Ch 26 Patients Rights Powerpoint Ch 26 cobb information(4) - Read-Only.pdf

Patient Rights Patient Care 1203 Cobb Additional Information Patient's Rights Consent Confidentiality (HIPAA) American Hospital Association AHA Patient Care Partnership, Patients Bill of Rights Privacy Extent of Care (DNR) Access to info living will, proxy, adv directives research participation Lega...

Patient Rights Patient Care 1203 Cobb Additional Information Patient's Rights Consent Confidentiality (HIPAA) American Hospital Association AHA Patient Care Partnership, Patients Bill of Rights Privacy Extent of Care (DNR) Access to info living will, proxy, adv directives research participation Legal Issues Verification, patient id Common terminology Battery Negligence Malpractice Beneficence Legal Doctrines Respondeat superior res ipsa loquitor Restraints Versus positioning aides Used to eliminate motion Manipulation of electronic data Exposure indicator Processing Algorithm Brightness/Contrast Cropping or masking off anatomy Documentation Changes to order Medical event ARRT Standard of Ethic Patient’s Rights Consent: When a patient enters the hospital/facility, they sign a general consent to treatment. In addition, when surgery or experimental procedures are done there might be an additional consent form confirming the patient understands what is about to be done. The patient has the right to refuse a treatment. It is the doctor’s responsibility to inform the patient of the possible consequences of refusing a recommended treatment. Types of Consent Informed Consent: person's agreement to allow something to happen (such as surgery) that is based on a full disclosure of the facts needed to make the decision intelligently—that is, knowledge of risks involved, alternatives, benefits, and other information needed by a reasonable person to make a decision. Implied Consent: Person’s agreement to allow something to happen which is not expressly given but rather inferred from a person’s actions or inactions. HIPAA Be confident that you know what HIPAA stands for. This is often a tricky question and easily confused. Health Insurance Portability and Accountability Act. ○ ○ Enacted under the US department of Health and Human Services in 2003. No information regarding a patient can be released without specific permission from the patient. Summary of the law: ○ ○ ○ ○ ○ ○ The patient must receive a clear, written explanation of how the health provider may use the disclosed information. The patient will be able to see and copy records and request amendments. A history of routine disclosures must be available to the patient. Healthcare providers must obtain consent before sharing routine information on treatment, payment, and healthcare operations. Patients have the right to request restrictions on uses and disclosures of their information. Patients may file complaints with a covered provider or with HHS about violations of these rules. Examples of how HIPAA standards are used in a hospital or medical facility: 1. No schedules or documents with patients names posted in public areas. 2. Use only first name when summoning patient from public areas. Suggested. Some facilities use just last name. Your job as a radiographer is to double check their ID and DOB once you have them in a private area. Technically this is not a violation because they are not saying what your medical issue is. However, if you are at a cancer center, people are to assume you have cancer. Be careful how use a patient’s name. 3. Any thing used for research MUST be anonymised. Not traceable to a specific patient. 4. Authorization of who release is to has to be specific. Meaning, if you want information about your mammogram done at a hospital to go to your primary care and your gynecologist, both names must be listed. 5. Only specific individuals trained in HIPAA compliance are allowed access to protected information. 6. Computer files containing patient information must be encrypted. Secure access is required for this information. AHA Patient Care Partnership (Patient’s Bill of Rights) American Hospital Association (AHA)’s Patient Care Partnership is a plain language brochure that informs patients about what to expect during their hospital stay with regard to their rights and responsibilities. ○ These are: 1. High Quality hospital care 2. A Clean and safe environment 3. Involvement in your care 4. Protection of your privacy 5. Help when leaving the hospital (aftercare plan, helping to identify who can take care of you, who to release information to, coordinate with caregivers outside of the hospital) 6. Help with your billing claims AHA Patient Care Partnership (Patient’s Bill of Rights) continued: Privacy: You will receive a Notice of Privacy Practices from your facility that explains how that facility uses, discloses and safeguards patient information. In addition, this notice will tell the patient how they can obtain a copy of information about their care (access to info). Extent of Care: DNR A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating. Ideally this is done before an emergency situation. This would be included in a “Living Will” which is known as Advance Care Directive. AHA Patient Care Partnership continued: Living Will, also known as Advance Directive or Proxy) - This is a legal document that states your wishes (in the event you are unable to) concerning endof-life care. You will want to give copies of this to your doctor, family and your care team. This can be done outside of a facility by and attorney, or it can be done when you are admitted into a facility. Patient Identification You must use 2 patient identifiers (required by The Joint Commission). 1. First and Last Name 2. Date of Birth ALWAYS compare to the X-Ray order. ALWAYS double check BEFORE transporting a patient. A tort is an act or omission that gives rise to injury or harm to another and amounts to a civil wrong for which courts impose liability. Torts fall into 2 categories: Intentional Misconduct, Unintentional Misconduct (negligence) Intentional Misconduct Examples a. Assault - the “threat” of touching in an injurious way. To avoid this, radiographer should always explain clearly what is going to occur and never use threats to force cooperation. b. Battery - unlawful touching without consent. If the patient refuses to be touched, that must be respected. A radiograph taken against the patients will or ON THE WRONG PATIENT, can be considered battery. c. False Imprisonment - unjustifiable detention of a person against their will. Must ALWAYS have a doctor’s order for restraints of the hands and legs. d. Invasion of Privacy - when confidentiality has not been maintained or when the patient’s body has been improperly and unnecessarily exposed or touched. e. Libel and Slander - malicious spreading of information that causes defamation of character or loss of reputation. i. ii. Libel usually refers to written Slander usually refers to verbal Unintentional Misconduct Including Negligence and Malpractice Negligence - refers to the neglect or omission of reasonable care or caution. Malpractice - is an act of negligence in the context of a relationship between a professional a and a patient or client. Additional negligence terms: a. gross negligence - negligent act that involves “reckless disregard for life or limb”. It denotes a higher level of negligence, more serious penalties. b. contributory negligence - act of negligence when the behavior of the injured party contributed to the injury. (ex: patient has an allergic reaction to contrast and sues, however, they did not disclose past reactions on the screening). c. corporate negligence - when the hospital as a whole is negligent (ex. Did not have protocols in place for fall precautions and a patient fell) Other Legal Terms Res ipsa loquitur - literally means “the thing speaks for itself”. This is often applied when negligence is completely obvious to anyone. Example: a double dose of medication was given to a patient. Respondeat Superior - means “let the master respond”. When the employer is responsible for the actions of an employee. Ex. using the above situation, the hospital is sued instead of the nurse or pharmacist. Rule of Personal Responsibility - increasingly becoming more applied, places responsibility on the person negligent. Under this law, the radiographer can not escape personal liability even if the hospital is being sued as well. Recommended for radiographers to have their own personal liability insurance policies. Restraints vs. Immobilization (positioning aids) Immobilization techniques are used to eliminate blurring motion on an x-ray, which would also lead to increased radiation exposure for a repeat exam. Communication is key when using any immobilization technique. You are to never “restrain a patient” against their will. The only time you should have anything to do with restraints is to return a restraint back into place if you had to untie it while performing an exam. Restraints of arms and legs ALWAYS have to be a doctor’s order. Documentation Changes to an Order - Must always be done by a physician. A radiographer should never determine on their own what procedure should be performed. If you feel as if it were made in error (ordered right foot and it’s the left foot in a boot), call the ordering physician to submit a new, correct order. Medical Event - Any event that occurs under your care must be reported and documented. Examples include but not limited to: reaction to contrast, wrong patient x-rayed, wrong side or part x-rayed, wrong medication administered, patient fell or injured during procedure. This falls under Standard Eight in the ASRT’s Practice Standards for Medical Imaging and Radiation Therapy. Standard Eight: The practitioner documents information about patient care, the procedure and the outcome. “Clear and precise documentation is essential for continuity of care, accuracy of care, and quality assurance.” ASRT’s statement concerning post-exposure. Use of Postexposure Shuttering, Cropping and Electronic Masking in Radiography After research of evidentiary documentation the ASRT issued opinions contained herein. Advisory Opinion It is the opinion of the ASRT based on evidentiary documentation and where federal or state law and/or institutional policy permits that: 1. It is within the scope of practice of a radiologic technologist to determine and apply appropriate pre-exposure collimation to individual projections of examinations to comply with the principle of ALARA. Postexposure shuttering, cropping, electronic collimation or electronic masking to eliminate the visibility of large regions of brightness are acceptable, where automatic processing fails to do so. 2. It is outside of the scope of practice of a radiologic technologist to use postexposure shuttering, cropping, electronic collimation or electronic masking to eliminate any anatomical information. This information is a part of the patient’s permanent medical record and should therefore be presented to the licensed practitioner to determine whether the exposed anatomy obtained on any image is significant or of diagnostic value. 3. It is outside the scope of practice of a radiologic technologist to use postexposure shuttering, cropping, electronic collimation or electronic masking to duplicate and use any acquired image for more than one prescribed view or projection on any exam. Facilities acquiring digital images are legally required to retain information in the DICOM information of each image that identifies the selected view or projection at the time of image acquisition. Using the same acquired image to represent two different prescribed views or projections is a falsification of the information in the patient medical record and imaging study made available to the licensed practitioner. The difference between ASRT and ARRT The ASRT, American Society of Radiologic Technologist, is the professional organization for radiologic technologists. They represent individual practitioners, educators, managers, administrators and students in all of the medical imaging modalities. Their goal is to advance the professions of radiologic technology and imaging specialties, to maintain high educational standards, enhance quality patient care and to further the welfare and socioeconomics or radiologic technologists. The ARRT, American Registry of Radiologic Technologists, is sponsored by the ASRT. The purposes of the ARRT are 1. Certify eligible applicants. 2. Encourage the study and elevating of standards of radiologic technology 3. Periodically publishing a listing of registrants. One way to remember which organization does what is by the definition of “registry” A registry is a place or office where registers or records are kept. Standard of Ethics - ARRT There are 2 parts to the Standard of Ethics document for the ARRT. 1. Code of Ethics - forms the first part of the Standards of Ethics. The Code of Ethics shall serve as a guide by which Certificate Holders and Candidates may evaluate their professional conduct as it relates to patients, healthcare consumers, employers, colleagues, and other members of the healthcare team. The Code of Ethics is intended to assist Certificate Holders and Candidates in maintaining a high level of ethical conduct and in providing for the protection, safety, and comfort of patients. The Code of Ethics is aspirational. 2. Rules of Ethics - form the second part of the Standards of Ethics. They are mandatory standards of minimally acceptable professional conduct for all Certificate Holders and Candidates.These Rules of Ethics are intended to promote the protection, safety, and comfort of patients. The Rules of Ethics are enforceable. 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 ASRT Practice Standards and Scopes of Practice Practice standards are authoritative statements established by the profession for judging the quality of practice, service and education. Professional practice constantly changes as a result of a number of factors including technological advances, market and economic forces, and statutory and regulatory mandates. Scopes of practice delineate the parameters of practice, identify the boundaries for practice and typically are formatted as lists of tasks that are appropriate to include as part of the work of an individual who is educationally prepared and clinically competent for that profession. Each scope of practice is limited to that which the law allows for specific education, experience and demonstrated competency. Many states have laws, licensing bodies and regulations that describe requirements for education and training and define scopes of practice for professions.