Ethics

Question 1

7 ethical principles

Answer 1

beneficence
nonmaleficence
autonomy
social justice
procedural justice
veracity
fidelity

Question 2

beneficence

Answer 2

is it beneficial? demonstrate a concern for well being and safety of the client

assessments are appropriate, current, relevant
evidence-based interventions
re-evaluation in a timely manner to determine if goals are being achieved and if plan needs to be revised
termination if services are no longer needed

Question 3

nonmaleficence

Answer 3

MAL
refrain from actions that cause harm
- avoid influences that may impair your ability to safely provide care (drugs, alcohol)
- don’t neglect or abandon the pt
- avoid complicated relationships
- avoid situations that may cause exploitation and conflict of interest

Question 4

autonomy

Answer 4

• right to self determination, privacy, confidentiality, and consent
• respect their right to deny services
• HIPPA

Question 5

social justice

Answer 5

• promote fairness and objectivity in the provision of OT services
• provide services in a fair and equitable manner

Question 6

procedural justice

Answer 6

comply with institutional rules, local, state, federal and international laws
- NBCOT code of conduct
- hold required credentials, training, CEUs
- billing and documentation
- not accepting gifts (or check with employer policies)

Question 7

veracity

Answer 7

verify for TRUTH
- comprehensive, accurate, and objective info when representing the progression
- honest documentation

Question 8

fidelity

Answer 8

faithfulness and loyalty
- treat clients and colleagues with respect, fairness, discretion, and integrity

Question 9

ethical decision making

Answer 9

1. identify ethical issues and potential dilemmas
2. gather all relevant info
3. determine conflicting values and areas of agreement
4. identify alternative courses of action
5. determine positive and negative outcomes
6. weigh consequences
7. seek inout from others
8. apply best professional judgment
9. contact agencies about ethical violations
10. determine desired or potential outcome of filing an ethical complaint

Question 10

COTAs and OT aids

Answer 10

COTAS - focus on treatment
OT aids - NON SKILLED tasks (setting up environment, being contact guard for someone)

Question 11

medicare

Answer 11

• largest single payer for OT services
• age 65+ or long term disability (ALS) who have received gov disability for 24 mo, retired railroad workers, all ages with ESRD that requires dialysis or transplant

Question 12

part A medicare

Answer 12

pays for inpatient hospital, SNF, home health, rehab facilities, and hospice care
specific time limits, deductible and coinsurance payments
usually covers minimum 5 days

Question 13

part B medicare

Answer 13

pays for hospital outpatient physician and other professional services including OT
considered a supplemental medical insurance program
monthly premium
usually covers 3 days/week

Question 14

medicare DME not covered

Answer 14

self-help items, bathtub grab bars, and raised toilet seats are not reimbursable DME because other people can use them, and they are not considered medically necessary

Question 15

medicaid

Answer 15

• states
• poverty (low income) and/or have a disability
• mandated services: inpatient and hospital, outpatient, home health, screening services, SNFs
  optional services: OT/PT/SLP, DME, dental care, eye care, prescriptions, transport
  (pre ACA)

Question 16

SMART and RUMBA goals

Answer 16

Specific
Measurable
Attainable
Relevant
Time

Realistic/relevant
Understandable
Measurable
Behavioral
Attainable

Question 17

steps in evidence based practice

Answer 17

1. a clinical problem is identified and an answerable research question is formulated
2. a systematic literature review is conducted and best evidence is collected
3. research evidence I summarized and critically analyzed
4. research evidence is synthesize and applied to clinical practice

Question 18

levels of evidence

Answer 18

I - SR of high quality RCTs or meta-analysis, high sample size, low bias
II - SR of lesser quality RCT, smaller, improper randomization, prospective studies
III - SR of non randomized or case-control study, retrospective studies
IV - case series, not defined comparison groups, insufficient follow up
V - evidence based on opinion

Question 19

grades of recommendation for research

Answer 19

A - strong evidence
B - moderate evidence
C - weak evidence
D - conflicting evidence
E - theoretical/foundational
F - expert opinion

Question 20

PICO question

Answer 20

Population
Intervention
Comparison
Outcome

Question 21

general medicare will cover..

Answer 21

development and periodic eval of maintenance of professional skills (feeding, positioning, dressing)
now covered maintenance therapy if it is established that it’s required for safe and effective intervention

Question 22

general medicare won’t cover..

Answer 22

separate billing for tx supplies

Question 23

quasi experimental pre-post study

Answer 23

IV on DV, does the intervention work

Question 24

experimental randomized 2-group design

Answer 24

needs a control group, so withholding treatment would not be ethical

Question 25

ethical situations

Answer 25

• find someone working after hours: ask and get more info
• poor work behaviors: meet about work objectives
• suspect skin cancer or other medical issue: contact client’s physician directly, don’t just tell them to
• if drunk: arrange for transportation and send them home

Question 26

contact authorities

Answer 26

abuse/signs because mandated reporting
if there is malpractice or harm

Question 27

scope of OT practice is under

Answer 27

STATE regulations! not AOTA practice guidelines

Question 28

statistically significant
correlation coefficient (strength of relationship)

Answer 28

p <0.05 is good!
r <0.70 correlation is unacceptable

Question 29

QI vs improving competence

Answer 29

quality improvement: improving program and process
improving competence: SKILL related, like documentation

Question 30

HIPPA violation

Answer 30

talk directly to the colleague to allow the person to self-correct their behavior; if they refuse, then the director must be made aware

Question 31

standardized assessments

Answer 31

keep going do not end it, follow protocols, cannot add cues

Question 32

Mother with schizophrenia stabilized in hospital and ready to d/c home

Answer 32

home visit to assess safety and need for further services; no info to indicate need for social services for kids

Question 33

Shouldn’t be driving

Answer 33

report the info to the physician, who is responsible to take action on the person’s ability to drive

An important step when recommending that a client stop driving is to inform the client and the referring physician about safety concerns, and to know state laws about legal obligation for reporting.