Transcript Legal Concepts, Risk Management, & Ethical Issues

Legal Concepts,
Risk Management,
& Ethical Issues
ST210
Concorde Career College
Objectives
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Identify and develop group behaviors
appropriate to the educational process
and the work environment including an
awareness of cultural perspectives
Identify and develop leadership and
problem solving skills that apply to the
educational process and the work
environment
Objectives
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Identify and develop team building and
networking skills that apply to the educational
process and the work environment.
Identify affective behaviors and integrate
positive examples into professional practice
Analyze the critical thinking process and apply
critical thinking skills to the educational process
and surgical case management
Objectives
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Evaluate positive employability characteristics
and begin to develop those qualities
Develop an education to employment strategy
that includes employment trends and
opportunities for the surgical technologist
Analyze the Patient’s Bill of Rights (American
Hospital Association – AHA) as it pertains to the
surgical patient
Objectives
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Identify ethical situations that healthcare
workers may face and apply the principles of
moral problem solving to ethical decision
making
Understand basic legal terminology and apply
major legal concepts to the responsibilities of
surgical case management
Understand the legal risks and responsibilities
of the surgical team members and the
consequences that may apply when those
responsibilities are not met
Self Management
Objectives:
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Describe the role of the risk
management department of the
healthcare facility
Identify errors that may occur in the
surgical environment and list methods
for prevention
List the benefits of professional liability
coverage
Terms
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Abandonment
Accountability
Affidavit
Allegation
Bona fide
Case law
Complaint
Defendant
Deposition
Federal law
Defamation
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Guardian
Iatrogenic injury
Indictment
Jury
Larceny
Statutory law
Common law
Liability
Corporate liability
Personal liability
Malpractice
Terms
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Negligence
Criminal negligence
Perjury
Plaintiff
Precedent
Standard of care
State law
Subpoena
Tort
Aeger Primo
Tort Law
Patient’s Bill of Rights
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Doctrine of borrowed
servant
Doctrine of corporate
negligence
Doctrine of foreseeability
Doctrine of personal
liability
Doctrine of the
reasonably prudent
person
Primum non nocere
Res ipsa loquitur
Respondeat superior
Torts
A civil wrong not arising out of a
contract or statute
 Provides a remedy in the form of an
action for damages.
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Intentional
 Unintentional
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OR staff: civil actions, not criminal
Torts
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Intentional –
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Assault
Battery
Defamation
False imprisonment
Intentional infliction of emotional distress
Invasion of privacy
Intentional infliction of emotional distress
Requires proof of the willful action of three elements
Torts
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Unintentional
Malpractice – the term used to describe the
behavior of a professional person’s wrongful
conduct
 Negligence – a breach of duty – omission or
commission of an act that a reasonable and
prudent individual would do under the same
conditions
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• Departure from the standard of care – the
defendant had a duty to the plaintiff; that duty was
breached by failing to confirm to the required
standard of conduct.
Unintentional Tort- Negligence Malpractice
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If an individual engages in an activity
requiring special skills, education, or
experience (like working in an OR),
the standard by which their conduct is
measured is the conduct of a
reasonably skilled, competent and
experienced person who is a qualified
member of the group authorized to
engage in that activity
O.R. Incidents
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Patient
Misidentification
Incorrect procedure
Foreign Bodies left
in patients
Burns
Positioning
Improper handling
of specimens
Drug errors
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Defective
equipment or
instrumentation
Loss of patient’s
property
Major breaks in
sterile technique
Exceeding scope of
practice or hospital
policy
Abandonment
Universal Protocol:
Surgical/Invasive Procedure
“Time-Out” Verification
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Purpose: To promote patient safety and
prevent risk of wrong site, wrong procedure,
wrong person surgery, this policy defines
the Universal Protocol requirements for
patient identification verification and the
“Time-Out” procedure to be conducted
before any invasive or surgical procedure
that exposes patients to more than minimal
risk, including procedures done in settings
other than the operating room.
Universal Protocol:
Surgical/Invasive Procedure
“Time-Out” Verification
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Policy: Patient identification
verification and conducting a “TimeOut” is required prior to all
invasive/surgical procedures that
involve puncture or incision of the
skin, or insertion of an instrument or a
foreign material into the body.
Universal Protocol:
Surgical/Invasive Procedure
“Time-Out” Verification
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Procedure: The RN is responsible to
complete and document on the
Surgical/Invasive Procedure “Time-Out”
Verification Checklist that verification of
patient identification and the required
elements of the “Time-Out” have been
conducted immediately prior to the invasive
or surgical procedure according to the
following guidelines:
Universal Protocol:
Surgical/Invasive Procedure
“Time-Out” Verification
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Surgical/Invasive Procedures Included:
Surgical/invasive procedures falling within
the scope of these guidelines include, but
are not limited to: biopsies, percutaneous
aspirations, cardioversions, cardiac and
vascular catheterizations, pericardiocentesis,
Trans-esophageal echos, endoscopies,
thoracentesis, chest tube insertions,
paracentesis, lumbar punctures, bone marrow
aspirations, closed reductions or manipulations
of extremities, circumcisions, incisions and
drainage of wounds, etc.
Universal Protocol:
Surgical/Invasive Procedure
“Time-Out” Verification
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Initial Patient Identification
Verification: The RN assigned to
the care of the patient is to verify
patient identification elements as
listed on the Surgical/Invasive
Procedure “Time-Out” Checklist
prior to any invasive or surgical
procedure
Universal Protocol:
Surgical/Invasive Procedure
“Time-Out” Verification
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Re-verification of Patient
Identification: Re-verification of
identification elements is required
if the patient is relocated to a
different setting or staff changes
occur prior to the invasive/surgical
“Time-Out”; the RN assuming the
care of the patient must re-verify
the patient identification
Universal Protocol:
Surgical/Invasive Procedure
“Time-Out” Verification
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Site Marking Requirements:
Marking of the site immediately
prior to the procedure is required
for procedures involving left/right
distinction, multiple structures
(such as fingers, toes, kidneys), or
multiple levels (as in spinal
procedures)
Universal Protocol:
Surgical/Invasive Procedure
“Time-Out” Verification
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Site Marking Exemptions: Site marking is
not required for single organ cases or
interventional procedures for which the
insertion site is not predetermined. Also
exempt are cases in which the physician
performing the procedure is in continuous
attendance with the patient from the time of
the decision to do the procedure (consent is
obtained from the patient) through the
performance of the procedure. For those
procedures in which site marking is not
required, the other requirements for
patient identification verification and
“Time-Out” still apply.
Universal Protocol:
Surgical/Invasive Procedure
“Time-Out” Verification
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Emergency Situations: In most cases,
when invasive procedures are performed
under emergency or urgent conditions, the
physician performing the procedure will be
in continuous attendance of the patient from
the point of decision to do the procedure.
Under those circumstances, marking the
site would not be necessary, although
the “Time-Out” to verify correct patient,
procedure, and site would still be
appropriate (unless it is such an
emergency that even the “Time-Out”
would add more risk than benefit).
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“Time-Out” Procedure: A “Time-Out”
procedure must be conducted in the
location where the procedure will be
performed, immediately before the start
of any invasive procedure or surgical
incision. The “Time-Out” procedure will be
initiated by the RN and requires the active
participation of all team members involved
in the procedure to verify each of the
following elements:
Patient’s name and date of birth
Correct side/site, including marking, if
applicable
Correct procedure
Correct patient position
Correct radiograph data, if applicable
Special equipment/implants/requirements
available, if applicable
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The “Time-Out Procedure” is to be
conducted in a “fail-safe” mode; the
surgical/invasive procedure is not
started until any questions/issues are
resolved.
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Required “Time-Out” Documentation:
The RN is responsible to initiate and
document the “Time-Out” procedure.
The RN is to document the required
elements of the “Time-Out” procedure by
initialing in the spaces provided by each
element of the “Time-Out”, writing in the
names of all team members participating in
the “Time-Out”, and signing on the
signature line designated “RN Signature
completing “Time-Out” Checklist”.
Consent
Consists of at least two parties – One
being the recipient of the action;
Second being the one to perform the
action.
 Voluntary and informed act in which
one party gives permission to the
other party to “touch” – Battery:
nonconsensual touching
 Surgical procedures require an
Informed Consent (certain situations
do not)
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Who Can Give Consent?
Competent adult
 Parent of legal guardian of a minor
 Hospital administrator
 Courts
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Consent cont.
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Two formats for Consent
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Express – direct verbal or written
permission (preferred by healthcare
facilities in written form)
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Implied – manifested by action or
inaction of silence, which presumes
consent has been given
Informed consent
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The Joint Commission’s definition –
agreement or permission
accompanied by full notice about what
is being consented to; the requirement
that a patient be apprised of the
nature and risks of a medical
procedure before a healthcare
professional can validly claim
exemption from liability for battery or
from responsibility for complications or
undesirable outcomes
Two Categories of Consent
used in Hospitals
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General
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Signed on admission to the hospital
for diagnostic procedures, medical
treatment, and normal and routine
“touching”
Special
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Used for any procedure that entails
higher than normal risks
Written Informed Consent
Surgeon is responsible for securing a
“Written Informed Consent”
 Conditions to be met:
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Must be in understandable language
 There can be no coercion or intimidation of
the patient
 Procedure must be explained
 Potential complications, risks, and benefits
must be explained
 Alternative therapies must be explained
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Written Informed Consent
cont.
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Proper written informed consent
should contain the following:
Patient’s legal name
 Surgeon’s name
 Procedure (side)
 Patient’s legal signature
 Signature of witness(es)
 Date and time of signatures
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Written Informed Consent
cont.
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The patient usually gives consent
If the patient is incapable of giving consent
(physically unable or legally incompetent),
another properly authorized person must
give consent. The same guidelines pertain
to this person
The patient must be of legal age or legally
declared emancipated minor
The patient must be mentally alert and not
under the influence of drugs
Written Informed Consent
cont.
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Consent may be given under the
following specific conditions:
A competent adult speaking for
themselves
 Parent or legal guardian of a minor
 Guardian in case of physical inability
or legal incompetence
 Temporary guardian
 Hospital Administrator
 The Courts
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Written Informed Consent
cont.
Any variance from normal procedure is
defined by hospital policy (exampleemergency)
 Some variances may include:
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Telephone
 Telegram
 Agreement of two consulting physicians (not
including the involved surgeon)
 Administrative consent
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Written Informed Consent
cont.
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Witnesses are defined by hospital
policy and may include:
Physician
 RN
 CST
 Other hospital employee
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Implied Consent
Allowed in emergency situations
 Not preferred by healthcare
institutions
 May apply during surgical procedures
– example – the surgery extends
beyond the planned procedure; an
unconscious patients are presumed to
have consented to appropriate
medical treatment
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Consent
Once given, consent can be taken
away
 Patients have a legal right to change
their minds
 It only takes a verbal reconsideration
 It should be well documented
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Documentation
~If you didn’t document it, you didn’t do it.~
Patient’s Chart
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Identification of the patient
Identification of physician(s), nurse(s), and
other healthcare providers involved with
care
H&P
DX
Treatment plan
Medication record
Physical findings ex- lab work
Discharge condition
Follow up treatment plan
Operative Record
Surgical team’s names and titles
 Patient’s condition before, during, and
after surgery
 Start and finish time
 Counts
 Details about the whole event
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Incident Reports
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A mechanism for reporting any
incidents that are related to adverse
patient care
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Used by surgical personnel to
describe an unusual event that has
occurred that may have legal
ramifications for the staff or patient
Advanced Directives
Written instruction dealing with the
right of an incapacitated patient to
self-determination
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Living will
 Medical power of attorney
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Ethical and Moral Issues
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Ethics: what is good for the individual
and for society and establishes the
nature of duties that people owe
themselves and one another.
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Attempts to define the concepts of
character and customs and their
relationship to beliefs, morals, and
personal values.
Moral Principles
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Defined as the guides for ethical
decision making, and the principle we
try to instill in our children.
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Include the concern that we have for
the well-being of others and respect
for their autonomy.
Bioethics
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The study of the ethical implication of
biological research and applications,
especially in medicine.
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The focus is to maximize total human
benefits.
Patient’s Bill of Rights
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Adopted in 1972 and revised in 1992
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Makes several assumptions that cover
the scope of a patient’s care
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A copy is given to every patient upon
checking in to the hospital or clinic
Summary Patient’s Bill of
Rights
Health care is a collaboration
 Open and honest communication
 Mutual respect
 Must be sensitive to cultural, racial,
linguistic, religious, age, gender, and
other differences, including disabilities
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Patient’s Bill of Rights
Receive considerate and respectful
care
 Obtain relevant, current, and
understandable information
concerning their care or treatment
 Make decisions about care received
before and during treatment
 Prepare an advance directive
 Expect privacy
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Patient’s Rights, cont’d
Expect that all private information will
remain private
 Review records concerning medical
care
 Consent or decline to participate in
research studies
 Expect reasonable continuity of care
 Be informed of hospital policies and
practices
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Issues That Affect the ST
Elective sterilization
 Fertilization procedures
 Elective abortion
 Human experimentation
 Animal experimentation
 Organ donation/transplantation
 Quality vs. quantity of life
 Gender reassignment
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Professional Codes of
Conduct
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The AST established a code of ethics
for the ST in 1985
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Failure to adhere to this code may
result in expulsion from the profession
Code of Ethics
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To maintain the highest standards of
professional conduct and patient care.
To hold in confidence, with respect to the
patient’s beliefs, all personal matters.
To respect and protect the patient’s legal
and moral rights to quality patient care.
To not knowingly cause injury or any
injustice to those entrusted to our care.
Code of Ethics, cont’d
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To work with fellow surgical technologists
and other professional health groups to
promote harmony and unity for better
patient care.
To always follow the principles of asepsis.
To maintain a high degree of efficiency
through continuing education.
To maintain and practice surgical
technology willingly, with pride and dignity.
Code of Ethics, cont’d
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To report any unethical conduct or
practice to the proper authority.
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To adhere to the Code of Ethics at all
times with all members of the health
care team.
Surgical Conscience
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Allows the ST to keep a patient’s
confidence, avoid discrimination
against any patient based on the
technologist’s PERSONAL values,
and be committed to cost control.
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Must have the personal moral
authority to accept responsibility for
his/her own actions.
Surgical Conscience
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Must be committed to maintaining the
confidentiality of information associated with
patient care.
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Dictates a nondiscriminatory treatment of all
patients.
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Personal values, feelings, and principles
take a secondary position to the needs of
the patient.
Surgical Conscience
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Be committed to cost control. Medical care
is expensive, so the ST must do their part to
keep cost under control.
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Be a guarantor of sterile technique in the
OR.
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Honesty, patient confidentiality,
nondiscriminatory treatment, cost
consciousness, and sterile technique.
Scope of Practice
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Identifies the disciplines and
processes that define the field and the
ways in which surgical technology is
different from other allied health fields.
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Refers to our core accountabilities for
which the provider has adequate
education, experience, credentialing,
etc.
Scope of Practice
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Was the skill taught in the ST program?
If not, have you since completed a program
that included clinical experience?
Is the task routine in surgical technology?
Is the task prohibited by hospital policy or
state law? Does it require a license?
Is this practice within an acceptable
standard of care?
Scope of Practice
To a large extent, the scope of
practice for a surgical technologist is
determined by the delegatory
decisions made by the supervising
surgeon.
 How does this relate to Surgical First
Assistant skills and functions?
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STs may perform second assisting
tasks
Job Descriptions
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Descriptions of the tasks, functions,
and responsibilities of a position within
an organization.
Role: the set of responsibilities or
expected results associated with a
job.
 Job: usually includes several roles.
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Credentialing
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Does not verify competency. Competency
is an ongoing evaluation.
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Certification is recognition by an appropriate
body that an individual has met a
predetermined standard.
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Licensure is the legal right granted by a
government agency in compliance with a
statute that authorizes and oversees the
activities of a profession.
Accreditation
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CAAHEP accredits most ST programs
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Accreditation is a process of external
quality review used by higher
education to scrutinize colleges,
universities, and educational
programs for quality assurance and
quality improvement.
Core Curriculum
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Documents designed by educators
that sets a specific standard for
curriculum development
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A template for instruction
Clinical Ladder Programs
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Allow an ST to ascend to positions of
increased responsibility within an
organization.
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Allows the ST to become more
directly involved in decision making,
broadening the role for proper surgical
patient care.
Risk Management
Department
Legal
Considerations
Purpose:
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Enhance safety
Minimize liability
Risk Management
Department
Legal Considerations
Functions:
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Prevention
Monitoring
Control
Risk Management
Department
Legal Considerations
Methods:
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Detection
Evaluation
Prevention
Errors in the Surgical
Environment
Legal Considerations
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Patient misidentification
Incorrect procedure/location
Burn
Fall
Positioning injury
Abandonment
Surgical Burn
Cuatery Skin Burn
Errors in the Surgical
Environment
Legal Considerations
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Specimen loss/misidentification
Medication error
Defective equipment/instrument
Property loss/damage
Lack of informed consent
Documentation error
Errors in the Surgical
Environment
Legal Considerations
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Breach of sterile technique
Exceeding scope of practice
Violation of facility policy
Failure to observe a critical event AND
take appropriate action
Retained foreign body
Retained Instruments
Errors in the Surgical
Environment
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The ST can help avoid medical errors by:
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Following written policies and procedures
Obeying standard precautions
Be aware of the location and proper use of
all emergency equipment
Professional development/continuing
education programs
Report unsafe conditions
Report injuries to staff or patients
Malpractice Insurance
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Hospital employees are typically covered by
insurance policies provided by the facility, as
long as the act was committed within the
scope of the institution’s policies and
procedures. However, a suit may be filed
against the employee by the facility in order to
recuperate legal costs in certain situations.
Extra insurance should be carried by the ST!
http://surgicalassistantresource.org/web_docu
ments/liability_insurance_report.pdf
Safe Medical Device Act
Effective November 1990
 Medical device users must report
incidents to the manufacturer and the
FDA that a medical device caused or
contributed to:
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Death
 Serious Injury
 Illness
 Other adverse experiences
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