Transcript Our Patients Have The Right To File A Complaint! Patient

A Review Of Patient Rights
Cultural Awareness
HIPAA Privacy & Security
Advance Directives
Ethics Consultations
Abuse, Neglect, Exploitation
Restraint & Seclusion
Pain Management
Answer the questions on the test as you view
this information.
Content reviewed & revised October 2013 - SN
Our patients have many rights. As healthcare
providers, we must know these rights in order to
assure the highest measure of care.
The first patient right we will review is that of
considerate, respectful care which includes
cultural sensitivity.
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Cultural Sensitivity
Our role as health care providers is to offer optimal health
care while respecting differences that exist between care
provider and our patients.
Recognize that
“One Size Does NOT Fit All”
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What Is Culture?
 Culture is habits, beliefs, and values shared by and learned
from a group of people
 It includes the way we practice them and the expectations of
the community
 A group’s culture guides its thinking, decisions, and actions.
Cultural patterns are learned and shared. ie: the way families
from a particular ethnic group respond to death & dying
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Cultural Factors
 Country of origin – how long a person has lived in our country / area may affect
his or her views toward health.
 Preferred language – Patients who are encouraged to talk or read about care in
their own language may feel more at ease and understand their care better.
 Views of Health – The patient may see an illness as having a supernatural cause,
such as punishment for sins, or may seek a certain traditional cure, such as an
herbal remedy or a specific diet.
 Family & Community relationships – A patient may expect certain people to be
involved in his or her care and allowed to visit
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Cultural Factors
 Communication Styles – Nonverbal and verbal styles may differ. Culture may
affect how or whether a patient expresses pain.
 Religion –A patient’s religion may affect his or her consent to treatment,
schedule of care or room arrangement, birth and death practices.
 Food Preferences – Religious, healing and other cultural practices all can affect
what foods a patient may eat or avoid.
 Clothing & Attire- May wear personal clothing & symbolic items as long as this
does not interfere with diagnostic treatment & procedures
 Sexual Orientation – sexual behavior may change over time, and sexual
orientation is not synonymous with sexual behavior.
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Culturally Competent Care For GLBT Persons
As healthcare providers, we should be caring for all persons equally with
dignity and respect. We must be aware to consider that each and every
person may have very personal facts about themselves which may be
difficult to disclose.
 There may be many reasons for gay, lesbians, bi-sexual, and transgender (GLBT) persons
to find it difficult to disclose same-sex behavior in a health care setting. They are likely
to be especially conscious of protecting their privacy in medical records. Ask the right
questions with the right attitude.
 Be sensitive to YOUR verbal and body language to create an atmosphere of care,
openness, and non-judgment.
 Remember that gender identity is distinct from sexual orientation. How a person
identifies their gender may also change over time. As with all patients, ask the
transsexual person how they prefer to be addressed.
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Culturally Competent Care For GLBT Persons

Be explicit with patients about documentation of and potential disclosure of sexual
orientation in the medical record. Obtain patient’s permission before documenting.

Become familiar with appropriate GLBT community referrals

Be aware of the uncomfortable feelings that transgendered patients may feel about their
bodies or life histories, especially those that have occurred in the healthcare setting.
Recognize that not all natural sexual organs may have been surgically removed in
transsexual individuals, and that there may be consequent screening exams which need to
be performed.
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Generational Diversity
People born in the same general time span
share key life experiences such as:
 Heroes
 Music
 Major events
 Technology
Age differences can affect how employees interact in the workplace.
Today you may find persons from the Traditionalist group,
Boomer group, Generation X group, Millienium group and
soon the Generation Z or 9/11 group all working together
under one roof.
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Most of us recognize that Millennials are
employees with very different workforce
just familiar with collaboration tools but
environment to allow or even encourage
the new generation of
behaviors who are not
expect their work
them to use these tools.
“Working With Five Generations In The Workplace” by Rawn Shaw.
http://www.forbes.com/sites/rawnshah/2011/04/20/working-with-five-generations-in-theworkplace/# retrieved November 5, 2013.
By 2015 the earliest of this generation will be
around 35, holding roles in middle management,
expertise leadership, or executives. Also, while
the median age of the working population in the
US is around 36.7, in emerging markets, it is
closer to 26 years old, with a larger younger
population of workers
http://www.forbes.com/sites/rawnshah/2011/04/20/working-with-five-generationsin-the-workplace/# retrieved November 5, 2013.
Generational differences sometimes may cause clashes in the workplace, especially among
workers on teams, (Constance Patterson, PhD.) notes. For example, she says, boomers
may believe gen Xers are too impatient and willing to throw out the tried-and-true
strategies, while gen Xers may view boomers as always trying to say the right thing to
the right person and being inflexible to change. Traditionalists may view baby boomers
as self-absorbed and prone to sharing too much information, and baby boomers may
view traditionalists as dictatorial and rigid. And, gen Xers may consider millennials too
spoiled and self-absorbed, while millennials may view gen Xers as too cynical and
negative.
Generational differences at work
A psychologist studies ways to help traditionalists, baby boomers, gen Xers and millennials
work better together, despite their generational differences. By MELISSA DITTMANN
http://www.apa.org/monitor/jun05/generational.aspx American Psychology Association
When Generational Views Clash
"A team that allows choices and openly explores ideas, and whose
members value learning, will better accommodate the needs and values
of members of different generations," Constance Patterson says.
Effective teams should
 value different views
 encourage active listening
 decrease ambiguity among team members' roles
 support the sharing of expertise
 share recognition and appreciation
 value hard work
 build in humor and fun to their work
GENERATIONS WORKING SIDE BY SIDE
Every employee is to be held to the same work standards . . .
Yet individual needs and generational differences
must be considered.
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Bariatric Sensitivity
Another area of consideration for our healthcare workers is to
become more aware of the needs of our obese patients.
As you will see, obesity is a multi-faceted disease state and
these patients have special physical and emotional needs.
Berkeley Medical Center offers a Lap-Banding Surgical Weight
Loss Program. Review of this information may increase your
sensitivity to this population of patients.
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Obesity is Associated with
Significant Progressive Co-morbidities
Patient’s seek surgery because their co-morbid conditions
are progressive. It’s not about their appearance!!
Only 1% of those that meet the criteria actually receive surgery.
Heart Disease
Stroke
Urinary Stress Incontinence
High Cholesterol
Sleep Apnea
Congestive Heart Failure
Osteoarthritis
GERD
Asthma
Depression
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Diabetes
High Blood Pressure
What Can You Do for the Patient?
•Listen Attentively
•Possess a calm manner
•Be open and friendly
•Give respect
•Don’t be afraid to smile and provide a therapeutic touch
•Don’t tolerate behind the back “fat” jokes or statements,
even in private
•Check your own biases
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So, how do we develop cultural
competencies?
It’s about learning and
communicating.
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Developing Cultural Competencies
 Avoid cultural stereotypes
 Ask about cultural issues significant to patient care in a
respectful and nonjudgmental way
 Learn the patient’s view about health. Learn about accepted
ways to show respect, understand relationships, consider
privacy needs.
 Work with the patient and others to find the best approach
to his or her care. It’s all about good communication!
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Communication Barriers
But, sometimes there may be barriers to communication such as:
 Physical Impairments -such as speech, hearing, sight, mental status
 Learning Abilities -– at what grade level can they understand?
 Emotional Stresses
 Cultural Differences -– different meanings for words & gestures
 Language Differences -– what is the primary language?
translator??
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Need for a
Interpretive Services Are Available
Jefferson Medical Center uses the AT&T Language Line:
Client ID # 220014
All calls - 1.800.774.4344
Berkeley Medical Center uses Deaf Talk Services for all language as well as hearing impaired
assistance needs:
Client ID # 25401
Phone: 1.866.237.0173
Either facility may use Deaf Net (Hagerstown: 301.791.9025) (Frederick: 877.788.8454) another
option – provides a live interpreter
Remember, the interpreted message is only as good as the original message.
Don’t assume that the interpreter or non-English speaker knows more
than what you have just told them
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Excused From Care Request
There is a policy in place with the purpose to establish a mechanism by
which an employee may request to be excused from participating in an
aspect of a patient’s care or treatment in situations where the
prescribed care or treatment presents a conflict with the employee’s
cultural values, sense of ethics or religious beliefs.
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HIPAA Privacy &
Security Review
HIPAA Privacy vs. Security
What’s The Difference?
 Privacy – refers to WHAT is protected - - the health
information about an individual and the determination of
WHO is permitted to use, disclose, or access this
information
 Security – refers to HOW private information is
safeguarded - - insuring privacy by controlling access to
information and protecting it from inappropriate
disclosure and accidental or intentional destruction or loss
 Refer to Compliance & Privacy course for more details
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What Information Is Protected
 Information health care providers put in the medical record
 Conversations between healthcare providers about the patient’s care or
treatment
 Information about the patient in health insurer’s computer systems
 Billing information including but not limited to demographics, SS#
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Patient’s Health Information Privacy Rights
 Right to a notice of privacy practices
 Right to request restrictions or limit disclosure and receive an account of those
disclosures
 Right to request an amendment to PHI if believed incomplete or incorrect
 Right to inspect and receive a copy of medical information which is in the medical
record (may not include behavioral health records or other special cases)
**University Healthcare policy: Patient must sign Release of Health Information
Authorization Form. May have a monetary charge for labor cost applied.
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Patient’s Health Information Privacy Rights
• Right to decide whether to give permission before information can be used or shared
for certain purposes
• Right to expect any discussion regarding private PHI will be conducted discreetly
• Right to expect persons not directly involved in patient’s care will not be present
without patient’s permission (w/ reasonable accommodation to the rule) (Pull
curtains, ask visitors to leave room during need for private conversations)
• Right to have medical record read ONLY by individuals directly involved in
treatment or the monitoring of its quality
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Patient’s Health Information Privacy Rights
• Right to not be placed in the hospital directory (check BEFORE giving out
information)
• Right to have ALL communications be treated as confidential
• Right to file a complaint if the patient believes their rights are being denied or
their PHI is not being protected : Complaints can be filed with the Health &
Human Services Office for Civil Rights or our organizational privacy officer
• Right to identity of the person(s) breaching confidentiality regarding PHI
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NEED TO KNOW MINIMUM STANDARD
Communications with or about patients involving patient health
information should be:
• Private
• Limited to those who need the information for treatment, payment,
healthcare operations
• Any suspected infraction of patient confidentiality will be reported
and documented as defined in our administrative policy
Protecting confidential information is a responsibility
that the ENTIRE workforce shares - regardless of whether they
directly or indirectly care for patients.
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ADMINISTRATIVE SAFEGUARDS
Promoting security awareness
Provide training to all employees
Develop process for security breaches
Develop disaster recovery plan
Enforce password rules –
ANYONE!!
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NEVER SHARE YOUR PASSWORD WITH
PHYSICAL SAFEGUARDS
Screensavers
Logging off
Password protection
Virus protection
Secure locations of computers, etc
Proper disposal of portable media
Verify identity of ANYONE working on your PC
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TECHNICAL SAFEGUARDS
Assign each user a unique username and password
Control access of all users to include only what is necessary
Remove access of terminated users
Perform audit trails to track usage
Report violations
Provide encryption for information that is sent electronically
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Your Patient Has The Right
To Know The Identity and
Professional Status of
Healthcare Providers
This is part of our Service Standards!

Always ask permission to enter room

Always ask by what name you should address the patient

Always introduce yourself & others with you

Always let your patient know of your skill level

Always thank the patient for using our services
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Our Patients Have
The Right To Be
Informed And To Be
Involved In Their Care
Our patients have the right
 To complete & current information concerning diagnosis, treatment, &
any known prognosis
 To be informed of any continuing health care requirements following
discharge
 To reasonably informed participation in decisions involving care,
including the decision to discontinue treatment to the extent permitted
by law
 To be informed of medically significant alternatives for care or
treatment
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Our patients have the right
 To know who is responsible for authorizing & performing procedures or
treatment
 To be informed of research or experimentation & to refuse to participate in
any such activity
 ALWAYS ask permission before a procedure
 ALWAYS explain the procedure, time of expected results, any delays, and any
expected discomfort
 ALWAYS ask the patient how you can better meet their needs
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Our Patients Have The
Right To Formulate
Advance Directives &
Have An Ethics
Consultation If Needed
Advance Directives are written or oral statements
about one’s health care preferences.
Three most common forms are the
• Living Will
• Medical Power of Attorney
• Combined Living Will / Medical Power Of Attorney
Health Care Surrogate can be signed by M.D. if the
patient has no Advance Directive.
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Medical Power Of Attorney
•
Empowers the individual to appoint representatives to make
health care decisions.
•
Allows individuals to state specific health care preferences.
•
Goes into effect if patient becomes unable to speak for him or
herself.
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Living Will
• Directs physician to only provide
treatments that will relieve pain
and
provide comfort
• Allows life prolonging
interventions to
be withheld or withdrawn
• Only pertains to terminal illness
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POST Form
Physicians Orders for Scope of Treatment

Hot pink form containing orders by an M.D. regarding the patient’s end-of-life care preferences.

Recommended for anyone with a chronic illness, especially nursing home or hospice patients.

Reinforces Living Will & Medical Power of Attorney

Makes it very clear what the individuals wants and does not want in end-of-life care.

To follow the patient during transfers
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Ethics Consultations Can Be Requested

Three main functions are case consultation, policy recommendation, and
education

An advisory service to help patients, families & staff identify, analyze &
resolve health care problems

Collaborative approach to find balance between
1) physician needs and desires that are based on more measurable quantities
and 2) the patient’s needs and desires that are based on more qualitative
factors

Consult may be requested by doctors, nurses or anyone involved in the case
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Our Patients Have The Right To Be
Cared For In An Environment That . . .
Preserves Dignity
Fosters Positive Self Image
Provides Privacy
Provides Safety
Let’s Look At Our Responsibility
To The Patient regarding
Abuse, Neglect, & Exploitation
Abuse & Neglect
Child abuse & neglect occurs when a child suffers physical
trauma, is deprived of basic needs, or is subjected to mental
injury because of something the parent or caretaker
did or did not do.
Elder abuse & abandonment involves the desertion of
an older adult by a caretaker and/or injury, unreasonable
confinement, intimidation or punishment with resulting physical
harm, pain or mental suffering.
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What Is Exploitation?

Misuse of resources without consent or consent obtained through misrepresentation,
coercion, or threats of force.

Exploitation results either in some type of gain for the offender or personal loss to the
perpetrators’ victim

Evidence could include a caregiver with unusual interest in the finances of the elderly
person or an unusual interest in a minor

Other indicators might be the victim not having their medical needs met because of
funds that should be available but are not. (Medicines, hearing aids, glasses.)
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Reporting Abuse & Neglect

The Department of Health & Human Resources (DHHR) must be notified of every
case of alleged or suspected abuse or neglect of a child or incapacitated adult or
exploitation

Failure to report is considered a misdemeanor & those convicted may be fined,
incarcerated or both.

Medical professionals are mandated reporters
Report cases of suspected abuse and/or neglect immediately to DHHR at
304-724-2600 in Jefferson County, and
304-267-0100 in Berkeley County, during regular business hours.
After hours call the Hot Line at 800-352-6513.
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Our Patients Have the
Right To Be Free of
Restraints & Seclusion
except when medically necessary
for treatment or safety.
What is your role in helping
to reduce the need for restraints?
What Can You Do To Reduce The
Need For Restraints or Seclusion?
• Stay calm and non-threatening
• Verbal de-escalation techniques
• Decrease in stimulation
• Physical / diversion activity
• Relaxation techniques / soothing music
• Pain management
• Increase visual observation by moving patient within line of vision of
nurses station
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Our Patients Have The Right Not To Be
Transferred To Another Facility . . .
unless the patient has received a complete explanation of the need for
transfer & the alternatives to such a transfer, and unless the transfer
is acceptable to the other facility
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Our Patients Have
The Right To Pain
Management
To have their pain assessed and managed.
What can you do to be involved in pain
management?
What You Can Do To Help!
 Pain management is more than medication!
 Pain management includes, but is not limited to, medication, positioning, personal
care, diversion and imaging, massage, and various other techniques, as well as
touch, and presence.
 Every hospital employee can be proactive in pain management simply by giving
the patient your full attention, asking the right questions, and attempting to
meet the patient’s needs
 If you work in a non-clinical role and the patient is having pain, please notify a
clinical employee
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Our Patients Have The Right To
Know Their Rights!
Patients and others shall be advised of
these rights and responsibilities via publications
provided to patient / families at time of admission.
Signage is also displayed throughout the hospital.
Our Patients Have The Right
To File A Complaint!
• Patients & families or representatives should always feel that they can
share a concern or make a complaint
• This will have no adverse effect on the patient’s care or future access to
care
• How to file a complaint is provided to the patient upon admission
• Take complaints to Manager, Risk Management
• Joint Commission has a 24/7 hotline 1.800.994.6610
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Our Patients Have
The Right
To File A Complaint!
Concerns and Complaints
We are committed to
providing the highest quality care. If
you have a concern regarding
your care, please ask to speak to
the charge nurse on your unit, the
patient advocate at your hospital,
call the hospital administrator , or
call our Compliance and Ethics
Hotline (800) 540-5877.
If the hospital does not respond to
your complaint to your satisfaction,
or if you are unhappy for any other
reason, you may contact any of the
following resources from the list
provided:
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Joint Commission’s Office of
Quality Monitoring
(800) 994-6610
[email protected]
West Virginia Advocate, Inc.
1207 Quarrier Street
Charleston, WV 25301
(304) 346-0847
Office of Health Facility Licensure and
Certification
(to report the violation and to request an
inspection of the facility)
WV Department of Health and Human
Resources
Capitol and Washington Streets
One Davis Square, Suite 101
Charleston, WV 25301
(304) 558-0050
State Ombudsman c/o West Virginia Commission
on Aging
Charleston Towne Center Mall
1900 Kanawha Boulevard East
Charleston, WV 25305
(304) 588-2241
Patient Responsibilities
 To provide accurate and complete information about health history, current complaints,
medications, allergies, demographics
 For making known whether s/he fully comprehends information of treatment
 For his/her actions if treatment is refused or not followed
 Following hospital rules and regulations
 Considerate of the rights of other patients, personnel, and visitors
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References
Administrative Policies
Berkeley Medical Center: Administrative Policy:

300 Patient Rights & Responsibilities

305 Management of Patient Family Complaints, Grievances

319 Interpretive Services

320 Obtaining Interpreter & Other Services
Jefferson Medical Center Policies:

Interpretative Services

Patient Rights & Responsibilities
•
U.S. Department of Health & Human Services. http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html
•
The HITECH Act and HIPAA.
http://www.hipaasurvivalguide.com/hipaa-survival-guide-21.php
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