RT101 Module A Exam 2 Prep PDF

**[RT101 Module A -- Medical Ethics 1 & 2, & Legal Issues in Healthcare]** **Medical Ethics 1** A pyramid of needs and needs with Mediterranean Sea in the background Description automatically generated with medium confidence Maslows Hierarchy of Needs **How to Show Professionalism in Healthcare**...

**[RT101 Module A -- Medical Ethics 1 & 2, & Legal Issues in Healthcare]** **Medical Ethics 1** A pyramid of needs and needs with Mediterranean Sea in the background Description automatically generated with medium confidence Maslows Hierarchy of Needs **How to Show Professionalism in Healthcare** - Advocate for Pts - Communicate Effectively - Work as a Team - Keep a Positive Attitude - Deliver Top-Quality Care - Maintain Your Integrity **Empathetic Care** - **Empathy** -- a sensitivity to others that allows you to meet their needs constructively rather than merely sympathizing or relating to their distress - Ex: show concern & care for a pt who was involved in a tragedy while quickly & accurately providing the images needed for a rapid diagnosis or treatment **Moral principles** -- instill a sense of right & wrong with a desire to do the right thing **Professional ethics** -- define correct moral behavior while performing our professional duty **Laws** -- are a means used by the government to enforce commonly accepted moral standards in society  **Personal Morality** -- the rules we live by and believe to be morally correct - Based on the lessons of right vs. wrong that were taught to us at an early age - Plays an important part in decision--making as professionals - This will change for everyone because it's personal, different views (things we've experienced **Societal morality** -- beliefs we share with our community about values & duties - Influences: - Laws - Customs - Moral components of culture **Group Morality** -- develops from shared concepts & beliefs - Radiographers (professional groups) have certain moral principles to adhere to - *Providing efficient care to patients* - *Maintaining professional competence* - *Maintaining confidentiality of pt information* - We all understand the basic concept of the evolution of "ethics." Our viewpoints are grounded in our **moral beliefs** or principles of right and wrong; they represent very broad-reaching, individualistic, and subjective beliefs. Certain subsets of moral beliefs could be called **ethical codes,** and they spring from our fundamental moral beliefs. - To further distinguish what's right from what's wrong in providing medical imaging and radiation therapy services, we narrow it down a bit \-- to - **professional ethics.** You could also describe these as moral responsibilities within a given profession. - The ARRT outlines a definitive set of professional ethics in its *Standards of Ethics*. The standards are comprised of a **Code of Ethics,** which is an aspirational guide for maintaining general professional conduct in radiologic technology, and the **Rules of Ethics**, which are specific, mandatory standards of minimally acceptable professional conduct. - As we move from the bottom of the pyramid to the top, we have moved from broad-reaching moral beliefs to narrowly defined rules, from an individualistic orientation to a profession-wide application, and from highly subjective to highly objective. **Ethics** -- a branch of philosophy (knowledge) that deals w/ moral principles. "applied morality" - The proper response to any situation - Ethics consist of the standards of behavior our society accepts **Group Ethical Behavior** - Includes the duties & obligations placed on us by our profession - The essential principles of ethical behavior for the group are stated in the *Code of Ethics or ethical code* - When you get hired, there will be duties placed on you that are not discussed; it's implied **Standards of Ethics for Radiographers** - Governing documents that articulate the types of behavior expected of a Radiographer & describe behavior that is not tolerated - Code of Ethics - Rules of Ethics (*all information is on ARRT site)* **Structure of *Standards of Ethics*** A. **Code of Ethics** - **termed "aspirational" -- what you strive to be** -- defining the R.T. you strive to be. This Code serves as a guide by which candidates *and* Registered Technologists may evaluate their professional conduct as it relates to patients, healthcare consumers, employers, colleagues, and other members of the healthcare team. B. **Rules of Ethics** - 22 of them, to be exact. Unlike the aspirational code, these are mandatory standards of minimally acceptable professional conduct. Some of the Rules cover acts of omission; others, acts of commission. NOTE: Rules are enforceable. C. **Administrative Procedures** - provide for the structure and operation of the Ethics Committee in handling challenges raised under the Rules of Ethics. This is similar to "due process" in the legal system; however, ARRT is bound by these Administrative Procedures rather than the technicalities usually employed in legal proceedings. **Standards of Ethics** - Aspirational Guide to... - Professional Conduct - Providing services w/ full respect - Delivering discrimination-free pt care - Practicing technology appropriately - Acting in the best interest of the pt - Acting as the physician's agent - Minimizing radiation exposure (Remember ALARA -- as low as reasonably achievable) - Conducting oneself ethically - Respecting privacy - Continually improving knowledge and skills - We have 24 CE every 2 years, to continue to progress through the profession -- standard of ethic **Rules of Ethics** (look at PWP slides for additional information on each rule) **Rules \#1 - \#3** - Fraud or Deceptive Practices - Fraud involving certification and registration -- apply every 2yrs you have to answer these questions - Fraudulent communication regarding credentials - Fraudulent billing practices - Rules \#1 through \#3 pertain to misrepresenting your certification and registration status. Most often, these rules apply when an individual submits an altered ARRT credential card or an altered state license for employment purposes. **Rules \#4 - \#6** - Subversion - Examination/CQR Subversion - Education subversion - *Continuing Education Requirements (CE), clinical experience and competency requirements, structured education activities, and/or ARRT's Continuing Qualifications Requirements (CQR)* - Failure to cooperate with ARRT investigation **Rules \#7 - \# 9** - Unprofessional conduct - Failure to conform in a minimal acceptable standards - Sexual misconduct - Unethical Conduct - These Rules cover unprofessional conduct that: - is a departure from applicable federal, state, or local government rules regarding radiologic technology practice; or - may create unnecessary danger to a patient's life, health, or safety. **Rules \#10 - \#12** - Scope of Practice - Technical incompetence - Improper supervision in practice - Improper delegation or acceptance of a function - As an R.T. **you** are responsible for knowing what you can or cannot do within your scope as a Registered Technologist. **Rules \#13 AND \#14** - Fitness to Practice - Actual or potential inability to practice - Inability to practice by Judicial Determination - These Rules involve actual or potential inability to practice radiologic technology with reasonable skill and safety to patients by reason of illness; use of alcohol, drugs, chemicals, or any other material; or as a result of any mental or physical condition. **Rules \#15 - \#17** - Improper management of patient records - False or deceptive entries - Failure to protect confidential patient information - Knowingly providing false information **Rules \#18 AND \#19** - Violation of State or Federal Law or Regulatory Rule - Narcotics or Controlled Substance Law - Regulatory authority or certification board rule **Rule \#20** - **Criminal Proceedings -** R.T.s are required to notify ARRT of any ethics violation, including state licensing issues and criminal charges and convictions, **within 30 days of the occurrence or during their annual renewal** of certification and registration, whichever comes first. Applicants for certification and registration are required to notify ARRT of any ethics violation, including state licensing issues and criminal charges and convictions, within 30 days of the occurrence. **Rules \#21 AND \#22** - Duty to Report - Failure to report violation - Failure to report error **Application for Certification and Registration or Renewal** - You are responsible for providing complete & accurate info - Pay attention to the three ethics questions: criminal, regulatory, & honor code - Carefully read the Agreement for Candidates and the Written consent Under FERPA *\*This legally binding document has big consequences for you\** **Criminal Violations -- Questions asked** - Have you ever been charged with or convicted of a misdemeanor or Felony? (this includes court convictions & military courts-marital) - Has a regulatory authority or certification board (other than ARRT) ever done one or more of the following? - What conduct may constitute a violation of an honor code? **Ethical Principles & Theories** - Both moral principles & ethical theories provide guidelines for determining whether actions are right or wrong **Consequentialism** -- an action is right if the outcome is good. The act is correct if the consequences are good - Utilitarianism **Non-consequentialism** -- the rightness of an action is not solely determined by its consequences. It does not depend on consequences to make an act right or wrong **Ethics of care** -- considered situational ethics. This theory recognizes that the right actions for a pt in a situation may be from other pts or circumstances - Demands moral judgment that reflects community values such as respect, patience, tact, & kindness **Virtue-based ethics** -- related to ethics of care, considered situational - This theory places a value on virtues - Admirable character traits **Rights-based Ethics** - Rights of individuals - Place duties on others\* - Clarifies our duties - **Defines accountability** **Principlism** = (principle-based ethics) widely accepted standard for selecting and defending solutions to ethical dilemmas in the healthcare setting 1. Understand impacts 2. Do no harm 3. Protect rights 4. Protect the vulnerable 5. Address Bias [There are 6 moral principles that guide us to the right actions] - **Beneficence** -- Goodness - Actions that bring about good are considered right - **Nonmaleficence** -- no evil - An obligation to not inflict harm - **Veracity** -- truth - An obligation to tell the truth - **Fidelity** -- faithfulness - An obligation to be loyal or faithful - **Justice** -- fairness - An obligation to act with equity - **Autonomy** -- self-determination - Respecting the independence of others and acting with self-reliance *Remembering in ABC order* - *Autonomy* -- self determination; self-respect - *Beneficence* -- goodness - Commitment to the truth -- *Veracity* - Do no harm -- *Non-maleficence* - Equity -- *Justice* - *Fidelity* -- Faithfulness or loyalty; honoring professional commitments **Resolving Ethical Conflicts** **Ethical analysis** -- method of evaluating situations in which the correct action is in question. You must assess the problem objectively & come to a conclusion that you can implement & defend - Both *moral principles and ethical theories* provide guidelines for determining whether actions are right or wrong **Four Basic Steps of Ethical Analysis:** 1\. Identify the problem 2\. Develop many ways you can help, direct and assist the patient 3\. Then you will select one of them **Radiology-Specific Ethical Dilemmas** 1. Operation & Manipulation of Electronic Data a. Image cropping -- pt. gets a higher dose than is needed b. Editing metadata c. Editing image date 2. ALARA -- as low as reasonable achievable d. Dose creep -- too high of a dose when it is not needed e. Alteration of exposure indicators -- to change the numbers once the exposure is already taken **Medical Ethics 2** **Patients rights --** Radiographers' major ethical concern is to protect pt rights, at all times - All pts are entitled to considerate & respectful care - Pts are entitled to info about their well-being & hospital stay. As well as to know the names & qualifications of those providing care - *As a radiographer, you will greet every pt, introduce yourself, and state your title - what you do.* - All risks will be discussed involving any procedures needing to be performed in Radiology - You must be ready & prepared to explain your study, & all that will entail **Patient Privacy** - The right to privacy implies that a pts dignity remains respected & that you are making every effort to maintain their modesty - Radiographers/Radiologist should never be left alone w/ a pt of the opposite sex, especially during cases when private areas may be exposed \*Always use 2 identifiers for pt identification: ask full name, DOB, & check pts armband\* \- Confidentiality is included in a pts right to privacy under HIPAA - Things to know: - When calling a pt from the waiting room or in ALL public areas, use only first names - Be sure there isn't any valuable pt. info on the daily schedule, can not be hung, or must be hidden - All health record info used for statistical, or research purposes must be depersonalized by eliminating any names, numbers, codes, or biometric identifiers associated. - Consent can be rescinded at any time - If adult pt is conscious and able to understand, nobody else can give consent **Implied Consent** -- granting permission for treatment w/o expressed consent. Implied due to continued acceptance of hospital care. (non-verbal) **Coral Consent** -- (pt. states consent, as legal as written but harder to prove.) **Written Consent** -- pt. reads, understands, and signs form - **Informed Consent** -- required for any procedure that involves substantial risks or complications - Acts as an agreement to care - Ex in Radiography: Myelogram, Arthrogram, lumbar puncture - Must include the risks and benefits of studies - *The Joint Commission* requires ***documentation of all the elements of informed consent as part of the legal record.*** - The following are the required elements for documentation of the **informed consent** discussion: - The nature of the procedure - The risks and benefits and the procedure - Reasonable alternatives - Risks and benefits of alternatives - Assessment of the patient\'s understanding of elements 1 through 4. **Issues of Concern** **Adequacy of Informed Consent** The required standard for informed consent is determined by the state. The three acceptable legal approaches to adequate informed consent are: 1. **Subjective standard**: *What would this patient need to know and understand to make an informed decision?* 2. **Reasonable patient standard***: What would the average patient need to know to be an informed participant in the decision?* 3. **Reasonable physician standard***: What would a typical physician say about this procedure?* **Exceptions to Informed Consent** - The pt is incapacitated - Life-threatening emergencies w/ inadequate time to obtain consent - Voluntarily waived consent **Children and Informed Consent** - Children (typically under 17) cannot provide informed consent - Parents must permit treatments or interventions - Not informed consent but "*informed permission"* **Patient's Bill of Rights** - Usually found when the pt first enters the hospital posted in the waiting room, exam room, or dressing room **Death with Dignity** - **DNR** -- Do Not Resuscitate, if death is imminent then there are to be no resuscitation attempts to prolong a pts life - **Advance Directive** -- outline of specific wishes about the medical care you wish to receive in the event the pt loses the ability to make or communicate decisions - **Power of Attorney (Healthcare Proxy)** -- a trusted person chose to act on a pts behalf - **Living will** -- instructions are given by pt. as to the extent of treatment to be done, in case pt cannot do so themselves **Legal Issues in Healthcare** - Laws -- a system of rules the government uses to enforce commonly accepted moral standards in the interests of society - Violations of the law may lead to fines, imprisonment, or loss of x-ray license **The Law** - **Criminal Law** -- against the state or society at large - **Felony** -- serious crime, punishable by imprisonment - **Misdemeanor** -- less significant crime, punishable by fines, or jail less than 1 year - **Civil Law** -- deals w/ the rights & duties of indivduals w/ respect to one another. - Seeking compensation rather than punishment - Fines (no jail time) **Two Types of Civil Law** - **Tort Law** -- is the body of law that deals w/ the legal theories of negligence & strict product liability - **Contract Law --** deals w/ how a valid, enforceable contract is formed & what should happen if the parties to the contract fail to perform as promised. **Tort** - Tort -- a civil wrong committed against the person or property of another - There are ***5 Intentional*** misconducts (torts): - Assault - Battery - False Imprisonment - Invasion of Privacy - Libel/Slander 1. **Assault** -- the THREAT of touching with injury or made to feel threaten 2. **Battery** -- unlawful touching of a person without consent 3. **False Imprisonment** -- the unjustifiable detention of a person against his or her will 4. **Invasion of Privacy** -- intrusion into a pts private affairs, disclosure of private information 5. **Libel & Slander** -- the malicious spreading of information that causes defamation of character or loss of reputation a. **Libel** refers to written information (ex: email) b. **Slander** is often applied to verbal communication (defamation) **Unintentional Misconduct (Torts)** - Negligence - Malpractice - **Gross Negligence** -- a negligent act that involves "reckless disregard for life or limb" - **Contributory Negligence** -- the act of negligence in which the behavior of the injured party contributed to the injury - **Corporate Negligence** -- applies when an organization hospital, as an entity in negligent *Negligence/Malpractice claims must prove 4 things in court:* 1. Duty 2. Breach 3. Causation 4. Damages/harm **Legal Doctrines** - **Res ipsa loquitur** literally means "the thing speaks for itself" - when loss & negligence are so apparent that they would be obvious to anyone. - **Respondeat superior** "let the master respond" employer is responsible for employees' negligent acts. - **Vicarious liability** (borrowed servant) -- The physician may be liable for wrongful acts committed by hospital employees under the physician's orders. - **Personal Liability** -- person is responsible for their own actions. **Clinical Life in Radiology** **Hospital Computers/** departmental use/personal log-in: - Scheduling, Billing, Charting - Entering charges & completing exams - Generating orders - Enter, accessing, & storing medical info - RIMS (Radiology Information Management System) - RIS (Radiology Information System - EMR (electronic medical record) - PACs - Telemedicine-sending health information over the internet RT Must: - Determine the chance of pregnancy if applicable & document - Obtain an accurate & thorough history of pt. complaint - Complete exam paperwork on (RIS) Radiology Information System - QC completed films with PACs (picture archiving & communication system) - All out-patient scripts may be scanned into the pts electronic chart **DO NOT** make a diagnosis, prognosis, etc - Can not state "pt is drunk" Must state what you observe pt. unsteady, unable to hold position **NCP** -- No chance of pregnancy - You can document what the pt tells you, pt. states NCP Requisitions required information: - Pt name - Exam to be performed, w/ laterality specified - Suspected diagnosis (ICD code) - Ordering Physician with signature - Date - Radiation & Oxygen are considered a drug - [must have a doctor's script in order to perform any Radiography exam] **Malpractice** -- when a patient is injured due to error caused by the healthcare provider \*Malpractice Prevention by applying the **7 C's\*** - **Competence --** knowing and adhering to professional standards and maintaining professional competence reduce liability exposure. - **Compliance --** compliance of health professionals with the policies and procedures in the medical office and hospital avoids patient injuries and litigation. - **Charting --** charting completely, consistently, and objectively can be the best defense against a malpractice claim. - **Communication -** patient injuries and resulting malpractice cases can be avoided by improving communications among health care professionals. - **Confidentiality -** protecting the confidentiality of medical information is the legal and ethical responsibility of health professionals. - **Courtesy --** A courteous attitude and demeanor can improve patient rapport and the lessen the likelihood of lawsuits. - **Caution --** personal injuries can occur unexpectantly on the premises and may lead to lawsuits. - \*If the injured person is a patient, the details of the incident must also be recorded in the patient's chart **The Joint Commission** - Accreditation agency for healthcare institutions that examine policies/procedures of the organization with an onsite examination. - Must demonstrate a high standard of care. - If an institution loses its accreditation, it also loses the ability to provide for Medicare patients. **Good Samaritan Law:** - Provides immunity to any individual including health care workers who in good faith render emergency care at the scene of an accident or an emergency. **Cultural Diversity in the healthcare system** - **CULTURE** a person's background and experience heavily influence personal beliefs. Radiographers must provide patient care in sensitive situations.