Unit 12 - Professional Issues Flashcards
4 things that must be proven in a case of negligence
- duty
- breach of duty
- causation
- damages
difference in assualt and battery
Battery is the physical act of touching another person without either expressed or implied consent (direct physical contact)
Assault is making a person feel or perceive that battery is imminent (victim is made to “feel” a certain way in response to your actions)
Latin word that means “thing that speaks for itself”
Res Ipsa Loquitur
dictates the principles of conduct and professionl integrity that guide the decision-making and behavior of CRNAs
AANA code of ethics
authoritative statements that describe minimum rules and responsibilities for which anesthetists are held accountable
practice standards
systematically developed statements to assist providers in clinical decision-making that are commonly accepted within the anesthesia community
practice guidelines
express the AANA official positions or beliefs on practice-related topics
position statements
asserts that a provider has an obligation not to inflict hurt or harm
nonmaleficence
the patient’s ability to choose without controlling interference by others and without limitations that prevent meaningful choices
autonomy
failure of a provider to fully provide information that a reasonable person would want to know before making a decision is a violation of:
autonomy
inappropriate use of diagnostic tests with the inherent risk of false-positive or false-negative results is an example of violating which principle
nonmalificence
principle that providers should act for the benefit of others
beneficence
principle that underpins the fundamental guiding principle of evidence-based interventions
beneficence
principle that people under similar circumstances and conditions shouldbe treated alike
justice
principle that requires all patients have the same moral claim to evidence-based quality health care
justice
6 elements of informed consent
- competence
- decision-making capacity
- disclosure of information
- understanding of disclosed information
- voluntary consent
- documentation
patient has the legal authority to consent
competence
the patient has the ability to decide about specific anesthesia care
decision-making capacity
for disclosure of information, the patient is informed at minimum of the:
- nature and purpose of proposed anesthesia technique
- risks, benefits, and side effects of proposed techniques
- alternatives and their risks, benefits, and side effects
- risks of not receiving anesthesia care
assent
unless developmentally inappropriate, minor children should be included in the informed consent disucssion and agreement should be sought
what is implied consent?
permits healthcare providers to provide life-saving care when immediate treatment is required and the patient is unconscious or can’t consent
can family translate for a patient?
only in an emergency
exam used to evaluate for cognitive impairment
MMSE
Mini-Mental State Exam
informed consent and disclosure for obstetric patients receiving regional anesthesia should include:
general anesthetic - any risk with high incidence, high mortality, or adverse fetal effects
a legally binding document that delineates a patient’s wishes regarding healthcare interventions in the case of incapacity and delegates authority to make healthcare decisions to another party
advanced directive
what should be documented when an advanced directive is reconsidered before anesthesia
- date and time of conversation with patient or legal representative
- names of all parties present for 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
who does the AANA recommend to be present when discussing changes in advance directives during the informed consent process?
the patient, family, and healthcare team
are DNR orders automatically suspended during procedures in the OR?
no
when does a breach of duty occur?
when expert witnesses review the medical record and determine that the standard of care was not adhered to
examples - doing something that should not have been done, failing to do something that could have been done
generally, if the odds are greater than___% that the breach of duty lead to the injury, proximate cause can be established.
50
tests used to determine causation: but for or cause-in-fact
if the injury would not have occured but for the actions of the provider, proximate cause is established
tests used to determine causation: 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 if what 4 conditions can be established?
- if the injury wouldn’t have occurred in the absence of negligence
- the injury was caused by something under the complete control of the defendent (provider)
- the patient did not contribute in any way to the injury
- the evidence for the explanation of events is solely under the control of the provider
classic example of the use of Res Ipsa Loquitur doctrine
2nd most common situation in which it is usually granted
- foreign object like a sponge or clamp inadvertently left in a surgical patient
- nerve injury sustained during the course of the surgery to an area remote from surgical site
defamation in the verbal form
slander
what would it be called if a CRNA knowingly writes a false statement in the patient’s chart that results in the defamation of the patient’s character
libel
the physical act of touching another person without either expressed or implied consent
battery
making a person feel or perceive that battery is eminent
assault
can assault occur to unconscious patients?
no - can’t occur if the pt is unaware of their environment
placing an epidural in a laboring patient without her consent is an example of (assault/battery)
battery
if you’re preparing to place an epidural and she feels that you’re going to place it without her consent, you’ve committed (battery/assault)
assault
administering a general anesthetic to a patient who has only consented for local by the surgeon is an example of (assault/battery)
battery
does harm have to be proven when assault or battery charges are brought upon a provider?
no
general rule for statute of limitations for a minor
doesn’t begin until the minor turns 18
ex: if the statute of limitation is 3 years, a minor can file the lawsuit up to the age of 21
what are special damages in medical malpractice cases
actual damages that result from an injury
- medical expenses, lost income, property damage
abandonment
failure to provide continuity of care once duty to a patient is established
vicarious liability
a person or entity may be liable for the actions of another
general damages in medical malpractice case
directly result from injury
- ex. pain and suffering
punitive damages in medical malpractice case
punishment for reckless behavior
very rare
requires medical insurance to cover certain preventative health visits without a co-pay in order to promote the early detection of disease and prevent long-term morbidity
affordable care act
established an institute for comparative effectiveness research and authorized funding for research in pain management
affordable care act
enacted to ensure public access to emergency services regardless of ability to pay
EMTALA (emergency in medical treatment and active labor act)
act that imposes specific obligations on medicare-participating hospitals offering emergency services to provide a medical screening exam when a request is made, regardless of ability to pay
EMTALA
a lawsuit based on EMTALA is filed against the hospital or the healthcare provider?
hospital
schedule 1 controlled substance
no currently accepted medical use, high potential for abuse
ex - LSD, peyote, mescaline, heroine, etorphine, marijuana, MDMA, ecstasy
schedule 2 controlled substance
high potential for abuse potentially leading to dependence
ex: pentobarbital, cocaine, meth, methylphenidate, methadone, hydromorphone, meperidine, fentanyl, morphine, opium, oxycodone, hydrocodone, phencyclidine
class 3 controlled substance
moderate to low potential for abuse and dependence
ex: tylenol with codeine, buprenorphine, ketamine, anabolic steroids, testosterone
class 4 controlled substance
low potential for abuse and dependence
ex: xanas, valium, ativan, ambien, talwin, tramadol, chloral, phenobarbital
class 5 controlled substance
lower potential for abuse than schedule 4 or contain limited quantities of certain narcotics
ex- cough suppressants with codeine, Lomotil, pregabalin
act that was intended to create a healthcare information technology infrastructure in order to improve quality care and coordination between providers
HITECH - health information technology for economic and clinical health act
act that limits the amount a patient can be charged for copies of their PHI
HITECH
sets minimum standards for private employee benefit plans
ERISA - employment retirement income security act
a critical incident report is best recorded in what form
narrative
what 4 things should be extensively documented in a critical incident report
- what happened
- what drugs and doses were given and when they were given
- time sequence of events
- all parties present
initial response when named in a lawsuit
notify insurance carrier immediately
what are the initial actions you should take if you’re named in a lawsuit?
- notify your insurance carrier
- do not discuss the case
- do not alter any records
- gather all records of the case
- make notes
- cooperate with your attorney
top 4 causes of anesthesia related lawsuits
- death
- nerve damage
- permanent brain damage
- awareness
