P - Professional Aspect Flashcards
A patient claims to suffer an injury due to an anesthetic and is out of work for six weeks due to the injury. He files a lawsuit to recover his lost wages. In this instance, he is suing for
special damages
Three types of damages may be sought for in a civil lawsuit: general damages, special damages, and punitive damages. General damages result directly from the injury and include reimbursement for pain and suffering. Special damages occur as a result of the injury, such as lost wages, medical expenses, and funeral expenses. Punitive damages are rare in medical malpractice cases, but are intended to punish the wrongdoer for the negligence that led to the damage to the plaintiff.
If an anesthetic complication occurs that is likely to produce a prolonged hospitalization or permanent injury, you should notify
the liability carrier
If an anesthetic complication occurs that is likely to produce a prolonged hospitalization or permanent injury, you should notify the liability carrier.
A CRNA sends a text message on his personal cell phone to another CRNA asking if Mr. Jones in operating room 6 is doing well during his prostatectomy. This text message
could lead to civil liability
Protected health information is defined as any information relating to the past, present, or future mental or physical health of a person, or gives enough information that could reveal an individual’s identity, such as name, birth date, address, or demographic data. Furthermore, this information should only be transmitted through devices approved by a facility or digital environments with secure connections, HIPAA-compliant messaging services, or network encryption. All healthcare providers should be cognizant that confidentiality breeches can result in civil liability, criminal investigations and sanctions, job loss, and disciplinary action by state licensing boards.
An attempt to touch a person without their consent, even if no harm is caused, is referred to as
assault
assault = attempt Battery = Beating
Assault is the attempt to touch another person. Battery is the actual touching of a person without their consent. Harm does not have to be caused in cases of assault or battery.
A patient undergoing a high-risk, cosmetic surgery refuses to suspend their advance directive. The CRNA assigned to the case refuses to participate on the moral statement that they believe the significant risk of life is not worth the benefits of the elective surgery. The facility ethics committee deemed the procedure appropriate if the patient understands and accepts the risks. The appropriate step to take is to
locate another CRNA to perform the case
A CRNA has the right to conscientious objection, which means that they can refuse to participate in a case if the patient’s advance directive violates their moral, ethical, or other beliefs so long as it doesn’t place the patient at risk for harm or constitute a breach of duty. If another qualified practitioner is available, then they should perform the case. If no one else is available and the procedure has not been deemed medically unnecessary or inappropriate, then the CRNA should honor the wishes of the patient and perform the case.
The key difference between expert witnesses and other witnesses called to appear before the court in a malpractice trial is that
expert witnesses may express their opinion rather than fact
Although many expert witnesses are recognized in their field for their publications, research, and specialized experience or training and may be paid for their services, these are not necessary elements. Any licensed practitioner can appear before the court, and it is the sole discretion of the judge, not the jury or any other member of the court as to whether they are qualified as an expert in the matter. The key difference between expert witnesses and factual witnesses is that expert witnesses can give their opinion on a matter and can therefore testify speculation rather than fact.
In a continuous quality improvement program, a partial disconnect of the anesthesia circuit that was detected by the practitioner before the patient suffered any harm would be referred to as a
critical incident
In continuous quality improvement programs, events are identified and analyzed as opportunities to improve processes. An event that could potentially produce in harm in a patient, such as a circuit disconnection, whether the event was detected before harm was committed or not, is referred to as a critical incident. A sentinel event is a single, isolated event such as a patient death or su
Which is NOT a document that gives one person the right to make medical decisions on behalf of a person who is incapable of making the decisions for themself?
Sustainable attorney-in-fact
A durable power of attorney, medical power of attorney, and healthcare power of attorney are all terms that refer to the legal representative that can make medical decisions on behalf of another who is not able to make those decisions for themself.
Which person would be most qualified to testify as an expert witness for a CRNA in a neuroanesthesia case?
An active CRNA with 8 years of neuroanesthesia experience
Qualified nurse anesthetists’ expert testimonies are used in many situations such as medical malpractice suits, institutional peer review, and in state board disciplinary hearings. Only nurse anesthetists can testify on the nurse anesthesia standard of care. Expert witnesses should be currently certified, have expertise in the area that they are testifying, and be well-versed about the nurse anesthesia standard of care. In this case, the retired, former CRNA does not qualify because he no longer has an active certification.
In quality of care models, the sequence and coordination of patient care would be part of which component?
process
The three building blocks of quality of care are structure, process, and outcome. Structure refers to the setting in which the care is delivered. It includes the facilities, organizational structure within which the care is delivered, and personnel that deliver care. It also includes the qualifications and licensing of the personnel, the equipment they use, the standards of the facility, and even factors such as the ratio of staff to patients. The process of care refers to the sequence and coordination of operations in the care of patients. For example, when in the sequence of care is the preanesthetic evaluation performed? How is monitoring performed during an anesthetic? Outcome refers to the changes in a patient’s health status following the delivery of care.
Which of the following terms describes a civil wrongdoing?
TORT
A tort is a civil wrongdoing. It is not necessarily a criminal act, but an act that involves damages inflicted by one person on another.
You have an objection to a patient’s advance directive (AD). According to federal law, you should clearly explain your objection to the patient and
identify the state law on which your objection is based
According to federal law (applies to facilities that participate in Medicare and Medicaid), if there is an objection to a patient’s advance directive, you should clearly explain the objection, identify the state law on which it is based, distinguish between objections of the facility and objections of the particular clinician, and describe the range of healthcare conditions and/or procedures that could be affected by the objection.
The concept of vicarious liability arises under the common law doctrine of
respondeat superior
Vicarious liability is a form of liability that arises from the concept of respondeat superior. This means that an employer has a duty for reasonable oversight of their employees and can be held liable for their actions.
Which of the following is NOT one of the three components of the quality improvement model?
analysis
Donabedian, a leader in the creation of the quality improvement model, identifies three components to quality: structure, process, and outcomes. Structure is the facilities and environment in which care is administered and includes policies and procedures, governance, noise levels, ease of access, privacy, etc. Process is how the care is actually delivered and includes concepts such as compassion, communication, development of trust, etc. Outcomes involve the measurements of results of the care provided and includes elements such as mortality, morbidity, and speed of recovery.
You are served a legal complaint indicating that you are being sued for injury to a patient. The first thing you should do is
notify your liability carrier
If you are served notice that you are being sued, you should notify your liability insurance carrier immediately.
A patient has no advance directive. During an emergency situation, the patient becomes confused and agitated. He states he wants to be left alone to die immediately prior to collapsing in cardiac arrest. You should
perform CPR immediately and call for assistance
An advance directive can be given orally in many states, but often requires special confirmation such as two witnesses who document it. In order for any advance directive to be valid, though, the patient must be in an appropriate, decision-making state at the time it is made. This patient was confused and not in a state to issue an advance directive, so CPR should be instituted immediately.
A CRNA will be adding a new procedure to their scope of practice at their facility. They have secured privileges, demonstrated competence, and ensured they are within state and federal guidelines. What should they do before performing the procedure?
Contact their liability carrier
The AANA Scope of Practice encompasses all activities in which a CRNA may be engaged. It is not a laundry list of specific activities that a CRNA may and may not perform. Instead, the CRNA must demonstrate competence to perform the new activity, be licensed within the state to perform it, comply with federal and state regulations regarding the activity, have the necessary equipment and resources to perform it, and be credentialed and have privileges to perform the procedure at the specific facility. Once that is completed, they should contact their professional liability carrier before performing the procedure to ensure that it would be covered.
According to JCAHO guidelines, which of the following occurrences are required to undergo a root causal analysis?
As part of the patient safety goals of the JCAHO guidelines, any sentinel event such as wrongful patient death, surgery on the wrong patient or wrong body part, or injury from medication errors should undergo root causal analysis to determine the point of error so that it can be corrected in the future.
In quality improvement terminology, an event that has the potential to cause patient injury if not noticed and corrected quickly is a
critical incident
Critical incidents are events that have the potential to cause patient injury if not noticed and corrected quickly. Critical incidents are much more common than adverse outcomes, making their measurement more reliable. An example would be a disconnection in an anesthesia circuit. If corrected quickly, it does not produce a problem but could have devastating consequences if it went unnoticed.
Which injury carries the highest incidence of occurrence for a patient in lithotomy position?
lower extremity neuropathy
The incidence of lower-extremity neuropathy from the lithotomy position is 151 in 10,000 patients. The incidence of permanent neurologic injury from a spinal is 4.2 per 10,000 and from an epidural, it is almost double that, at 7.6 per 10,000. Corneal abrasion has a rate of about 15 per 10,000 and ischemic optic neuropathy (ION) has an incidence of about 2.8 per 10,000 spinal surgeries.
Which component of the quality of care model does the location in which anesthesia care is provided represent?
structure
Quality of care is typically referred to as being comprised of three components: structure, process, and outcome. Structure refers to the setting in which the care is provided including the location, personnel, and facilities used. Process incorporates the sequence of activities and what was actually done. Outcome refers to the change in health status after care was delivered.
