anesthtic techniques
- risks, benefits, and s/es of each
- alternatives and their risks/beneiftis/ses
- risks of not getting it at all - pretty obvious i’d think lol
What kind of risks should be included in informed consent?
the common ones and the rare ones if they would result in severe morbidity or mortality
T/F: unlesss developmentally inappropriate, minor children should be included in the informed consent discussion and their agreement should be sought
true
*document “assent”
T/F: in an elective case, a provider has no ethical obligation to proivde inappropriate care or acre associated with unreasibly high risks (ie: jehovah’s witness informed refusal of blood products for a high risk case)
True
byeeeeeee
T/F: family members can be used to translate consent in an emergency
True
this is the only time
T/F: if pt prsents with cognitive impairement, you should use a mini-mental state exam (MMSE) to evaluate
True -lol
and designate a legal decision maker
T/F: if pt prsents with cognitive impairement, you should use a mini-mental state exam (MMSE) to evaluate
True -lol
and designate a legal decision maker
What must an anesthesia provider do to obtain informed consent for epidural placement in a parturient who recently received 50mg of meperidine?
A. review the efficacy of current pain managment
B. Document the pt’s dilation, effacement, and station
C. determine that the pt has sufficient capcity
D. get consent from her husband
C
t/F: state law and facility policies should be consulted when a minor is receiving OB services
True
In a case of maternal-fetal conflict, the provider’s respect for maternal ___________________ may oppose what principle in promoting hte well-being of the mother and fetus
mothers autonomy
may oppose benifience
benifit vs risk
In a case of maternal-fetal conflict, the provider’s respect for maternal ___________________ may oppose what principle in promoting hte well-being of the mother and fetus
mothers autonomy
may oppose benifience
benifit vs risk
How to respond if your mom asks what happens if your in an emergency and cant come do my epidural and I’m in a lot of pain waiting for a long itme?
reassure her that alternativie pain management will be available until an anesthesia provider can get to her
What should the provider do if there is a maternal-fetal conflict?
keep open, non-coercive communication with mom while procuring an ethics consult, referencing hospital policy and reviewing state law
A terminal cancer pt with a DNR presents for a cath placement. Which standard of nurse anesthesia practice has the most immediate relevance to the anesthetists preop activities?
A. Standard 2 on thorough preop assessment and evaluation
B. Standard 3 on plan for anesthetic care
C. Standard 4 on infomed consent and related anesthesia services
D. Standard 13 on wellness
C. Standard 4 on informed consent
reconsideration of pre-exissitng AD is a critical component of the informed consent process bc some events that may occur are responses to the anesthetic and not part of the terminal disease process.
T/F: advnaced directives should be routinely suspended preop
false - they require a detailed discussion
t/F: reconsideration and discussion of advance directives should be discussed during the informed consent process
True
T/F: name of all parties pressent for discussion of advance directive alterations should be documented
True
Who does the AANA recommend to be present when discussion changes in the advance directives sduring the informed consent process?
Pt, family, and healthcare team
Identify the standards of care that have been published bye the AANA (select 3)
-wellness
-infection control and prevention
-chronic pain management
-latex allergy management
-transfer of care
-mass casualty incident prepardenss
- wellness
- infection prevetion
- transfer of care
the AANA has publicationso n latex allergy, chronic pain, and mass casualty incident managment – but these are practice guidelines - suggestions that “should” be adhered to
What term refers to any sort of professional misconduct
Malpractice
In a negligence or malpractice claim, the patient (plantiff) must prove what 4 things
- Duty - provider had a duty to the pt
- Breach of duty- provider fialed to fulfill their duty
- Causation - a close casual relationship existed b/t proivders acts and pts injury
- Damages - actual damage was the result of a breach in the standard of care
When going to court, who is the plantiff?
the patient
fucking verbage
What is Res ispa loquitur mean?
example?
“The thing speaks for itself”
it can shift the burden of proof from the plaintiff (pt) > the defendant
cases involving a foreign object such asa sponge or clamp left in the pt
What term is associated with when a foreign object is left inside the pt
Res ipsa loquitur
the thing speaks for itself
can shift the burden of proof from the plaintiff to the defendant
what’s the term for defamation in verbal form?
Slander
defamation in verbal form vs written form
slander = verbal form
libel = written form
How is a breach of duty idenitified?
when expert witnesses review the MR and determine the standard of care was not adhered to.
2 most common causes where a res ipsa charge request is usually granted
- sponge/instrument left inside pt
- nerve injury sustained during hte course of surgery to an area remote from the surgical site
A CRNA is relieved by another anesthesia provider 4 hours into a complex case. The outgoing CRNA gives a short report that results in a missed repeat abx dose. The pt ultimately develops sepsis that results in an unexpected 3-day ICU stay. Which causes of action agaisnt he primary CRNA might apply to this scenario? (select 2):
-loss of chance of survival
-malpractice violation of the AANA standards of care
-abandoment
-vicarious liability for releving anesthetist
-malpractice violation of the AANA standards of care
-abandoment
The physical act of touching another person without either expressed or implied consent
battery
making a person feel or percieve that battery is imminent
Assult
what is a tort
a civil wrongdoing
ie. battery/assult
battery- direct physical contact
assult- being made feel like they are going to be battered
T/F: assult cannot occur in unconscious patients
True
bc they are unware of their enviiornments
assult = pt feeling or perceiving that battery is imminent
What would it be called if you place an epidural without consent
battery
What would it be called if your prepping for an epidural and the pt feels like your going to place it without her consent
assult
jesus christ
what would it be called if the pt only consented to local and you convert to general
battery
T/F: harm does not need to be proven when batttery or assult charges are brought upon a provider
True
If the statue of limitations of an offense is 3 years, a 15 yo can fild a lawsuit up to what age
21 (18+3)
the 15yo doesnt matter, the statue of limitations for a minor doesnt begin until the minor turns 18
Legal term for when one person or entitiy (hospital/doctor) may be liable for the actions of another persion (RN/PA)
What term is used interchangably with this and what does it mean
Does this apply to CRNAs working under physcian?
Vicarious liability
Respondeat Superior “Let the master answer”
Not typically
What is respondeat superior associated with
what does it mean
ex
Vicarious liability
let the master answer
Hospital liable for actions of a nurse
Doctor liable for actions of a PA
*doesnt typically apply to CRNAS/ologists
T/F - General damages refer to the actual damages that result from an injury such as medical expenses, lost income, property damage
False - General damanges = non-economic
Special damanges = clearly quantifiable
T/F: punitive damages (punishment for reckless or malicious behavior) are rare
True
General vs special damages
General = non-econimic : pain and suffering, emotional distress
Special = clearly quantifiable: medical espenses, lost income, property damage
General damages “directly result” from an injury
Special damages are “actual damages” that result
B/T general, special, and punitive damages, which ones may be subject to caps imposed by state legistlatures
general and punitive
special damages = actual damages that are clearly quantifiable - wouldnt be ethical not to cover
T/F: **negligence **is failure to provide continuity of care once duty to a patient is established
False - Abandoment
Which law requires citizens to give the government an idividual shared responsibility payment?
A. Emergency in Medical Treatment and Active Labor Act
B. health Insurance Portability and Acccountability act
C. Health Information Technology for Economic and Clinical Health Act
D. Affordable Care Act
D. Affordable care act
-mandaded that all individuals carry health insurance + insurers no longer able to charge more for pre-existing conditions
T/F: under the ACA, essential healthcare benefits cannot be supject to either annual or lifetime dollar limits
True
T/F: It was the ACA that changed it so that adult up to the age of 26 can remain on their parents plan
what if they are married?
True
-counts even if they are married, financially independent, or not in college
T/F: the ACA requires medical insurance to cover certain preventable health visits without a co-pay
True
trying to shift towards early detection and prevention
What does the Emergency in Medical Treatment and Active Labor Act (EMTALA) cover?
ensuring public access to emergency services regardless of ability to pay
Is a lawsuit based on EMTALA is filed against a hospital or provider?
Hospital
What will result in a fee called “individual shared responsibility payment”
what law?
what if you dont pay it?
Failing to proivde proof of health insurance coverage
ACA
It’s part of federal taxes and if unpaid will be deducted from any future tax returns
T/F: under the EMTALA, the patients request of transfer to another facility should be honored
True
T/F: EMTALA applies to missed diagnoseses or negligence in an ER
FALSE - as long as the pt was triaged in a timely fashion and the diagones condition was non-urgent
EMTALA = proive ER care to everyone despite ability to pay
Missed diagnoses cases are persued as malpractice in a state court
T/F: **Missed diagnosis’s **are pursed as **malpractice **in a state court
True
What is kown as the “Anti-Patient Dumping” act
The EMTALA
assures public acces to emergency services regardless of ability to pay
What is kown as the “Anti-Patient Dumping” act
The EMTALA
assures public acces to emergency services regardless of ability to pay
Match each drug to its scheduled based on the Controlled Substances Act: Schedules I-IV
-Heroin, cocaine, Ketamine, Tramadol
I - Heroin
II - Cocaine
III - Ketamine
IV - Tramadol
Which are worse regarding scheduling of controlled substances - I or IV
I is worse! - first is the worst
The Controlled Substance Act (CSA) schedules drugs according to what 2 things?
Their therapeutic benefit vs abuse potential
T/F: The Health Information Technology for Economic and Clinical Health Act (HITECH) was intended to create a healthcare information technology infrastructure in ordder to improve quality care and coordination b/t providers.
True
What act sets minimum standards for private employeee benefit plans, including health care benefits offered, and provides protection for persons in these places?
The emplyment Retirement Income Security Act (ERISA)
What schedule drug is propofol considered?
It’s not a scheduled drug
Which act increaes the potential legal liabiity for non-compliance, providing for more enforcement and includes manadtory penalties for “willful neglect”
what is willful neglect?
HITECH
storage or exposure of unencrypted PHI
*Encryption is key
What act limits the amount a patient can be charged for copies of their PHI?
HITECH
*fees differ b/t states
When a patient experiences a serious anesthetic complication, what information is most appropriate to offer the patients relatives?
a. Provides the names and roles of the party or parties at fault
b. disclose nothing until you are certain of hte patients out come
c. tell the family that risk management will contac them
d. describe the facts of the event while also expressing regret
D. describe the facts of the event while also expressing regret
T/F: a critical incident report is best recorded in narrative form
True
Should the critical incident report be started before or after talking with the family?
what 4 things should be included
Before (so the info is fresh)
- Who - who was present (all parties, not just anesthesia)
- What - What happened
- What - What drugs and doses were given and WHEN
- Time sequence of events
When filing a critical incident report, how should you document the diagnosis if it was not obvious?
document the differential dagnoses that guided your choices
