Law, Documentation & Law, Documentation & EthicsEthics

RTEC 93RTEC 93

Veinpuncture and Veinpuncture and Pharmacology for Radiologic Pharmacology for Radiologic

TechnologistsTechnologists

ASRTASRT Includes venipuncture and IV Includes venipuncture and IV

medication administration in medication administration in the curriculum guidelines for the curriculum guidelines for the educational opportunities the educational opportunities offered to technologists.offered to technologists.

Standards of Practice for Standards of Practice for RadiographyRadiography

American College of Radiology American College of Radiology (ACR)(ACR)

Additional support for the Additional support for the administration of administration of medications and medications and venipuncture as part of the venipuncture as part of the technologist’s scope of technologist’s scope of practice if found in the practice if found in the 1987 Resolution No. 271987 Resolution No. 27

Veinpuncture LawsVeinpuncture Laws

CALIFORNIA HEALTH AND CALIFORNIA HEALTH AND SAFETY CODESAFETY CODE

HEALTH AND SAFETY HEALTH AND SAFETY CODE SECTION 106955-CODE SECTION 106955-107111107111

Hospital Policies for Hospital Policies for Radiologic TechnologistsRadiologic Technologists

Competency in venipuncture Competency in venipuncture and IV contrast and IV contrast administration requires the administration requires the completion of a formal completion of a formal course of instruction and course of instruction and supervised clinical practice supervised clinical practice and evaluationand evaluation

Standard of CareStandard of Care

Degree of skill (proficiency), Degree of skill (proficiency), knowledge, and care ordinarily knowledge, and care ordinarily possessed & employed by members possessed & employed by members in good standing within a profession.in good standing within a profession.

To test whether the standard of care To test whether the standard of care has been met, one must determine has been met, one must determine what a reasonable, prudent what a reasonable, prudent practitioner would have done under practitioner would have done under similar circumstances.similar circumstances.

Causes of Legal ActionCauses of Legal Action

Approx 10% of all medical Approx 10% of all medical negligencenegligence claims are somehow related to claims are somehow related to diagnostic imaging.diagnostic imaging.

Medical NegligenceMedical Negligence – failure to use – failure to use such care as a reasonably prudent such care as a reasonably prudent health care professional would use in health care professional would use in similar circumstances.similar circumstances.

Four Elements to Prove Four Elements to Prove NegligenceNegligence

1.1. Must establish a duty to the patient Must establish a duty to the patient by the health care providerby the health care provider

2.2. Breach of this duty by an act or by Breach of this duty by an act or by failing to perform some act.failing to perform some act.

3.3. A compensable injuryA compensable injury

4.4. A causal relation between the injury A causal relation between the injury and the breach of duty.and the breach of duty.

Cause of Legal ActionCause of Legal Action

TortTort – Civil wrong committed by one – Civil wrong committed by one individual against another. May be individual against another. May be classified as either intentional or classified as either intentional or unintentional. This type of claim arises unintentional. This type of claim arises from a breach of duty. from a breach of duty. ex: less than ex: less than optimal care, threatened, or injured in optimal care, threatened, or injured in departmentdepartment

Usually based upon legitimate concerns Usually based upon legitimate concerns of negligent care or claims of assault, of negligent care or claims of assault, battery, or false imprisonment.battery, or false imprisonment.

Cause of Legal ActionCause of Legal Action

AssaultAssault – Any willful attempt or threat to – Any willful attempt or threat to inflict injury on the person and any inflict injury on the person and any intentional display of force that would intentional display of force that would give the victim reason to fear or expect give the victim reason to fear or expect immediate bodily harm.immediate bodily harm.

BatteryBattery – An unlawful touching of another – An unlawful touching of another that is without justification or excuse. that is without justification or excuse. Ex: Ex: a technologist performs an exam or touches a a technologist performs an exam or touches a patient without that patient’s permission, even patient without that patient’s permission, even if no injury arises from such contact.if no injury arises from such contact.

Cause of Legal ActionCause of Legal Action

False ImprisonmentFalse Imprisonment – Conscious – Conscious restraint of another without proper restraint of another without proper authorization, privilege, or consent. authorization, privilege, or consent. The The more common claim of false imprisonment more common claim of false imprisonment arises when a person is restrained against his arises when a person is restrained against his or her will.or her will.

DefamationDefamation – Holding up a person to – Holding up a person to ridicule, scorn, or contempt in a ridicule, scorn, or contempt in a respectable & considerable part respectable & considerable part

of the community.of the community.

Corporate LiabilityCorporate Liability

Requires the hospital or health care Requires the hospital or health care entity to be responsible for the quality entity to be responsible for the quality of care delivered to consumers.of care delivered to consumers.

Health care corp. must assess & Health care corp. must assess & evaluate the quality of care delivered evaluate the quality of care delivered & must be prepared to make changes & must be prepared to make changes as needed.as needed.

The corp. may be required to intervene The corp. may be required to intervene if suboptimal care is being provided by if suboptimal care is being provided by one of its independent contractors.one of its independent contractors.

Informed ConsentInformed Consent

A person’s agreement to allow something A person’s agreement to allow something to happen (i.e surgery) that is based on to happen (i.e surgery) that is based on full disclosure of the facts: knowledge of full disclosure of the facts: knowledge of benefits, risks, and alternatives to the benefits, risks, and alternatives to the procedure.procedure.

RequiredRequired when a patient is subjected to when a patient is subjected to any type of invasive procedure.any type of invasive procedure.

If the pt consents to a procedure & then If the pt consents to a procedure & then revokes the consent, the doctor must revokes the consent, the doctor must stop the procedure.stop the procedure.

The LawThe LawEvery human being of adult years and Every human being of adult years and

sound mind has a right to determine sound mind has a right to determine what shall be done with his own body what shall be done with his own body and a surgeon who performs an and a surgeon who performs an operation without his patient’s operation without his patient’s consent commits an assault, for consent commits an assault, for which he is liable in damages.which he is liable in damages.

Six functions of this LawSix functions of this Law

1.1. Protects individual autonomyProtects individual autonomy2.2. Protects the patient’s status as a Protects the patient’s status as a

human beinghuman being3.3. Avoids fraud and duressAvoids fraud and duress4.4. Encourages health care practitioners Encourages health care practitioners

to carefully consider their decisionsto carefully consider their decisions5.5. Fosters rational decision making by Fosters rational decision making by

the patient, andthe patient, and6.6. Involves the public in medicineInvolves the public in medicine

The Health Record in CourtThe Health Record in Court

The radiograph as evidenceThe radiograph as evidence Dark/light radiographDark/light radiograph Mis-marked filmsMis-marked films Wrong patient informationWrong patient information

DocumentationDocumentation

In court, if you testify that you In court, if you testify that you properly assessed the patients properly assessed the patients medical risk and obtained consent medical risk and obtained consent from the patient from the patient verballyverbally prior to the prior to the examination; will that serve as examination; will that serve as meeting the Technologist Standard meeting the Technologist Standard of Practice? of Practice?

DocumentationDocumentation

Federal requirements and the JCAHO Federal requirements and the JCAHO (Joint Commission on Accreditation of (Joint Commission on Accreditation of Healthcare Organizations) require Healthcare Organizations) require that the medical staff of an that the medical staff of an institution have bylaws, rules and institution have bylaws, rules and regulations that include a provision regulations that include a provision for accurate and complete medical for accurate and complete medical records with the original copies of records with the original copies of documents in the patient record.documents in the patient record.

The record is a means of The record is a means of communication between the communication between the healthcare professionals who are healthcare professionals who are treating the patient.treating the patient.

Must Include:Must Include:

Patient identification datePatient identification date Medical history of the patient, including Medical history of the patient, including

chief complaint; present illness or injury; chief complaint; present illness or injury; relevant past, family and social histories; relevant past, family and social histories; and inventory by body systemsand inventory by body systems

Report of relevant physical examinationReport of relevant physical examination Diagnostic and therapeutic ordersDiagnostic and therapeutic orders Clinical observations, including results of Clinical observations, including results of

therapytherapy

Reports of diagnostic and therapeutic Reports of diagnostic and therapeutic procedures and test as well as their procedures and test as well as their resultsresults

Evidence of appropriate informed Evidence of appropriate informed consent (when consent is not obtainable, consent (when consent is not obtainable, the reason should be entered in the the reason should be entered in the record)record)

Conclusions at termination of Conclusions at termination of hospitalization or evaluation of hospitalization or evaluation of treatment, including any pertinent treatment, including any pertinent instructions for follow-up careinstructions for follow-up care

Charting Drug InformationCharting Drug Information

Any time a drug is administered to Any time a drug is administered to an inpatient it must be chartedan inpatient it must be charted

Information includes: Information includes: Drug nameDrug name Dose of the drugDose of the drug

Route of administration (if parenterally, Route of administration (if parenterally, then the side of injection)then the side of injection)

Date & TimeDate & Time

DocumentationDocumentation

The five rights of medication The five rights of medication administration is to be included in every administration is to be included in every patient’s permanent medical record. patient’s permanent medical record.

The size, type and location of the The size, type and location of the needle, number of venipuncture needle, number of venipuncture attempts; and the identity of the health attempts; and the identity of the health care personnel who performed the care personnel who performed the procedure. procedure.

Document Meds GivenDocument Meds Given

5 rights of medication 5 rights of medication administration:administration:

1.1. The right patientThe right patient

2.2. The right medicationThe right medication

3.3. The right routeThe right route

4.4. The right amountThe right amount

5.5. The right timeThe right time

ExampleExample

4-25-2007 at 0900 a venous access of 4-25-2007 at 0900 a venous access of Mr. Jones was performed using an 20-Mr. Jones was performed using an 20-gauge antiocatheter. The access was gauge antiocatheter. The access was established in the antecubital of the left established in the antecubital of the left arm after one attempt. Then 100 ml of arm after one attempt. Then 100 ml of Isovue 300 was administered by IV Isovue 300 was administered by IV push via the access. The patient push via the access. The patient tolerated the injection procedure and tolerated the injection procedure and medication without complaints of pain medication without complaints of pain and with no unexpected side affects. K. and with no unexpected side affects. K. Clark, R.T.Clark, R.T.

Charting Exam CompletionCharting Exam Completion

M.D.’s order in patient’s chart should M.D.’s order in patient’s chart should be verified prior to examinationbe verified prior to examination

Document exam completion next to Document exam completion next to M.D.’s written orderM.D.’s written order Ex: 4/25/07, 1300, 2 view CXR Ex: 4/25/07, 1300, 2 view CXR

complete K. Clark (RT)complete K. Clark (RT)

HIPPAHIPPA

The Health Insurance Portability and The Health Insurance Portability and Accountability Act of 1996 mandates that Accountability Act of 1996 mandates that federal laws or regulations ensure the federal laws or regulations ensure the confidentiality of medical records. confidentiality of medical records.

Patients or representatives should have Patients or representatives should have access to all records except in the event the access to all records except in the event the provider feels that it is not in the best provider feels that it is not in the best interest of the patient’s health to have interest of the patient’s health to have access or if the knowledge of the health access or if the knowledge of the health care information could cause danger to the care information could cause danger to the life or safety of any person.life or safety of any person.

HIPPAHIPPA

Within radiology:Within radiology:

Technologists are sometimes asked Technologists are sometimes asked by patients if they can examine their by patients if they can examine their records while in transit, waiting for a records while in transit, waiting for a procedure or undergoing an procedure or undergoing an examination. The record information examination. The record information should not be shared with the patient should not be shared with the patient in this fashion as this may lead to in this fashion as this may lead to misinterpretation of information.misinterpretation of information.

DocumentationDocumentation

As applied to radiology:As applied to radiology:

Assess the order: procedure requested, Assess the order: procedure requested, identifying information, doctoridentifying information, doctor

The report: results are kept in patient The report: results are kept in patient chartchart

The Importance of a The Importance of a Professional EthicProfessional Ethic

Ethics: the systematic study of Ethics: the systematic study of rightness and wrongness of rightness and wrongness of human conduct and character as human conduct and character as know by natural reasonknow by natural reason

Professional Ethic: the ethical Professional Ethic: the ethical conduct of a professionconduct of a profession

Ethical DilemmasEthical Dilemmas

A situation requiring moral judgment A situation requiring moral judgment between two or more alternatives; there between two or more alternatives; there are two or more competing moral norms are two or more competing moral norms present, creating a challenge about what present, creating a challenge about what to doto do

Ethical AnalysisEthical Analysis

1. identifying the problem1. identifying the problem 2. developing alternative solutions2. developing alternative solutions 3. selecting the best solution3. selecting the best solution 4. defending your selection4. defending your selection

Professional EthicProfessional Ethic

Conduct must support the emotional and Conduct must support the emotional and physical needs of the patientphysical needs of the patient

Patient privacy and dignity or even the Patient privacy and dignity or even the simple right to be told the truth must be simple right to be told the truth must be adhered toadhered to

Assist in providing accurate information Assist in providing accurate information which enables physicians to make proper which enables physicians to make proper diagnosisdiagnosis

REMEMBERREMEMBER

Radiology Technologist are legally liable for Radiology Technologist are legally liable for their actions in the daily performance of their actions in the daily performance of diagnostic procedures.diagnostic procedures.

Health care practitioners who do not remain Health care practitioners who do not remain current in the field or who do not follow the current in the field or who do not follow the accepted standard may be liable under the accepted standard may be liable under the legal theory of medical negligence.legal theory of medical negligence.

Identifying the ProblemIdentifying the Problem

Thoroughness in problem identification, Thoroughness in problem identification, looking at every possible twist or nuance looking at every possible twist or nuance in a given situationin a given situation

Developing Alternative Developing Alternative SolutionSolution

Attempt to exhaust all possible pathways Attempt to exhaust all possible pathways to a resolution of the dilemma, taking to a resolution of the dilemma, taking care to view the dilemma from the care to view the dilemma from the perspective not only of the patient and perspective not only of the patient and the patient’s family but also the health the patient’s family but also the health care professionals and administrators to care professionals and administrators to whom they entrust their care.whom they entrust their care.

Selecting the Best Selecting the Best SolutionSolution

Most challenging stepMost challenging step

It is a personal activity that involves It is a personal activity that involves choosing an alternative not only based choosing an alternative not only based on widely held moral stands but one that on widely held moral stands but one that is also in full accord with your own is also in full accord with your own individual value systemindividual value system

Defending Your SelectionDefending Your Selection

Explain the basis for your ethical decision Explain the basis for your ethical decision in terms that you can justify to colleagues in terms that you can justify to colleagues and patients alikeand patients alike

Situation Judgment Tests – SJT’sSituation Judgment Tests – SJT’s“I Think Dr. Jones Misread the “I Think Dr. Jones Misread the Film”Film”

You have just finished a routine radiologic procedure on You have just finished a routine radiologic procedure on Mrs. Green. As you develop the film, it becomes clear Mrs. Green. As you develop the film, it becomes clear that Mrs. Green is probably suffering from a rare form that Mrs. Green is probably suffering from a rare form of bone disease. Dr. Jones, a young resident, glances of bone disease. Dr. Jones, a young resident, glances at the film and smiles. “I didn’t think Mrs. Green had at the film and smiles. “I didn’t think Mrs. Green had anything to worry about,” he says. “That joint pain she anything to worry about,” he says. “That joint pain she was complaining about must be all in her head.” Later, was complaining about must be all in her head.” Later, you see Dr. Jones talking to Mrs. Green’s family. He is you see Dr. Jones talking to Mrs. Green’s family. He is smiling and joking with them as he signs Mrs. Green’s smiling and joking with them as he signs Mrs. Green’s discharge papers. Shaken, you mutter to yourself, “I discharge papers. Shaken, you mutter to yourself, “I think Dr. Jones misread the film.” What should you do”think Dr. Jones misread the film.” What should you do”