Transcript Professional Ethics September 16, 2002

Professional Ethics and
Legal Issues for the ST
Week 5
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
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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
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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
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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,
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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
AORN: Ethical Dilemmas
 VIDEO TIME!
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
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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
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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 whiteout 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
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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
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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.
Summary
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Ethical Issues
Moral Issues
AST Code of Ethics
Patient Bill of Rights
Surgical Consents
Principles of Documentation
Legal Issues
Operating Room Incidents
Sentinel Events