Ethical Guidelines Flashcards
Beneficence
do no harm
Core principle of patient advocacy
Beneficence
Examples of beneficence
- educating patient on new prescription
- encouraging smoking cessation
- requesting doctor for stronger pain medication for patient who c/o severe pain
Nonmaleficence
avoiding harm
protect patient from harm
Nonmaleficence example
-not prescribing medications for a patient with certain risks
Utilitarianism
- obligation to act in a way that is useful to or benefits the majority
- to use a resource for the benefit of most
Example of utilitarianism
- WIC program
- Would cost society more if women, infant, or children, are harmed by inadequate food intake
Justice
- quality of being fair and acting with a lack of bias
- fair and equitable distribution of societal resources
Justice example
-Homeless man triaged and treated as the same as a patient with health insurance
Dignity
quality or state of being worthy of ethical and respectful treatment
Dignity example
- secure hospital gowns so patients are not exposed
- foley catheter bags should be placed on other side of bed so others don’t see
Fidelity
- obligation to maintain trust in relationships
- Keeping one’s promise
Fidelity example
-relationship between patient and provider
Confidentiality
- obligation to protect the patient’s identity, personal info, test results, medical records, conversations, and other health information
- protected by HIPAA
PHI
protected health information
what is included in PHI
- name, address, date of birth, social security number
- individual’s past, present, or future physical/mental health and provision of care
Autonomy
- obligation to ensure that mentally competent adult patients have the right to make their own health decisions
- express treatment preferences
- a mentally competent patient can accept or refuse, even if their children disagree
Accountability
-health care providers are responsible for their own actions and do not blame others for their mistakes
Paternalism
- situation in which one person interferes with or overrules the autonomy of another
- occurs when provider makes a decision for a patient because they believe it is in the patient’s best interest
- patient is powerless
Veracity
-obligation to present information honestly and truthfully
ANA code of ethics for nurses contains what
-goals
-values
and ethical precepts that direct the profession of nursing
Ombudsman
- a person who acts as an intermediary between the patient and the organization
- investigates and mediates the complaint form both sides and attempts to achieve a fair conclusion
Guardian ad litem
-individual assigned by a court to act in the best interest of the ward
Ward
-usually a person who is a child, or someone who is frail or vulnerable
Living will
- document that contains the patients instructions and preferences regarding health care if the patient becomes seriously ill or dying
- ensure a copy is available in the chart
Health care power of attorney
- document that indicates if a patient becomes incapacitated in the future, their preferences for medical care are listed
- goes into affect when patients doctor has determined that he or she is physically unable to communicate in a willful manner
- must be signed in presence of two adult witnesses who must also sign the document to be legal
Health care power of attorney can make financial decisions T/F
False
only for health care decisions
What is health care power of attorney also known as
advance directive for medical decisions,
health care proxy,
durable medical power of attorney
health care surrogate
Power of attorney
- document where patient designates a person who has the legal authority to make all decisions for them
- encompasses health care decisions as well as finances and other aspects of their life
Power of attorney is also known as
durable power of attorney
Power of attorney can make health and financial decisions for the patient T/F
True
Covered entities
- organizations subject to the Privacy Rule by HIPPA
- all health care providers
- health insurance companies
- health care plans
- labs
- hospitals
- SNFs
- third-party administrators
What is a third-party administrator
- organization that processes claims and administrative work for another company
- health insurer, health plan, retirement plan
HIPAA requirements
- all providers are required to provide each patient with a copy of their office’s HIPAA policy to be signed
- must be reviewed and signed annually by the patient
- patients have the right to view their medical files
- a mental health provider has the right to refuse patients’ request to view their psychiatric and mental health records
- Providers have up to 30 days to comply if patients request to view their records
- Patients are allowed to correct errors in their medical records
When is patient consent not required
- to contact the health plan/insurance company that is paying for their medical care
- to contact a third party that the insurance company or doctor’s office hires to assist in payment
- to perform certain health care operations
- contact collection agency for unpaid bills
- report abuse/neglect or domestic violence
- consult with other HCP
Can HCP leave lab results on patient’s phone?
Only if patient has given permission or requested to do so
Are mental health records treated differently under HIPAA?
Yes
- should be separated from other medical records
- separate consent form is needed to release psychotherapy records
Exceptions of mental health records and HIPAA
- duty to warn: if patient poses serious and imminent harm to others
- when patients do not object and are given an opportunity, HIPAA allows provider to share and discuss patients mental health info with family members and others involved in their care
Are sign in sheets on the front office a HIPAA violation
No, only if the diagnosis is not listed
-can show names, dates, and times
Is calling in a patient from the waiting room a HIPAA violation
No, only if the patients first name is used
if more than one person with the same name, use the first letter of last name
Is leaving a voicemail a HIPAA violation
No
- provide name and contact and limit to 60 seconds
- when a patients phone number is listed, is expresses consent for phone calls to be made
Information that can be left on voicemail
- appointment reminders
- notifications about prescriptions
- preoperative and postoperative instructions
HIPAA violation? Hospital staff wanting info on patients progress
- Yes
- if they are not part of the health care team, no information can be released
HIPAA violation? Family member calls and wants information on patients progress
Yes
-Put on hold and ask patient about the call, if they give permission, can speak with family member
Minor criteria
-<18 years
Do minors need to give consent to release records to their parents
-No
Affordable Care Act
- goal of expanding health insurance
- prevents health insurance company from rejecting people with preexisting health conditions
- penalty for employers and individuals who choose not to participate in the national health plan
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985)
- aka COBRA coverage
- provides continuation of coverage of preexisting group health insurance from the employer for workers and families who lose their coverage for a fixed period of tie
- coverage generally offered for 18 months
Managed care plans include..
HMO
PPOs
HMO (health maintenance organization)
- patients assigned a primary who is the gatekeeper
- set copay per visit
- participating HCP is paid a set fee per patient monthly
- HCP must provide a referral for specialists and consults who are in the HMO network
- Out of network physicians are not covered and reimbursed at a lower rate
PPO (Preferred provider organization)
- patient can visit any provider in the network without a referral
- not assigned a PCP
- can choose their own
- Usually more expensive than HMOs
What are Medicare and Medicaid under
Centers for Medicare and Medicaid Services (CMS
Medicare part A is for
inpatient hospitalization
When is Medicare part A automatic
at age 65 if patient has paid premiums
- automatically deducted from pay-check by employer
- If not paid, not eligible (full-time housewife)
When is Medicare part A covered at any age
persons with end-stage renal disease
Which religious groups do not participate in Medicare
Amish
Mnnonites
Which medically necessary services will Medicare part A cover
- inpatient hospitalization
- inpatient psychiatric hospitalizations
- hospice care
- home health care
- skilled nursing facility care
What will Medicare part A NOT cover
-custodial care such as nursing homes and retirement homes
What is Medicare part B for
outpatient insurance
- voluntary program with monthly premiums
- must enroll during the general enrollment period
What will Medicare part B cover
- medically necessary services
- outpatient visits (walk-in clinics, urgent care, ED)
- lab and other tests (EKG, xrays, CT)
- durable medical equipment
- second opinions
- kidney dialysis, self-dialysis equipment
What does Medicare part B NOT cover
- most eyeglasses and eye exams (except after cataract surgery implants)
- hearing aids
- most dentures and dental care
- cosmetic plastic surgery unless medically necessary
- OTC drugs and most prescriptions
Does Medicare part B cover preventative services
some
- AAA screen
- flu shot, Pneumovax and Prevnar 13 (once in a lifetime)
- hep B vaccine series
- Hep C screening
- screening colonoscopy
- routine pap
- prostate cancer screening
- bone density screening, if at risk
- HIV screen, STI
- physicals annually
- smoking cessation and treatment
- alcohol screen
- DM screen
- CVD screen
What is medicare part C
aka Medicare Advantage
- cover both inaptient and outpatient care (both A and B)
- some plans cover some prescription drugs
- administered by private health insurance companies approved by Medicare
What is medicare part D
- prescription drug benefit
- Only individuals who are enrolled or eligible for A and B are eligible
- All prescription drugs have a preferred formulary and must be used otherwise won’t be covered
Who is Medicaid for
- low-income individuals and families who meet the federal poverty-level
- children, pregnant women, adults, seniors, and individuals with disabilities
What will Medicaid over
healthcare and prescription drugs
- substance use disorder
- family planning services
- maternal and infant health programs
What is the children’s health insurance programs
-cover uninsured infants to adolescents and pregnant women
Case managers
- usually experienced RNs who act as coordinators for the outpatient management of patients with certain diagnoses
- mainly done by telephone
Patient-centered medical home (PCMH)
- aka primary care medical home
- another way to deliver patient-centered primary care
- patient and family considered important members of health care team
- coordinated to ensure smooth transition between home and hospital, home health agency, and community services.
- 24/7 access to health care team through any method
Quality improvement programs
- monitoring, identifying problems, measuring outcomes, and establishing new parameters for improved performance.
- goal to improve quality of care, decrease complications, decrease hospitalizations, lower patient mortality, decrease system errors, increase patient satisfaction
Risk management
-process to identify risky practices to minimize adverse patient outcomes and corporate liability
Accreditation
- voluntary process
- nongovernment association evaluates and certifies that an organization meets the requirements and excels in its class
- ANCC
Joint commission
-achieving certification means that a facility has met or surpassed an organization’s strict requirements
Sentinal event reporting
- patient safety event not related to natural course of patients illness that results in any of:
- death
- permanent harm
- severe temporary harm with intervention required to sustain life
Examples of sentinal events
- suicide that occurs in facility or within 72 hours of discharge
- unanticipated death of an infant
- discharge of infant to the wrong family
- rape or assault of staff, visitor, or vendor
- invasive procedure on wrong patient
- unintended retention of foreign object
- fire, flame, or unanticipated smoke or heat during an episode of patient care
Root cause analysis (RCA)
- process to identify contributing factors that result in an error
- When an SE occurs, an RCA is recommended
- focus on system rather than blaming individuals
Outcomes analysis
- analysis and tracking of patient outcomes by using outcome measures
- surveys, questionnares
Majority of hospice care occurs where
in patients home
What is the goal of hospice care
palliative, not curative
How is hospice care covered
under Medicare part A
Medicaid
most health insurance plans
Eligibility criteria for hospice
- need certification by HCP the patient is terminal and has <6 months to live
- patient rapidly declining or exhibits worsening symptoms
- needs assistance with >2 ADLs
- patient accepts palliative care, not curative.
Respite care
- short term respite for primary caregiver
- reimbursed by Medicare
Healthy male symbol
-empty square
Diseased male
filled square
healthy female
empty circle
diseased female
filled circle
death symbol
diagonal dash across circle or square
What part of Medicare covers ambulance for emergency care only
B
Will Medicare part B cover ambulance for transportation needs
no
What is the utilitarian principle
- using limited societal financial resources on programs that will positively affect the largest number of people and have the lowest possible negative outcomes
- not used to refer to an individual or one person
What office enforces HIPAA breach notification rules
Office for Civil Rights
