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Ethics and patient safety > Ethics and patient safety > Flashcards

Ethics and patient safety Flashcards

1
Q

Name the four exceptions to informed consent

A
  1. Emergency
  2. Waiver by the patient
  3. Patient is incompetent
  4. Therapeutic privilege (unconscious, confused, physician deprives patient from autonomy in interest of health)
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2
Q

When is parental consent not necessary (partial emancipation)

A
  • Sex (contraception, STIs)
  • Drugs (substance abuse)
  • Rock and roll (emergency/trauma)
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3
Q

Examples of when a minor is legally emancipated and does not need parental consent for anything

A
  • Married
  • Self-supporting (more tan 13 years old)
  • Military
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4
Q

Exceptions to confidenciality

A

“The physician’s good judgement SAVED the day”

  • Suicidal/homicidal patients
  • Abuse (children, elderly, or prisoners)
  • protect potential Victims (duty to protect)
  • Epileptic patients and other impaired automobile drivers
  • reportable Diseases (eg, STI, hepatitis, food poisoning)
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5
Q

Name the five R’s to prevent medication errors

A
  • Right drug
  • Right patient
  • Right dose
  • Right route
  • Right time
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6
Q

Most common cause of a hospital acquired UTI

A

Indwelling urethral catheter

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7
Q

Time criteria to diagnose a hospital acquired pneumonia

A

48 hours or more after being admitted

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8
Q

Most common nosocomial infections

A

UTIs

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9
Q

Second most common nosocomial infections

A

Hospital acquired pneumonia

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10
Q

Definition of an unexplained readmission

A

When the patients unexpectantly returns to the hospital in less tan 30 days after being discharged

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11
Q

Name the 3 categories of medical errors

A
  • Diagnostic
  • Treatment
  • Preventive
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12
Q

Name the 3 types of medical errors

A
  • Slips
  • Lapses
  • Mistakes
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13
Q

Define a slip (medical error)

A
  • Actions not carried out as intended or planned (administering something IV instead of SC)
  • Observable
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14
Q

Define a lapse (medical error)

A
  • Missed actions or omissions

* Not observable

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15
Q

Define a mistake (medical error)

A

*When the intended action is wrong

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16
Q

Define an adverse event

A

Harm or injury that result directly from medical care, not from negative outcomes due to the patient’s disease or medical condition

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17
Q

Define a near-miss

A

Errors that occur but do not result in injury or harm to patients because they are caught in time or simply because of luck

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18
Q

Name the 3 types of diagnostic errors

A
  • No-fault errors
  • System-related errors
  • Cognitive errors
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19
Q

Define the cogntive type of diagnostic errorrs

A

Errors that result from a diagnosis that was wrong, missed, or unintentionally delayed due to a clinician error

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20
Q

Name the 3 examples of the cognitive type of diagnostic errors

A
  • Anchoring bias
  • Confirmation bias
  • Availability bias
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21
Q

Define the anchoring bias

A

Wrong diagnosis occurs when a clinician holds on to a particular diagnosis and becomes dismissive to signs and symptoms pointing to another diagnosis

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22
Q

Define a confirmation bias

A

Looking for evidence to support a pre-conveived opinión rather tan looking for evidence that refutes it or provides greater support to an alternative diagnosis

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23
Q

Define an availability bias

A

Tendency to asume a diagnosis based on a recent patient encounter (the most cognitively “available” diagnosis)

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24
Q

Who should do the oficial disclosure of an error

A

The most senior physician responsable for the patient and most familiar with the case

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25
Q

Systematic approach to medical errors that is retrospective in nature (eg, uses interviews and records to identify underlying problems)

A

Root cause analysis

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26
Q

Systematic approach to medical errors that uses fishbone (Ishikawa) diagrams to plot ideas

A

Root cause analysis

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27
Q

Prospective engineering approach which seeks to anticipate and prevent adverse events through safety design

A

Failure mode effects analysis (FMEA)

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28
Q

Name the principles of quality improvement

A

“STEEEP”

  • Safe
  • Timely
  • Effective
  • Efficient
  • Equitable
  • Patient-centered
29
Q

Name the 4 measures of quality

A
  • Structure
  • Process
  • Outcomes
  • Balancing measures
30
Q

Examples of models of quality improvement

A
  • PDSA
  • Six sigma
  • Lean
  • Flowhcarts
31
Q

Name the steps to reduce variation and improve performance in the six sigma model of quality improvement

A

“DMAIC”

  • Define
  • Measure
  • Analyze
  • Improve
  • Control
32
Q

Model of quality improvement that reduces everything that does not enhance patient outcomes

A

Lean

33
Q

What would happen if a living will and a person with the medical power of attorney were contradicting themselves

A

The physician should follow the living will

34
Q

What’s the priority of surrogate decision makers

A

“the spouse ChiPS”

  • Spouse
  • adult Children
  • Parents
  • Siblings
  • Other relatives
35
Q

Who is the surrogate decision maker if the patient has no family

A

A person who cares about and knows the patient’s wishes

36
Q

Measures that can be taken in patients who are having difficulty taking medications

A
  • Provide written instructions
  • Simplify treatment regimens
  • Use teach-back method (patient repeats to the physician)
37
Q

Can an underage woman request an abortion

A

Many states require parental notification or consent for minors for an abortion

38
Q

What would be the correct course of action if a serious suicidal patient refuses to stay hospitalized

A

The patient can be hospitalized involuntarily if he/she refuses

39
Q

What would be the appropiate course of action if a patient is victim of intimate partner violence

A

Ask if patient is safe and has an emergency plan

40
Q

What would be the appropiate course of action if a colleague presents to work impaired

A

Report the situation to a local supervisory personnel (designated hospital committee), if there’s no answer, alert the state licensing board

41
Q

Level of disease prevention that prevents disease before it occurs

A

Primary prevention

42
Q

Level of disease prevention that screens early for and manages existing but asymptomatic disease (eg, Pap smear, BP community screening)

A

Secondary prevention

43
Q

Level of disease prevention that provides treatment to reduce complications from disease that is ongoing or has long-term effects (eg, chemotherapy)

A

Tertiary prevention

44
Q

Level of disease prevention that focuses on identifying patients at risk of unnecesary treatment to protect them from harm of new interventions

A

Quaternary prevention

45
Q

Characteristics of a health maintenance organization (insurance plan)

A
  • Patients are restricted to a limited panel of providers who are in the network
  • Low monthly premiums, copayments, and deductibles
  • Payment is denied to services that don’t follow evidence-based guidelines
  • Requires referral from primary care physician to see a specialist
46
Q

Characteristics of point of service insurance plan

A
  • Patients can see providers outside of the network, but have higher out-of-pocket costs, deductibles, and copays
  • Requires referral from a primary care provider to see a specialist
47
Q

Characteristic of preferred provider organization (insurance plan)

A
  • Patients are allowed to see physician inside or outside the network
  • Higher premium, copays, and deductibles
  • Does not require referral from a primary care provider to see a specialist
48
Q

Characteristics of exclusive provider organization (insurance plan)

A
  • Patients are limited (except in emergencies) to a network of doctors, specialists, and hospitals
  • Does not require referral from a primary care provider to see a specialist
49
Q

Describe the capitation payment model

A

Physicians receive a set amount per patient assigned to them per period of time, regardless of how much the patient uses the healtcare system

50
Q

Patients eligible for Medicare

A
  • More tan 65 years old
  • Less tan 65 years old with certain disabilities
  • End-stage renal disease
51
Q

Patients eligible for Medicaid

A

People with limited income and/or resources (joint federal and state program)

52
Q

Life expectancy criteria to be eligible for hospice care (either in Medicare or Medicaid)

A

Less tan 6 months

53
Q

Define the principle of double effect

A

The prioritization of positive effects over negative effects (like in hospice care)

54
Q

Does pregancy make a child emancipated

A

No, responsibilities for the pregnant minor and her baby fall in the minor’s parents

55
Q

Type of euthanasia that a physician can perform

A

Passive, only if the patient asks for it

56
Q

If a physician thinks treatment is futile but the surrogate insists in continuing treatment, what would be the appropiate course of action

A

The treatment should continue

57
Q

If a patient is cortically dead but the family insists in continuing treatment, what would be the appropiate course of action

A

The treatment should stop

58
Q

If an adult refuses to treat a child due to religious beliefs, and the event is not an emergency but still critical, what would be the appropiate course of action

A

Declare the child a ward of the court, and the court grants permission to treat

59
Q

How long can a physician or a law enforcement oficial detain a patient if he/she is considered to be a danger to themselves or others

A

Up to 48 hours pending a hearing

60
Q

A physician can detain a child and recommend that he/she is committed to a judge if the child is…

A
  • An immediate danger to self or others
  • Orphaned or unable to care for their own daily needs
  • Uncontrollable due to illness, even if parents are seeking for help
61
Q

What is the first thing that should be done after an event that causes harm to the patient

A

Care for the patient’s medical needs

62
Q

Type of error that is not usually needed to be disclosed to the patient but needs to be reported to the system

A

Near-miss

63
Q

Describe the 3 dimensions of the Triple Aim principle of quality improvement

A
  1. Improve patient experience of care
  2. Improve the health of populations
  3. Reduce per capita costs of health care
64
Q

What’s the use of a Pareto chart

A

It is used to describe a large proportion of quality problemas caused by a small number of cases

65
Q

Define a “never event”

A

Particularly shocking medical error that should never occur

66
Q

Most common type of elder abuse

A

Neglect

67
Q

Define a “sentinel event”

A

Adverse event resulting in serious or permanent injury to a patient

68
Q

What are the components of malpractice

A
  • Duty
  • Breach
  • Harm done
  • Breach caused the harm

Ethics and patient safety (1 decks)

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