professional ethics and legal issues for the st week 5
TRANSCRIPT
Ethical Concepts
Medical ethics - a philosophical science that deals with what is right verses what is wrong as determined by an established professional code of conduct. Establishes our duty and obligation to our patients.
We have the ability to practice ethical beliefs even though they may vary from our own values and morality.
Morality - refers to actions or conduct that is considered acceptable to established customs of a group or society of people. (How we as individuals or a society might judge our actions or conduct).
Morals are developed as a result of societal expectations.
Ethical Concepts Continued
Values - desirable personal standards or qualities as viewed by an individual or society.
Our value system is something we develop as a result of our familial and societal upbringing.
Medical Ethics Viewed by health care workers as not what is absolutely right or
wrong, but at what is our obligation and duty to our patient. Health care workers depend on established guidelines to
perform their duties and obligations. Guidelines can be established at the federal, state, professional
organizational, institutional, and judicial level. Health care workers know that the established guidelines can
be challenged in a lawsuit. Philosophers in ethics support that ethics is complicated
depending on the perspective of a person’s religion, culture, society, person, and situation.
Association of Surgical Technologists (AST) Code of Ethics Maintain the highest standard of professional conduct
and patient care Hold in confidence all matters regarding the patient Respect and protect the patient’s legal and moral
rights Not cause injury or any injustice to those patients in
our care intentionally Work with fellow health care team members
promoting unity for optimal patient care
AST Code of Ethics Continued
Always follow the principles of surgical asepsis Maintain the highest level of competence by
continuing education Maintain surgical technology by practicing with dignity
and pride Will report to the proper authority any unethical
behavior or action observed Will maintain this Code of Ethics with all health care
team members and those in our care
Universal Ethical Principles (Bioethics)
Autonomy: the ability to make your own decisions and act upon them with no interference from others
Veracity: telling the truth Beneficence: doing good or performing an action
that benefits another under all circumstances Nonmaleficence: do no harm Confidentiality: protect patient privacy Justice: fairness/impartiality Role fidelity: work within your scope of practice
American Hospital Association’s Patient Bill of Rights Care that is compassionate and respectful Information concerning their care that is relevant,
current, and understandable Make decisions regarding their care before and
during their care and refuse care Advanced directives will be honored by the health
care providers (refers to living wills, right to die, or death with dignity)
Every consideration of privacy All communications and medical records will be
treated as confidential unless otherwise determined by law
AHA Patient’s Bill of Rights Continued May review their medical records and receive
explanations regarding it at their request Receive medical care and services that are
appropriate and medically indicated within the capacity of the medical institution
May ask and receive information regarding the business relationship among the health care providers
May consent or refuse to participate in medical research studies or experiments
AHA Patient’s Bill of Rights Continued Expect reasonable continuity of care Be informed of hospital policies regarding
patient care
Resolution of Ethical Dilemmas Facts/background information Identify ethical principles involved Who are people involved in decision making
(ethical agents) What are your opinions and what will be the
outcome of each Resolution not necessarily THE solution Action based on decisions Look back at actions after done/evaluate
Types of Consent
General: the one everyone signs when they are admitted to the hospital to accept treatment
Special: Covers procedures that involve more than normal risk (examples are surgical, anesthesia, procedures involving body cavity entrance, and experimental treatments)
Surgical Consents
A patient is a person who consents to a provider of health care services to provide health care
Consent to receive services is ultimately up to the patient with the exception of legal incompetence, a minor, and emergent situations
The patient is autonomous Surgical consent is permission by the patient for surgery to be
performed by the surgeon and the health care team Two individuals are involved with surgical consents: the patient
who is receiving care and the surgeon providing care with the exception of incompetence, minors, and emergencies
Surgical Consents Continued
Consent should be voluntary and the patient must be informed of all risks and possible outcomes of a surgery by his/her surgeon in layman’s terms
Surgical consent should be verbal and/or written Surgical consent can be implied in situations of
emergency or a finding during the planned procedure that warrants treatment as well
Consent may be obtained in emergencies by telephone, fax, e-mail, two physicians consulting on a patient, not the surgeon, or two nurses but not the circulator
Components of an Informed Surgical Consent Legal name of patient Name of surgeon Surgical procedure to be done Legal signature of patient (can be parent,
legal guardian, courts, administrator of hospital)
Witness signature (surgeon/physician, RN, other hospital employee)
Time and date of signatures
Principles of Documentation
Documentation in health care refers to the placing of information on a patient’s permanent medical record that is a thorough account of the patient’s course of health care written by the health care providers
The medical record is a legal and confidential document
Certain things are required to be reported by law: abuse, communicable diseases, neonatal diseases, births, deaths, suspicious deaths, known criminal acts, professional misconduct, and incident reports
Components of the Medical Record
Patient identification All health care providers’ identification Patient’s medical history Diagnosis Treatments, plan of actions, and results Consents (general and special) Medications received by the patient All findings during the course of hospitalization Discharge information Follow up plans
Components of the Medical Record Related to Surgery Informed consent Operating room documentation for pre-op,
intra-op, and post-op Count records Incident reports (generally not part of
permanent medical record)
Medical Records Continued
If errors are made on the medical record, you are to draw a single line through the incorrect entered information, place your initials above the line, and write the corrected entry beside or above the incorrect data. NEVER erase, scribble out or white-out any information on a patient’s medical record!!!!!! This leaves room for speculation in a court of law. Mistakes happen, don’t try to hide anything. It is viewed as suspicious.
Basic Legal Terminology
Accountability: you are held responsible for your actions
Assault: verbal or physical act that threatens or makes another fearful
Battery: intentional touching, hitting, or wounding someone without their consent
Defamation: making false statements about someone that causes damage to that person’s reputation or character
Guardian: court-appointed individual for someone incapable of making their own decisions
Informed consent: permission for treatment with awareness of risks
Basic Legal Terminology Continued
Larceny: taking someone else’s property without their consent
Liability: obligation to do or not do something Malpractice: the misconduct of a professional that
results in the injury to another Negligence: Omission (not doing) or commission
(doing) something that a reasonable and cautious person would or wouldn’t do under the same circumstances. Disregard for patient safety.
Negligence is the most common charge a health provider will potentially face
Basic Legal Terminology Continued
Perjury: lying under oath in a court of law or institutional proceedings
Standard of Care: conduct that is expected by a professional
Tort: injustice for which an injured party is entitled to compensation
Standard of Care for the Surgical Technologist AST Recommended Standards of Practice
(handout) AST Code of Ethics (handout) Core Curriculums for the ST and STFA Surgical Conscience
Credentialing
The public is protected from unsafe health care workers by the process of credentialing. Credentialing establishes that a health care provider has met the minimum knowledge requirements to practice in a health care field.
Types of Credentialing
Registration: “formal process where qualified individuals are entered in a registry.”
Certification: “recognition by an appropriate body that an individual has met predetermined standards.”
Licensure: “legal right granted by a government agency in compliance with a statute that authorizes and oversees the activities of a profession.” (Caruthers & Price, p. 50)
Surgical Conscience
Honesty Willing to accept responsibility for one’s
actions Commitment to maintaining confidentiality Commitment to maintaining competence Nondiscriminating Committed to cost control Committed to practicing the principles of
surgical asepsis
Things That Can Go Wrong in the OR
Wrong patient Wrong procedure Foreign bodies left in from incorrect counting
procedures Burns from cautery being used wrong Falls Nerve damage Specimen loss or incorrect labeling of the
specimen
More Things That Can Go Wrong in the OR Incorrect medication administration or
incorrect usage of medications Patient injury from defective equipment No informed consent Injury/infection due to break in sterile
technique Errors in documentation Failure to recognize inappropriate events and
take appropriate action Exceeding practice standards
Sentinel Events
A major occurrence or event that should not have happened because it could have been prevented
Incident Reports
Are filled out by the person in charge at the time of the mistake, adverse outcome, or injury
Are not part of the patient’s medical record Are sent to the Risk Management Department
of the hospital or institution
Risk Management
Collect and use data from incident reports or occurrence reports to try to come up with a way to prevent the event from occurring again
Data is stored for use if need by the hospital’s insurance company or in a court of law
Also deal with clarification of issues where chain of command is an issue
Review policy issues if there is a concern voiced
Prevention of Things Going Wrong
Having a thorough education and understanding of safety principles and practicing with a diligent surgical conscience can prevent things from ever going wrong.
It is the responsibility of each health team member in the OR to provide excellent and safe care to each and every patient no matter who they are.