Quality, Safety, and Ethics

Question 1

True or false: A surrogate can change a patient’s advanced directive after the patient becomes incapable of making medical decisions, based on the surrogate’s own preference.

Answer 1

False

Question 2

This is the collaborative process among phsyicians, patients, and surrogates that discuss end-of-life (EOL) care and decisions.

Answer 2

Shared decision making

Question 3

3 steps in shared decision making?

Answer 3

Information exchange
Deliberation
Decision

Question 4

Are withholding and withdrawing life support considered equivalent in the US?

Answer 4

Yes

Question 5

Is euthanasia and allowing death to occur considered equivalent?

Answer 5

No

Question 6

This is when there is rationale for providing relief of pain and other symptoms even when this may have the forseen (but unintended) consequence of hastening death. Eg: administering opiates before terminal extubation.

Answer 6

Doctrine of “double effect”

Question 7

When are treatments considered “futile”?

Answer 7

When there is no beneficial physiologic benefit

Question 8

What distinguishes inappropriate/inadvisable treatment from futile treatments?

Answer 8

Treatments which unlikely benefit, beneficial effect with extreme cost and uncertain or controversial benefit are considered inappropriate and inadvisable but not futile

Question 9

True or false: If a patient is paralyzed, you should reverse the muscle relaxant prior to starting withdrawal of life- sustaining treatments.

Answer 9

True; you always want to be able to assess pain and discomfort

Question 10

True or false: Food and fluids can be withheld legally and ethically and withdrawn if congruent with a patient’s goals of care.

Answer 10

True

Question 11

True or false: Advance directives are not portable—they are valid only in the state where they were written.

Answer 11

True

Question 12

What does the Uniform Determination fo Death Act state about brain death?

Answer 12

If a pt meets neurologic criteria of breath death as defined by loss of the functional activity of the brain stem and cerebral cortex, the pt is legally deemed dead.

Question 13

This is the principle that a patient has the right to make an informed and uncoerced decision on medical treatment

Answer 13

Autonomy

Question 14

What are the 4 things that need to be disclosed in informed consent?

Answer 14

Diagnosis
Nature and purpose of treatment
Risk of treatment
Treatment alternatives

Question 15

This is the principle to “do no harm” in treatment of patients.

Answer 15

Nonmaleficence

Question 16

This is the principle of actions that promote the well-being of others.

Answer 16

Beneficence

Question 17

This is the principle that refers to the fair distribution of limited health resources

Answer 17

Justice

Question 18

This is the scientific discipline that focuses on the structures, processes, and outcomes of health care delivery

Answer 18

Quality improvement

Question 19

True or false: Physicians are not obligated to continue providing mechanical ventilatory support after brain death.

Answer 19

True

Question 20

Obtaining informed consent prior to a procedure is respecting which of the four basic principles of medical ethics?

Answer 20

Autonomy

Question 21

What is The Belmont Report?

Answer 21

A statement created by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research that summarizes basic ethical principles and guidelines for research involving human subjects; three core principles identified are respect for persons, beneficence, and justice.

Question 22

This is the safe, timely, effective, eifficient, equitable and patient centered care that has the components of structure, process, and outcome

Answer 22

Quality health care

Question 23

The integration of what device can significantly lower frequency of errors, which improves outcomes, patient safety, and efficacy of resource utilization

Answer 23

Checklists

Question 24

There was a lot of common sense stuff in this chapter, such as

Answer 24

Residents working a lot sucks
Have good patient:physican
Attendings are ultimately responsible for everything
Dont be an alcoholic