professional issues Flashcards
AANA code of ethics
holds crna accountable to his or her own actions or judgements regardless of institutional policy or physician orders
-no participation in fraudulent business practices
-responsbility to society
-speaks to endorsement of products and services
-research integrity
position statements
express AANA official decisions
also define knowledge, skills, and abilities considered necessary for a crna
nonmalfescience
do no harm (intentional or unintentional)
primus non nocere
ex) why get a random HIV test before surgery and make the patient pay all this $$ for no reason
4 principles of healthcare ethics
respect for autonomy
beneficence
nonmalfescence
justice
benefiscence
evidence based- tx should outweigh risks
justice
patients, despite background, should be treated fairly and equitably
informed consent for anesthesia should include which of the following topics?
1. description of the recommended type of anesthetic
2. agreement to undergo scheduled procedure
3. risks and benefits of each type of appropriate anesthetic
4. patient preferences, questions, and fears
3, 4
6 elements of informed consent and what they mean
persons who require special assistance and what to do
which standard of care addresses advanced directive
standard 4 informed consent and related anesthesia services
informed consent discussion that reconsiders advanced directives should clearly
- define which interventions are supportive v resuscitative
- ID specific interventions the patient wants or does not want
- ID specific circumstances in which interventions would be applied or witheld
- define specific circumstance or time in which advance directive is modified or suspended
- define what circumstances, if any, trigger immediate reinstatement of directive
- involve minors of appropriate developmental age in discussion. parents or guardians of minors should be immediately avail during periop time period including intra op
how to document advanced directives conversation
- date and time of convo with parent or legal representative
- name of all parties present for discussion
- specific interventions modified or withheld including mechanical ventilation, CPR, abx, intubation
- specific duration of time for suspension or modification of directive
in a negligence or malpractice claim, the patient (plaintiff) has to prove 4 separate things
- duty: anesthesia provider had a duty to the patient
- breach of duty: anesthesia provider failed to fulfill their duty
- causation: close causal relationship between providers acts and patients injury
- damages: actual damage was result of breach of care
tests used to determine causation include
but for cause in fact: injury would not have occurred but for the actions of the provider, proximate cause is established
substantial factor: if the act of the provider was a substantial factor in the injury despite other causes, proximate cause is established
res ipsa loquitur
can shift the burden of proof from the plaintiff to the defendant and can happen in these 4 circumstances
1. if the injury would not have occurred in the absence of negligence
2. injury was caused by something under the complete control of the provider (defendant)
3. patient did not contribute in any way to the injury
4. evidence for explanation of events is solely under the control of the provider
ex) something left in patient or nerve injury really far from surgical site
slander
defamation in verbal form. crna says false things that defamate patients character
ex) telling everyone she’s crazy when she doesn’t have a dsm dx for it lol
libel
defamation in written form. crna knowingly writes false statement in patients chart that is a defamation of character
a crna is relieved by another anesthesia provider 4 hours into case. she forgets to let the incoming crna know about the repeat abx dose and the patient develops sepsis and has to go to the icu because they didnt get the repeat dose. which of the following is true and which standard is this
1. loss of chance of survival
2. malpractice violation of AANA standards of care
3. abandonment
4. vicarious liability for relieving crna
standard 11: accurate reporting of patients condition
2,3
abandonment because transfer of care is incomplete
battery
physical act of touching another person without expressed or implied consent. key idea is that theres direct physical contact
assault
making the person feel or perceive that battery is imminent
define abandonment
obligation to provide continuity of care
ex) detailed hand offs to a qualified provider
define loss of chance of recovery or survival
patient must show that recovery or survival was likely but for the actions of the anesthetist
ex) missed or late dx of a curable cancer
wrongful death
death that occurred earlier than it would otherwise. if caused by negligence, survivors can sue
vicarious liability
one person (or entity) may be liable for the actions of another.
respondent superior (let the master answer) is used inter changeably
ex) hospital held liable for actions of RN, physician held liable for actions of PA. typically does not apply to CRNA’s working under physician
classification of damages (3)
what the affordable care act (ACA) accomplished
- required all individuals to carry health insurance
- launched health care exchanges to help people find medical insurance
- prevented insurance carriers from denying coverage or charging higher premiums to patients with pre existing conditions
- established new standards and requirements for health insurance policies
emergency in medical tx and active labor act (EMTALA)
access to emergency services regardless of ability to pay
lawsuit is usually against hospital, not provider. in the case of missed dx, remedy must be pursued as malpractice in state court
schedule 1-5 drugs, definition, examples
is propofol a scheduled drug
no
health information technology for economic and clinical health act (HITECH)
improve quality care and coordination between providers
-willful neglect like stage storage of unencrypted PHI
employment retirement income security act (ERISA)
minimum standards for private employee benefit plans, including health care benefits offered, and provider protections for persons in these plans
the critical incidence report should include
what happened
what drugs and doses were given and why
time sequence of events
who was present (all parties not just anesthesia)
if no dx was obvious, document differential dx
list causes of anesthesia law suits from most to least common
- death
- nerve damage
- permanent brain damage
- awareness
among the 40% of deaths made for death or permanent brain damage, what are they usually related to
airway management issues:
1. inadequate ventilation (hypoxia, hypercarbia, or both)
2. esophageal intubation
3. difficult intubation
likelihood of transfusion being high in a child who is a jehovahs witness
obtain a court order for transfusion before the surgery. if its elective, just wait until the kid is old enough to participate in the decision without his parents.
biggest component of crisis resource management that should be practiced
communication
counter measures for fatigue
OSHA limit for noise in an 8 hour span
90dB
single noise levels should not exceed
115dB
is substance use DO curable
no but recovery can occur
risk factors for developing substance use DO
ID major goals for the institute for healthcare improvement triple aims broad conceptual approach to improving health outcomes
improve patient experience
improve population health
reduce per capita costs
NIM has 6 domains of high quality health care
- patient centered
- safe
- effective
- timely
- efficient
- equitable
patient centered care is based on 4 concepts
- dignity and respect
2., information sharing - participation
- collaboration
example of medical malpractice: difficult intubation
writing in chart “no issues during intubation” after difficult intubation. aka writing false statement in chart
second victim and third victim after negative event occurs
second: anesthesia provider
third: rest of patients
