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Ethics > Ethics final Exam > Flashcards

Ethics final Exam Flashcards

1
Q

AAPA

A

American Academy of Physician Assistants , In charge of education and professional development (CEUs), look at data for national averages on salaries, the number of patients seen ect.

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2
Q

ARC-PA

A

Accreditation Review Commission on Education for PAs, defines standards for all PA programs and reviews them based on those standards

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3
Q

NCCPA

A

National Commission on Certification for PAs:

  • only current certification body: administers PANCE and PANRE
  • serves as a source of information concerning state enabling laws, regulations, and rules
  • performs research and practice analysis
  • Polices our profession: Competencies for the profession, Code of conduct, disciplinary policy
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4
Q

PAEA

A

Physician Assistant Education Association- supports the faculty of PA programs and makes sure that they are all staying active clinically, makes ciricuulum reccomendations, core competencies for new grads

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5
Q

Core Competencies for new PA graduates

A
  1. Patient-centered practice knowledge
  2. Society and population health
  3. Health literacy and communication
  4. inter-professional collaborative practice and leadership
  5. Professional and legal aspects of healthcare
  6. healthcare finance and systems
    - overall cultural humility, self-assessment, and ongoing professional development
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6
Q

Major environmental factors affecting PA profession

A
  1. Higher education
  2. Healthcare system delivery and capacity
  3. population health
  4. social determinants of health
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7
Q

NCCPA Values (PRACTICE)

A
  1. Professionalism
  2. Responsibility
  3. Accountability
  4. Collaboration
  5. Trust
  6. Inclusion
  7. Certification
  8. Excellence
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8
Q

Current PA competencies

A
  • Medical knowledge
  • Interpersonal and Communication skills
  • patient care
  • professionalism
  • practice-based learning and environment
  • society and population health
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9
Q

2019 draft of competencies

A
  • knowledge of practice
  • interpersonal and communication skills
  • patient-centered care
  • inter-professional collaboration
  • professionalism and ethics
  • practice-based learning and quality improvement
  • society and population health
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10
Q

NCCPA code of conduct

A
  • protect the integrity of NCCPA issued credentials: ie any cheating on the PANCE, false CEU documentation, unauthorized NCCPA certificate
  • comply with all applicable laws, regulation and standards: practice without impairment, professional and personal limitations, must report guilty pleas or no contest pleas to all felonies and certain misdemeanors
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11
Q

NCCPA disciplinary policy

A
  • specifies consequences for altering integrity in the PANCE or PANRE exam
  • provides for the denial or revocation of certification d/t gross incompetence, conviction of felony, court finds PA mentally incompetent
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12
Q

PANCE today

A
  • 300 questions: 5 blocks of 60 questions each (computer based)
  • 5 hours
  • assesses basic medical and surgical knowledge
  • results in 2 weeks
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13
Q

PANCE organ systems

A
  • 20% related to surgery
  • 13% cardiovascular
  • 10% pulmonary
  • 9% GI/Nutrition
  • 8% MSK
    • largest sections see lecture for further breakdown
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14
Q

PANCE knowledge and skills areas

A
  • 18% most likely diagnoses
  • 17% H +P
  • 14% pharm
    (New piece 5% professional pracice)
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15
Q

PANCE prep

A
  • PACKRAT and summative exams follow PANCE content
  • identifies strengths and weaknesses
  • Utilize NCCPA practice exams and AAPA study tools
  • Review Course
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16
Q

PANCE test-taking strategy

A
  • answer every question (score based on correct responses)
  • mark those unsure about and review if you have time
  • Do not change your answers unless you are sure of the change
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17
Q

Maintenance of certification

A
  • Re-register every 2 years , 100 CME and pay a fee by Dec. 31st
  • Re-certify with the PANRE every 10 years
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18
Q

CME requirements

A
  • 5 two year cycles
  • 100 CME hours
  • At least 50 from category I
  • the rest can be either category I or category II
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19
Q

Category I CME

A
  • Pre-approved by AAPA,AMA, AAFP, ACCME
  • can be clinical or professional
  • precepting w/ proof of participation
  • must include certificate/verification of completion
  • may include cost
  • includes PI-CME and slef-assessment CME ( 1st PI is logged as double)
  • Pre-approved certification programs (ACLS, BLS ect.)
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20
Q

Category II CME

A
  • not pre-approved by prior organizations
  • Voluntary, self-learning
  • Includes teaching, journal reading, studying for boards, precepting with no approved form
  • professional improvement, committee work, professional elected positions
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21
Q

PANRE

A
  • 240 MC questions
  • 4 blocks of 60 questions, 4 hrs
  • 60% of the content is the same as the PANCE (primary care focus)
  • 40% of content directed towards 3 general areas ( Adult medicine, surgery, primary care)
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22
Q

PANRE pilot program

A
  • Earn 100 CME hours for 2 years
  • Certification extended: If “fail” have 1 year to re-test, If “pass” 10 year re-certification renewed
  • 25 MC questions/ quarter for 2 years; covers core medical knowledge, provides immediate feedback
  • Passing standards TBD
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23
Q

Chapter Med 8

A
  • WI administrative code for regulation of PA practice
  • Outlines all general rules and regulations for licensing of PAs
  • revised in April of 2018
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24
Q

WI licensure

A
  • Fill out application: April of the year of graduation
  • Program verification form
  • Consent for NCCPA results to state
  • Fee and photo; personal questionnaire
  • Online exam: open book exam on WI statutes and Administrative code (oral exam stipulations if need be)
  • Federation Credentials Verification Service (FCVS) for Universal State Licensing Data
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25
Q

Chapter Med 8: 8.05 state exam

A
  • based on Wisconsin Statutes and Administrative Code book
  • Chapter Med 8, Med 10, Phar 8
  • MC questions, 85% to pass, if fail pay fee and reapply 2x, at not less than 4 month intervals
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26
Q

Renewing WI license

A
  • Every 2 years
  • Renewal fee
    WI does not require CME renewal
  • Must notify change of supervising physician within 20 days
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27
Q

Prescribing controlled substances

A
  • allowed in all states except Kentucky
  • Grouped into 5 schedules based on abuse potential
  • Requires DEA license
  • Requires monitoring of ePDMP
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28
Q

DEA number

A
  • tracks and maintains records of your prescription patterns
  • Apply for DEA number following certification
  • includes prescribe, dispense, distribute
  • DEA number required for each state you prescribe in
  • 3 years is $731 (usually covered by employer)
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29
Q

Credentialing and privileges

A
  • Based on your institution
  • May not be the same as state laws and requirements (cannot be less restrictive, but may be more restrictive)
  • Verify PA education and experience
  • Verify licensure and certification
  • grant privileges based on physician recommendations, peer review, CME
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30
Q

certified

A

National level, met requirements of core medical knowledge for the profession

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31
Q

Licensed

A
  • governed by state regulations and standards

- Med chapter 8 in WI

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32
Q

Credentialed

A
  • documents in place to verify ability to practice at an institution
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33
Q

Privileges

A
  • List of functions, tasks, and responsibilities that a hospital or facility approves for a PA to do
  • Requires documented references- peer, supervising physician
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34
Q

Conflict of interest

A

A situation in which a person is or appears to be at risk of acting in a biased way because of personal interests
- financial, personal, professional

35
Q

Fiduciary relationship/duty

A
  • patient to provider, legal term meaning an unequal distribution of power
  • duty: duty to provide care based on trust of the patient with his/her interests in mind
36
Q

Informed consent

A

A process of communication between a patient and a physician that results in the patient’s authorization or agreement to undergo a specific medical intervention

37
Q

Informed consent documentation

A
  • performing a surgical procedure or administering anesthesia
  • administering radiation or chemotherapy
  • administering blood transfusion
  • inserting surgical device or appliance
  • administering an experimental medication
38
Q

Emergent surrogate decision makers

A
  • in the event of an emergency provider may initiate treatments if pt or surrogate is unable to consent
39
Q

decisional capacity

A

patient has the ability to understand medical information, consider the situation and potential consequences as well as reason various medical options AND communicate a clear decision/choice

40
Q

Incapacity

A
  • determined by psychologist or physician
  • once incapacitated a surrogate decision maker is needed
  • D-POA, guardian, family member, or intimate associate
  • can be temporary or permanent
41
Q

Minors right to consent in WI

A
  • contraceptive care, pregnancy testing, STI dx and tx, rape or sexual assualt
  • HIV testing- 14 or older
  • AODA out patient eval or detox- 12 or older
  • Minor child becomes legal adult when they have a child
42
Q

Permitted HIPAA disclosures

A
  • treatment: to those providing, coordinating or managing care/services for the patient.
  • payment: to obtain coverage and reimbursement for payment of services
  • operations: care coordination/case management, medical reviews/ audits or legal services, insurance, administrative
43
Q

HIPAA disclosures required by law

A
  • Public health
  • FDA
  • Workman’s Comp/OSHA
  • Court ordered
  • Law enforcement
  • Funeral director, coroner, medical examiner
  • organ donation/transplant coordination
  • threat to patient or public
  • essential government functions
44
Q

Patient rights to the medical record

A
  • request restrictions and access to records
  • inspect and copy records
  • request amendments
  • request a list of disclosures
  • revoke prior authorizations
  • request alternate means of communication
  • file a complaint
  • decline listing in directories
45
Q

4 principles of ethics

A
  • autonomy- self-rule
  • beneficence- act in the patients best interest
  • nonmaleficence- do no harm
  • justice- fair distribution of resources, risks, costs, standards of care
46
Q

HIPAA

A
  • Health Insurance Portability and Accountability Act of `1996
47
Q

Malpractice

A

negligence on the part of the physician, allied health professional, or hospital that causes physical OR emotional damage to the patient.

48
Q

Standard of Care

A
  • what most provider would do to treat a specific injury/illness
  • in theory all providers would have the “same” treatment plan or intervention
  • If standard of care is not used= negligence
  • usually determined by medical expert/witness
49
Q

Negligence

A
  • Failure to exercise standard of care
  • Res Ispa Loquitur: “ the thing speaks for itself”
  • All those connected w/ act are liable for negligence
50
Q

Gross negligence

A
  • conscious and voluntary disregard of the need to use reasonable care, which is likely to cause foreseeable grave injury or harm to persons
  • implies a level of intent or severe carelessness
51
Q

Statue of Limitations

A
  • 3 years from the time that the malpractice occurred OR within one year of discovery of the injury so long as no more than 5 years have passed
  • Limits claims for non-economic damages (pain and suffering) to $750,000
52
Q

Discovery Rule

A

Statue of limitations does not begin until the occurrence of the event puts the plaintiff on notice

53
Q

Life of a lawsuit

A
  • Error is made and damage or harm MAY have occur ed: risk management must be notified
  • Negligence is claimed: lawyer/insurance is contacted, request for mediation
  • Lawsuit is filed
  • data retrieval
  • deposition
  • settlement v. litigation
  • average time of completion is 7 years
54
Q

Lawsuit conclusion

A
  • settlement vs. trial
  • only 7% of cases go to trial
  • plaintiffs win only 21% of the time
  • insurance company pays attorney fees, experts fees, court costs
  • PAs and PA teams sued far less
55
Q

Elements of negligence action

A
  1. Duty
  2. Breech of duty
  3. Breach Caused injury
  4. injury resulted in compensatable damages
56
Q

duty

A
  • evidence that the healthcare provider had the duty to provide medical care
  • usually implied when medical treatment is begun
57
Q

Breach of duty

A
  • standard of care not met= negligence

- action or failure to act

58
Q

injury

A
  • proximate cause
  • proof that an injury occurred and that the breach was the actual cause of claimant’s injury
  • direct cause–> effect
  • did tx or missed tx lead directly to injuries of bodily harm or mental harm
  • did it change the outcome? Would the patient have died anyway in a critical care situation?
59
Q

Damages

A
  • must have sustained emotional or economic damage to prosecute a medical negligence suit successfully
60
Q

Malpractice awards

A
  • compensatory: money to accommodate disability, pain and suffering, financial compensation to restore to prior injury state
  • punative: deter future wrongful act
61
Q

Common malpractice pitfalls

A
  • M-missed diagnoses
  • A- assessment inadequate
  • L- legibility esp medications
  • P- proper documentation and pt privacy rights
  • R- results not followed through on
  • A- alliances with patients- build rapport
  • C- consent not clearly disclosed
  • T- timely care; delayed diagnoses or referral
  • I- insurance- are you properly insured?
  • C-communication
  • E- ethical practitioner
62
Q

Reasons PAs are sued

A
  • lack of supervision: practicing outside their scope
  • untimely refferal
  • failure to diagnose or delayed (50%)
  • inadequate exam
  • lack of documentation
  • lack of communication
63
Q

Negligent supervision

A
  • employer fails to reasonably monitor and control employees actions
  • if physician is available or they violate the PA;physician ratio
  • If CARES act passes this would change
64
Q

vicarious liability

A

Allows pt to commence a malpractice action against a PAs supervising physician and may be solely liable for the negligent acts performed by the PA

65
Q

Imputed liability

A

Non-negligent party held liable for actions of another based on their relationship (employer, agency responsible for its employees)

66
Q

Medical misconduct

A
  • practicing fraudulently
  • practicing w/ gross incompetence or gross negligence
  • practicing while impaired
  • being convicted of a crime
  • filing a false report
  • guaranteeing that a tx will result in a cure
  • refusing to provide services d/t race, creed, color or ethnicity
  • performing services not authorized by the patient
  • harassing, abusing, or intimidating the pt
  • ordering excessive tests
  • abandoning or neglecting a pt in need of immediate care
  • altering records
67
Q

Facility rules and regulations

A
  • credentialing and privileges
  • JCAHO
  • reporting adverse outcomes=mandatory
68
Q

serious event

A
  • fatal or life-threatening
  • permanent or significant disability
  • requires a prolonged hospitalization
  • congenital anomaly
  • requires interventions to prevent permanent impairment or damage
69
Q

disclosing errors

A
  • prompt explanation of outcomes that were not anticipated to include explanation of how the injury occurred, short and long term effects, remedies/steps to prevent future occurrences
  • DO NOT necessarily constitute improper care, negligence, or unethical behavior
70
Q

apologies

A
  • an acknowledgement of responsibility and expression of remorse
  • use of disclosing errors and apologies reduce legal actions
71
Q

EMTALA

A
  • ensure access to emergency care regardless of ability to pay and prevents inappropriate transfers to other facilities
  • hospital must provide appropriate screening and stabilize prior to any transfer
72
Q

abandonment

A
  • when the practitioner does not conform to the applicable standard of care when discontinuing the patient relationship
73
Q

Adequate notice of discharge

A
  • notice in writing- certified letter is common
  • “reasonable” time to select another provider (10-30 days customary)
  • provide emergency care during this time
  • provide info on maintaining medical records
  • provide resources to obtain providers
  • identify risk of failure to establish continued care and issues leading to discharge
74
Q

National practitioner data bank

A
  • reduce the incidence of medical malpractice by restricting the ability of practitioners to move around
  • covers physicians, allied health, and dentists
75
Q

The 4 C’s of risk management

A
  • compassion
  • communication
  • competence
  • charting
76
Q

Altering the medical record

A
  • Don’t do it

- if you make a mistake use SLIDE - (single line, initial, date, error)

77
Q

Importance of communication

A
  • providers who spend less than 15 mins more likely to be sued
  • successful providers encourage the patient to talk
  • successful providers are more careful to explain what they are doing befor they do it
78
Q

Employer provided malpractice coverage

A
  • umbrella policy
  • riders for all supervised employees
  • shared representation
  • cost is less
  • know the time it is effective and type of coverage
  • you want the limit $1 million per claim/ $3 million annual
79
Q

individual malpractice insurance

A
  • separate limits of liability, specific to yuor responsibilities
  • no conflict of interest with employer
  • guaranteed your own single representation
  • can be written to cover other employment/moonlighting
  • can take it with you when you leave
  • $1200-5000/ year
80
Q

What affects premiuims?

A
  • scope/type of practice
  • hospital privileges
  • years of experience
  • history of lawsuit or claim
81
Q

Federal/State liability coverage

A
  • National health service corps

- community/free clinics

82
Q

Patient compensation fund

A
  • provides coverage over the $1M/$3M limit
  • funded by HCW and employers
  • Only MDs and Nurse anesthetists are guaranteed participation
  • Annual premium $300
  • PAs can participate under employer umbrella
  • Must be under MD supervision
83
Q

Claims made policy

A
  • covers claims made only DURING the period it is in force
  • usually during your employment
  • renewed annualy
  • less costly but maybe the only option
  • MC form of employer offered plans
  • expires when you leave your job
  • Add tail coverage (costly, 5 year term may not be enough depending on statute of limitations)
84
Q

Occurrence Policy

A
  • covers all claims that occurred while policy was in force
  • broadest protection available “forever”
  • claims may be made during or after employment ends
  • more $$$, does not require tail coverage , not often available or provided as employer policy

Ethics (1 decks)

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