Lecture 5: Orders, Sexual Abuse and the HCCA Flashcards
What prerequisites are needed for you to perform an authorized act?
- Some sort of order/requisiton from a phycisian
- have training and compentence/confidence
What is an order?
Authorizing statement from a regulated health professional with perscribing authority
CMRITO members require orders to perform a procedure even if it falls under their scope of practice
What legislation mandates who can prescribe an X-ray procedure in Ontario?
HARP
Who can order an x-ray procedure in Ontario
- phycisian
- dental surgeons
What are the 2 types of orders?
- direct order
- medical directive or protocol
Direct Orders
an order for a specific patient, procedure or treatment
must be from a regulated health professional with authority to perscribe
must be in writing, dated, authenticated by ordering health professional
Verbal Order
a direct order communicated over the phone or electronically transmitted
typically when we need to change an order
Must contain:
- name of the health professional ordering it
- date and time it was ordered
- be signed by the individual accepting it
- MRTs need to document changes and verbal order
What is a medical directive?
- something you’re allowed to do for a certain situation
- an order for a specific range of patients and a specific treatment
- always written
- can be called a standing order
4 Things to do when resolving concerns
- discussing the concern directly with the health care professional
- identifying outcomes desired for resolution
- providing a rationale and best practice in evidence in support of the concern
- documenting the concern and steps taken to resolve it in the appropriate record
Can you perform a controlled act that you are not authorized to perform?
No unless delegated
What is delegation?
Transfer of authority to perform a controlled act given by someone who is authorized
ie; an inpatient in ur exam room needs tracheostomy suctioning and RT says to do it past the larynx. We can do it if were competent and confident
Delegation of Authorized Acts
MRTs can accept the delegation of a controlled act but cannot delegate one of their acts to others
What does an MRT need to be to complete any type of order?
To be
- competent
- accountable
- collaborative
As per the RHPA what is sexula abuse
- inappropriate touching in a sexual nature
- sexual intercourse or other forms of sexual relations between MRT and patient
- behaviour or remarks of a sexual nature by the member towards the patient
What duties as an MRT can be contstrued as sexual abuse?
- feeling for landmarks
- asking personal questions
- asking them to change & what you ask them to take off
How can an MRT prevent sexual abuse accusation?
- being careful how we word things
- clear communication
- approacability (body language)
What is the CMRITO policy on sexual abuse?
- zero tolerance
- ## the CMRITO recognizes the seriousness and extent of injury that sexual abuse causes victims
What is the discipline for sexual abuse?
- reprimand the member
- revoke the members registration
- fine the member up to $35k
- require the MRT to pay any legal fees incurred by the college
Communication tips from the CMRITO
- avoid jargon
- be careful of words that can cause miscommunication
- know when to call an interpreter
- use diagrams or charts
Mandatory reporting for child abuse
CMRITO members are required to report when a child is in need of protection
- reporting must be done immediately even outside the hospital
- includes non-accidental injury, sexual abuse and neglect
X-ray signs of child abuse
- posterior rib fractures
- metaphyseal corner fractures
- diaphyseal fractures in children under 3
- skull fractures
- multiple injuries at different healing stages
Physical signs of x-ray fractures
- cigarette burns
- bruises
- behavior
- improbable explanations
What members must report when things happen to them?
- they have a professional malpractice against them
- they have been found or pled guilty to an offence
- they are a member of another regulatory body
- there have been findings of misconduct or incompetence against them by another regulatory body
What is consent?
- agreeing to something & knowing the risk of what youre going to
- important for health care workers because anything we do can cause harm
What is the HCCA
- health care consent act
- the act governing consent in ontario
What is treatment?
anything done for therapeutic, preventative, diagnostic etc. care for health related purpose
What is a course of treatment?
a series of similar treatments administered to a person over a period of time for a particular health problem
Plan of treatment?
deals with treatment of current health problems as well as likely future health problems
When dont we need consent
- to assess or examine a person to determine the general nature of the persons condition
- the taking of a persons health history
- the communication of an assessment or diagnosis
- admission to a hospital or other facility
- assistance with washing, dressing, hygiene
- a treatment that in the circumstances poses little or no risk of harm to the patient
Implied consent in an MRT department
They have an order and showed up to get the xray
2 elements of consent
Consent and capacity
What is required for consent?
- relate to treatment
- be informed
- be involuntary
- not be obtained through misinterpretation or fraud
What is informed consent?
Being specific and clear about what a patient is agreeing to
- nature of treatment
- alternatives
- benefits
- risks
- opprotunity for questions
When is consent given?
Must always be given before the procedure and can be revoked anytime during the procedure
Capacity of consent
Patient must be capable of given consent
How to determine if a patient is capable of giving consent?
- Understand the information that is relevant to making a decision about the proposed treatment
- appreciate the reasonably foreseeable consequences of accepting or refusing the treatment
What does it mean for incapacity of consent?
- the person shows evidence of being confused or delusional
- the person is experiencing severe pain or acute fear and anxiety
- the person appears to be severely depressed
- impaired from alcohol or drugs
What cannot be used as grounds for incapacity to give consent?
- existence of psychiatric diagnosis
- existence of disability (vision or hearing)
- a request for alternative
- a patients age
Changing capacity to give consent
patients conditions can change over time
Order of substitute decision makers
- Guardian or person appointed by court
- An attorney for personal care under power of attorney
- Representative appointed by the Consent and Capacity Board
- Spouse or partner
- Child of patient, parent of patient, or Children’s Aid Society
- Parent with only right of access
- Sibling
- Any other relative
- The Public Guardian and Trustee
Exceptions to getting consent?
if it is considered an emergency/if the patient is severly suffering or at risk for sustaining serious body harm
- the patient must be incapable of giving consent
- the delay of getting consent will prolong the suffering or risk of serious harm
- communication with a capable patient is not possible due to language or a disability
Steps for obtaining consent
- determining the patients capacity
- if it is not an emergency and patient is incapable follow the guidlines of the college
Who gets consent for x-ray procedures?
Prescribing doctor
What is the role of the MRT when it comes to consent?
- ensure they understand
- clarify and review/ answer questions
What is PHIPA
Personal Health Information protection act
What does PHIPA do?
Policies covering the collection use and disclosure of personal health information
What is the federal version of PHIPA
Personal information protection and electronic documents act
- in general doesnt apply to municipalities universities, schools & hospitals
What is confidentiality?
Patient information should never be accessed out of curiousity
Patient info can be shared within the circle of care if required for practicing
Breaches of confidentiality must be reported to CMRITO
