Safety Unit 1 Flashcards
Focuses on noncompliance, informed consent, right to refuse tx
Risk mgt
Identifies, evaluates, develops plan for potential risks
Risk mgt
Planned program of loss prevention & liability control
Risk mgt
Evaluates & improves d process
Team, headed by team leader
Provides for process and mgt health care team
Coordinator
Establishes policy
Senior mgt
Process: Senior mgt, Coordinator, Team leader
Continuous quality improvement
Managed by team of 5-10 people
Continuous quality improvement
Involves organized incident reporting
Continuous quality improvement
Prevention focused approach
Continuous quality improvement
Aka Care Maps
Managed Care
Critical pathways used as foundation of activities and guide services
Managed care
Emphasizes costs
Managed care
Uses interdisciplinary approach
Managed care
Goal is to reduced healthcare cost
Managed care
Be cautious to give info on d phone(hard to ID caller)
Privacy
Focuses on client outcomes
Managed care
Duty to warn of threatned suicide or harm others
Tarasoff Act
Limit the liability of professionals in emergency situations
Good Samaritan Laws
Define “reasonable care” in each state
Nurse practice acts
Nurse is responsible for using reasonable care in practicing nursing
Accountability
Rules of conduct established and enforced by authority
Laws
Intentional touching w/o consent
Battery
Intentional threat to cause harm
Assault
Release of info to an unathorized persons w/o clients consent
Invasion of privacy
4 Required Elements of Malpractice
Duty
Breach of duty
Causation
Injury
Professional negligence
Malpractice
Unintentional failure of individual
Negligence
Provides info abt needs & options so that clients can mke informed decisions
Advocacy
Safeguard clients autonomy and independence
Advocacy
Communicate clients needs to interdisciplinary teams
Advocacy
Defend clients in decisons affecting them
Advocacy
Actively supports clients rights
Advocacy
Cannot order restraints to be used as?
PRN
Requireed specifying duration & circumstances under restraints should be used
Physician’s order
Restraint of pt w/o informed consent or sufficient justification
False imprisonment
Is needed to use in restraints
Informed consent
Inaappropriate use causes deep sedation, agitation, combativeness
Chemical restraints
Can be used only for diagnoses-related condition
Chemical restraints
Cannot be used to control behavior
Psychotropic drugs
Provides pt w/ the right to be free from physical & chemical restraints imposed for the purpose of discipline or convenience and not required to treat medical symptoms
Omnibus Reconcillation Act
8 Bill of Rights
Privacy Respectful care Current information Informed consent Confidentiality Refusal of tx Reasonable response to a request for services Right to know hosp/clinic regulations
Permits pt to appoint surrogate or proxy in the event that pt becomes incompetent
Durable power of attorney
Indicates who is authorized to make health care decisons if indi becomes incapacitated
Living wills
Legal document signed by competent individual incase pt ability to make decisions is lost
Living wills
May be witheld to avoid prolonging life w/o dignity
Aggressive tx
Extraordinary measures used to maintains individuals physiologic process
Aggressive tx
Federeal law abt written info abt d rights of clients to make decisions
Self determination act
2 Advanced Directives
Living wills
Durable power of attorney
3 Refusal of Treatment
Self determination act
Agressive tx
Advance directives
Not released to others w/o permission
Confidentiality
Info is used only for purpose of diagnosis & tx
Confidentiality
Right to privacy of records
Confidentiality
When nurse witness a signature it means
It means that theres a reason to believe that client is informed of incoming tx
Legal responsibility of informed consent Rest To Who
Rest With individual who Will Perform treatment
Informed consent includes (6)
Explanation of tx and expected results Anticipated risks andnp discomforts Potential benefits Possible alternatives Answers to questions Statements that consent can be withdrawn anytime
Cannot give own consent unless she fits to one of other exemptions
Mother
Who retains the right to provide consent for infant
Mother
Can sign consent for themselves and fetus
Pregnant minor
6 minors who can provide own consent for tx
Married
Over specific age for STD, HIV, AIDS or drug/alcohol tx
Emancipated and mature minors
Minors seeking birth control services
Minors seeking in/outpatient psych services
Pregnant minor
Info must be given in understandable form
Lay terminology
Freedom of choice w/o force, fraud, deceit, duress, coercion
Voluntary
Can make choices or understand consequences
Capacity
4 Informed consent requirements
Capacity
Voluntary
Info must be understandable
Cant sign if drunk or premedicated
For employees, can only verify employment & comply w/legal investigation
Privacy
Necessary to obtain pt permission to release info to familyorfriends
Privacy
Healthcare team cannot use data w/o permission frm client
Privacy
People involved in diagnosis and tx related to pt
Authorized personnel
Violated when info revealed to unathorized persons
Privacy
Right to have info kept confidential
Privacy
Right to make personal choices w/o interference
Privacy
Right to be left alone
Privacy
Nurse or client cannot be forced to reveal info between themselves
Protected relationship
6 Ethical Standards
Respect for human dignity Confidentiality Competence Advocacy Research Promotion of public health
Commited to local and global goals
Promotion of public health
Participates in process of scientific inquiry
Research
Protects clients from incompetent or unethical practice
Advocacy
Has knowledge and skills to provide care
Competency
Does not discuss condition with anyone not invoved with care
Confidentiality
Give respectful service regardless of clients personality
Respect for human dignity
Adheres to standards of practice
Autonomy and accountability
Foundation of nursing science
Specific knowledge and skills
Problem focused
Risk mgt
Consists of clinical experts: nursing, medicine, physical therapy, social work
Collaborative practice team
Determines expected outcomes
Collaborative practice team
Determines appropriate interventions with a specified time frame
Collaborative practice team
Involves specific patient diagnoses that are hig-volume (frequently seen), high-cost, high-risk (frequently develop complications)
Collaborative practice team
Reduce complications
Critical pathways
Reduce cost
Critical pathways
Increase collaboration
Critical pathways
Improve quality of care
Critical pathways
Provide direction for care
Critical pathways
Orient staff to expected outcomes for each day
Critical pathways
Alteration in time frame or interventions is
Variance
All variances are tracked to note ?
Trends
Change in established plan that include more, different, or fewer services to client to achieve desired outcome
Variance
Deviations from specific plans
Variance
Is included in a database and is used to evaluate services provided
Variances
Are used to monitor variances
CQI strategies
Usually has advanced degree and considerable experience
Case Manager
Doesn’t provide direct patient care
Case manager
Supervises care provided by licensed and unlicensed personnel
Case manager
Coordinates, communicates, collaborates, solve problems
Case manager
Facilities client care for a group of patient (10-15)
Case manager
Follows client through the system from admission to discharge
Case manager
Notes variances from expected outcomes
Case manager
Identifies, coordiantes, monitors implementation of services needed to achieve desired outcomes within specified period of time
Case management
Involves principle of CQI
Case management
Promotes professional practice
Case management
Allocating to health care team members work required to care for groups of individuals
Assignment
Responsibility and authority for performing a task (function, activity, decision) is transferred to another individual who accepts that responsibility and authority
Delegation
Remains accountable for task
Delegator
Is accountable to delegator for responsibilities assumed
Delegatee
Can only delegate tasks for which the nurse is responsible
Delegation
Obligation to accomplish a task
Responsibility
Accept ownership for results or lack of results
Accountability
Responsibility is transferred
Delegation
Responsibility is shared
Accountability
(6) Don’t delegate
Total control Discipline issues Confidential tasks Technical tasks Controversial task During a crisis
Assist with implementation of defined plan of care
LVN
Perform procedures according to protocol
LVN
Differentiate normal from abnormal
LVN
Care for physiologically stable patients with predictable outcome
LVN
Has knowledge of asepsis and dressing changes
LVN
Ability to administer medications varies with educational background and state nurse practice act
LVN
Assists with direct patient care activities
UAPs
Includes nurses aides, assistants, technicians, orderlies, nurse extenders
UAPs
Scope of nursing practice is limited
UAPs
Designed to promote smooth functioning within a large and complex organization
Organizational hierarchy
Emphasis on vertical relationships
Chain of command
Involves creativity, problem solving, decision-making
Critical thinking
Purposeful and goal oriented; nurse identifies and selects options and alternatives
Decision making
4 types of decision making
Prespective
Behavioral
Sayisficing
Optimizing
Involves routine decisions with objective information
Prescriptive decision making
Options are known and predictable
Pescriptive decision making
Decisions are made according to standard procedures or analytical tools
Pscriptive decison making
Involves nonroutine and unstructured information
Behavioral decision making
Options are unknown and unpredictable
Behavioral decision making
Decisons made by obtaining more data, usingpast experiences, using creative approach
Behavioral decision making
Solution minimally meets objectives
Satisficing decision making
Expedient; use when time is an issue
Satisficing decision making
Goal is toselect ideal solution
Optimizing decision making
Best decision comes from this process but is the most time consuming
Optimizing decision making
Focus is trying to solve immediate problems; includes decision making
Problem solving
3 Methods of Problem Solving
Trial and error
Experimentation
Purposeful inaction
Repeated attempts at different solutions until it is identified that one solution works best
Trial and error
Used by inexpereinced staff
Trial and error
Study problem using trial periods or pilot projects to determine best outcome
Experimentation
Will have greater probability of achieving best outcome if sufficient time devoted to the process
Experimentation
Do nothing approach
Purposeful inaction
Use when problem is judged to be insignificant or outside a person’s control
Purposeful inaction
Gives an individual what he /she deserves regardless of race, color, creed, gender, or socioeconomic status
Distribution of justice
Provides equal access to care for all
Distribution of justice
Designed to manage health care according to need rather than provide care for everyone
Distribution of justice
Primary principle is to provide the greatest good for the greatest number of people
Allocation of resources
Decision about how limited resources will be used
Rationing
Judiciously use resources to achieve identified client goals
Nursing management
Guide nursing activities
Standard of sre and practice
Used to evaluate quality of care
Standard of care and practice
Determine the facts
Resolution of conflict
Promotes communication
Documentation
Maintains a legal record
Documentation
Meets requirements of regulatory agencies
Documentation
Reqired for third party reimbursement
Documentation
Statement of fact and patient’s physical response
Incident reports
Accurate and comprehensive report on any unexpected or unplanned occurence that affects or could potentially affect the client, family member, or staff person
Incident reports
Regularly scheduled, structured exchange of information
Change of shift report
Group of individuals’ values and beliefs that strongly influence individual’s actions and behaviors
Cultural norms
Personal preferences, commitments, motivations, patterns of using resources, objects, people, or events that have special meaning and influence individual’s choices, behaviors, actions
Values
Basic assumptions or personal convictions that the individual thinks are factual or takes for granted
Beliefs
Used to determine values
Beliefs
Include cultural traditions
Beliefs
Principles of right and wrong, good and bad
Ethics
Decision-making framework for solving ethical problems
ANA Code of Ethics
Support of client’s independence to make decisions and take action for themselves
Autonomy
Duty to help others by doing what is best for them; for refusal of care, autonomy overrides beneficence
Beneficence
” do no harm”; act with empathy toward patient and staff without resentment or malice
Nonmaleficence
Violated by acts performed in bad faith or with ill will, or when making false accusations about patient or employee
Nonmaleficence
Use available resources fairly and reasonably
Justice
Communicate truthfully and accurately
Veracity
Safeguard the client’s privacy
Confidentiality
Following through on what the nurse says will be done
Fidelity
7 Ethical principles of nursing
Autonomy Beneficence Nonmaleficence Justice Veracity Confidentiality Fidelity
Process of learning
Patient education
Begins with first encounter
Discharge planning
