Professional Issues Flashcards
Malpractice insurance role ?
is to cover costs that are associated with obtaining legal defense when a practitioner is being sued.
There are 2 types of malpractice insurance policies:
Occurrence policies
Claims-Made policies
Claims-made policies coverage explanation:
provide coverage only during the time that the insured is paying the premium.
Occurrence policies cover the insured for
all the potential claims made at any time during the policy period, even if the insured no longer work at the same place, or have changed insurance policies or has retired.
As far as the CRNA goes what is essential?
It is essential to obtain a tail policy for a minimum order number of years (5 usually) after a claims-made policy has ended.
What is an umbrella policy?
Obtained in addition to the tail policy. Useful if damages or settlement exceeds the limits of the original policy damages.
What kind of policy requires a tail coverage?
Claims-based policies
Tail policy protect
the insured for a PREDETERMINED PERIOD OF TIME after the policy has ended.
Which principle asserts that a provider has an obligation not to inflict hurt or harm
Nonmaleficence
Hippocratic oath primum non nocere meaning?
First do no harm
T/F There is no distinction between intentional or unintentional harm.
True
The use of unnecessary preoperative testing can put the provider in violation of the principle of
nonmaleficence.
Principles that govern human conduct as it relates to morality, right and wrong, or good and evil.
Ethics
Comprise the set of moral principles, beliefs, and values that guide how choices are made in health care.
Health care ethics
Commonly accepted principles of health care ethics include:
Respect for autonomy
Nonmaleficence
Beneficence
Justice
Refers to the patient’s ability to choose without controlling interference by others, and without limitations that prevent meaningful choices.
Autonomy
Might include failure of the provider to fully provide information that a reasonable person would want to know prior to making a decision during the informed consent process.
Autonomy
Respect for autonomy means that providers must
respect and abide by decisions made by competent patients.
Respect for autonomy dictates that providers make every effort to
remove barriers that may impede an informed decision.
Principle asserts that a provider has an obligation not to inflict hurt or harm—in other words, the Hippocratic oath primum non nocere (first do no harm).
Non-maleficence
This principle is often applied to the appropriate use of diagnostic testing with the inherent risk of false-positive or false-negative results.
Non-maleficence
For example, the use of pre-operative HIV testing has serious social costs and adds little or nothing to the anesthesia care plan or expected surgical outcome.
Non-maleficence
In another example, requiring a pregnancy test in every female of child bearing age is not justified by evidence-based research, and violates patient _____in the absence of consent.
autonomy
Some diagnostic testing has inherent medical risks (eg. coronary artery perforation during angiography), along with carrying a significant financial cost. The use of unnecessary preoperative testing can put the provider in violation of the principle of
nonmaleficence.
What is the principle that providers should take action for the benefit of others.
Beneficence
What are all the principles that support the position that medical mistakes must be disclosed to the patient.
Respect for autonomy
Nonmaleficence
Beneficence
Failure of which system when a nursel say “ he is a CEO of the hospital the next patient” that this information will engender a higher quality of delivered care.
failure in justice
Requires that all patients have the same moral claim to evidence-based quality health care.
The principle of justice
This includes both preventing harm and actively helping their patients.
Beneficence
Which principle underpins to the fundamental guiding principle of evidence-based interventions?
Beneficence
The benefits of the treatment should be demonstrable and must clearly outweigh the risks.
Beneficence
The principle that people under similar circumstances and conditions should be treated alike (also known as distributive justice).
Justice
Patients, despite differences in sex, age, race, ethnicity, education, sexual orientation, disability, geographic location, or socioeconomic status, should be treated fairly and equitably.
Justice
Informed consent conversations should include a discussion of
all available and appropriate anesthetic choices for both the particular surgery/procedure and relevant comorbidities.
It is recommended that the anesthesia consent process and paperwork should be
separate and apart from the surgical consent process; further,
The only appropriate person to conduct the anesthesia informed consent is the
anesthesia provider.
The preoperative consent process should allow for open sharing of information regarding
anesthetic care and focused on the patient’s concerns, needs, and question
What are the 6 elements of informed consent?
Competence Decision-making capacity Disclosure of information Understanding of disclosed information Voluntary consent Documentation
Why should you tell the patient your choice of anesthetic instead of theirs?
May be considered coercion, and puts the anesthetist at risk of litigation. Check your state law and institutional policy to determine whether the anesthesia informed consent must be signed by a witness and/or a translator if one is used.
Patient under age 18
Under most circumstances, parents or legal guardians are the competent party to consent.
Unless developmentally inappropriate, minor children should be included in the informed consent discussion and their agreement should be sought. This is termed
“assent” and should be documented.
In an emergency, when immediate treatment is required and the patient is unconscious or unable to consent, what law permits health care providers to provide lifesaving care.
“implied consent”.The emergency status must be documented in the medical record and informed consent should be sought from legal decision makers, or close family members, as soon as possible.
Informed Refusal states what? Give examples?
A patient has a right to refuse medical treatment or therapy. A common example is the refusal of blood or blood products by a Jehovah’s Witness. When a recommended therapy is refused, it places an even higher burden on the health care provider to disclose the risks and benefits of both the recommended and any alternative care.
In an elective case, a provider has no ethical obligation to provide inappropriate care, or care that is associated with
unreasonably high risks. Informed refusal should be documented as meticulously and carefully as informed consent.
When anesthesia providers are involved in the prenatal education process, the stresses of late term pregnancy are not yet influencing the learning and decision-making process. In addition, this provides
ample opportunity for patient and family questions about labor analgesia techniques and/or possible urgent and emergency situations.
For OB patients, written materials are recommended but do not replace the
requisite face-to-face discussion about the anesthesia plan of care.
OB patients Informed consent
Informed consent discussions should optimally occur prior to the onset of labor
Should be consulted when a minor is receiving obstetrical services.
State law and facility policies
May occur if a parturient refuses emergency care as a result of fetal distress.
Ethical conflict
In a case of maternal-fetal conflict, the provider’s respect for maternal autonomy may oppose what principle? What should the anesthetist do?T
principle of beneficence in promoting the well-being of the mother and the fetus. The anesthesia provider should keep communication open and non-coercive whilst procuring an ethics consultation, referencing hospital policy, and reviewing state law.
DNR and advance directive –>
ABecause many of these measures, when used in conjunction with a procedure/surgery, are temporary, it is recommended that advance directives be reconsidered before anesthesia is administered.
The AANA recommends that the patient, family, and health care team discuss reconsideration of advance directives during the informed consent process. s insufficient to simply tell the patient that institutional policy dictates how to proceed. In fact, policy language that dictates automatic suspension of advance directives during anesthesia or procedures should be rewritten with a more patient-centered approach.
An advance directive is a legally binding document that
delineates the patient’s wishes regarding healthcare interventions in the case of incapacity and/or delegates the authority to make healthcare decisions to another party.
Advance directives often include specific provisions that modify
aspects of anesthesia management including intubation, use of antibiotics, blood transfusion, and/or the use of CPR and advanced life support measures.
Just as informed consent must be documented, the reconsideration of advance directives discussion must also be documented:
Date and time of conversation with patient or legal representative.
Names of all parties present for the discussion.
Specific interventions to be modified or withheld including CPR, antibiotic use, intubation, and mechanical ventilation.
Specific duration of time for suspension or modification of directive.
Identify the standards of care that have been published by the American Association of Nurse Anesthetists.
Wellness
Infection Control and Prevention
Transfer of Care
The term malpractice refers to
any sort of professional misconduct. However, it is most frequently used in the setting of professional negligence, a subset of tort law.
In a negligence or malpractice claim, the patient (plaintiff) must prove 4 separate things:
- Duty
- Breach of Duty
- Causation
- Damage
- Duty -
the anesthesia provider had a duty to the patient
- Breach of duty -
the provider failed to fulfill their duty
- Causation -
a close causal relationship existed between the provider’s acts and the patient’s injury
