Ethics Flashcards
7 ethical principles
beneficence
nonmaleficence
autonomy
social justice
procedural justice
veracity
fidelity
beneficence
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
nonmaleficence
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
autonomy
- right to self determination, privacy, confidentiality, and consent
- respect their right to deny services
- HIPPA
social justice
- promote fairness and objectivity in the provision of OT services
- provide services in a fair and equitable manner
procedural justice
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)
veracity
verify for TRUTH
- comprehensive, accurate, and objective info when representing the progression
- honest documentation
fidelity
faithfulness and loyalty
- treat clients and colleagues with respect, fairness, discretion, and integrity
ethical decision making
- identify ethical issues and potential dilemmas
- gather all relevant info
- determine conflicting values and areas of agreement
- identify alternative courses of action
- determine positive and negative outcomes
- weigh consequences
- seek inout from others
- apply best professional judgment
- contact agencies about ethical violations
- determine desired or potential outcome of filing an ethical complaint
COTAs and OT aids
COTAS - focus on treatment
OT aids - NON SKILLED tasks (setting up environment, being contact guard for someone)
medicare
- 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
part A medicare
pays for inpatient hospital, SNF, home health, rehab facilities, and hospice care
specific time limits, deductible and coinsurance payments
usually covers minimum 5 days
part B medicare
pays for hospital outpatient physician and other professional services including OT
considered a supplemental medical insurance program
monthly premium
usually covers 3 days/week
medicare DME not covered
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
medicaid
- 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)
SMART and RUMBA goals
Specific
Measurable
Attainable
Relevant
Time
Realistic/relevant
Understandable
Measurable
Behavioral
Attainable
steps in evidence based practice
- a clinical problem is identified and an answerable research question is formulated
- a systematic literature review is conducted and best evidence is collected
- research evidence I summarized and critically analyzed
- research evidence is synthesize and applied to clinical practice
levels of evidence
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
grades of recommendation for research
A - strong evidence
B - moderate evidence
C - weak evidence
D - conflicting evidence
E - theoretical/foundational
F - expert opinion
PICO question
Population
Intervention
Comparison
Outcome
general medicare will cover..
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
general medicare won’t cover..
separate billing for tx supplies
quasi experimental pre-post study
IV on DV, does the intervention work
experimental randomized 2-group design
needs a control group, so withholding treatment would not be ethical
ethical situations
- 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
contact authorities
abuse/signs because mandated reporting
if there is malpractice or harm
scope of OT practice is under
STATE regulations! not AOTA practice guidelines
statistically significant
correlation coefficient (strength of relationship)
p <0.05 is good!
r <0.70 correlation is unacceptable
QI vs improving competence
quality improvement: improving program and process
improving competence: SKILL related, like documentation
HIPPA violation
talk directly to the colleague to allow the person to self-correct their behavior; if they refuse, then the director must be made aware
standardized assessments
keep going do not end it, follow protocols, cannot add cues
Mother with schizophrenia stabilized in hospital and ready to d/c home
home visit to assess safety and need for further services; no info to indicate need for social services for kids
Shouldn’t be driving
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.
