Risk Management

The efforts of a health care provider organization to collect and utilize data to decrease the chance of harm to patients or staff or damage to property

Accountability

Obligation to disclose details for evaluation; commonly used to mean “to be held responsible for”

Affidavit

Voluntary statement of facts sworn to be true before an authority

Allegation

Statement one expects to prove true

Bona Fide

In good faith or innocently

case law

All legal decisions reported on a given legal subject

complaint

First pleading filed by plaintiff’s attorney in a negligence action

defendant

In criminal cases, the person accused of the crime; in civil matters, the person or organization being sued

Deposition

Method of pretrial discovery in which questions are answered under oath

Federal law

Jurisdiction is given to federal courts in cases involving the interpretation and application of the U.S. Constitution, acts of Congress, and treaties

Guardian

Court-appointed protector for an individual incapable of making his or her own decisions

Iatrogenic injury

Injury resulting from the activity of health care professionals

Indictment

Formal written accusation from a grand jury

Jury

• Group of citizens who decide the outcome of a criminal or civil trial

Larceny

Taking another’s property without consent

Law, common

Principles that have evolved and continue to evolve on the basis of court decisions

Law, statutory

Any law prescribed by the action of a legislature

Liability

Obligation to do or not do something

Liability, corporate

Obligation to do or not do something that is the responsibility of the corporate body

Liability, personal

Obligation by the individual to do or not do something

Malpractice

Professional misconduct that results in harm to another; negligence of a professional...Need Insurance, negligence needs to happen for this to happen.

Negligence

Omission (not doing) or commission (doing) of an act that a reasonable and prudent individual would not do under the same conditions; may be associated with the phrase “departure from the standard of care”

Negligence, criminal

Reckless disregard for the safety of another; willful indifference

Perjury

Intentionally providing false testimony under oath

Plaintiff

Person who initiates a lawsuit

Precedent

Legal principle, created by a court decision, that provides an example or authority for judges deciding similar issues later

Standard of care

Description of conduct that is expected of an individual or professional in a given circumstance

State law

State statutes, regulations, principles, and rules having the force of law

Subpoena

Court order to appear and testify or produce required documents

Tort

Civil wrong; may be intentional or unintentional

Trial

When parties to a dispute present evidence in a court of law in order to achieve a resolution or, in a criminal act, to determine a person’s innocence or guilt

Aeger primo

(WILL BE ON CERTIFICATION EXAM)

“The Patient First” (motto of the AST)

Doctrine of corporate negligence

Health institution may be found negligent for failing to ensure that an acceptable level of patient care was provided.

Doctrine of borrowed servant

One who is controlling or directing the employee has greater responsibility than the one who is paying the employee. Courts frequently found that the surgeon was liable for any negligent act committed in his or her presence in the operating room under the captain of the ship doctrine. However, some rulings have found that the surgeon, under the borrowed servant rule, is not always responsible if a surgical technologist or registered nurse on the surgical team fails to carry out a routine procedure that he or she was properly educated to perform.

Doctrine of foreseeability

is the ability to see or know in advance; the ability to reasonably anticipate that harm or injury may result because of certain acts or omissions.

Doctrine of the reasonably prudent person

Persons should perform an action as would any reasonable person of ordinary prudence. In law,the reasonable person is not a typical person but a collection of the community’s judgment as to how the typical community member should behave in situations that might pose a threat of harm to the public

Primum non nocere

(possibly on state exam)

“Above all, do no harm.”

Res ipsa loquitur

(Possibly on state exam)

“The thing speaks for itself;” harm obviously came from a given act or thing of which the defendant had sole control.

Respondeat superior

“Let the master answer”; employer is responsible for the actions of his or her employees.

Tort law

describes any civil wrong independent of a contract. Tort law provides a remedy in the form of an action for damages. Most actions against operating room personnel are civil actions rather than criminal and may be either intentional or unintentional.

Intentional Torts

1. Assault
2. Battery
3. Defamation
4. False Imprisonment
5. intentional infliction of emotional distress
6. invasion of privacy

3 elements of proof

1. The defendant’s action was intended to interfere with the plaintiff or plaintiff’s property.
2. The consequences of the act were also intended.
3. The act was a substantial factor in bringing about the consequences.

Unintentional Torts

1. malpractice
2. negligence
3. pt. misidentification
4. performing an incorrect procedure
5. foreign bodies left in pt.
6. pt. burns
7. falls or positioning errors resulting in pt injury
8. Improper handling, identification, or loss of specimens
9. Incorrect drugs or incorrect administration
10. Harm secondary to use of defective equipment/ instrument
11. Loss of or damage to patient’s property
12. Harm secondary to a major break in sterile technique
13. Exceeding authority or accepted functions; violation of hospital policy
14. Abandonment of a patient

Consent

a term that refers to permission being given for an action.

Express consent

a direct verbal or written statement granting permission for treatment In health care, written form is the desired form of consent.

Implied consent

is consent in which circumstances exist that would lead a reasonable health care provider to believe that the person, or patient, had given consent although no direct or verbally expressed words of consent had been given.

informed consent

A situation in which a patient gives voluntary permission to another party (i.e., surgeon or anesthesia provider) to perform the procedures that have been explained; includes the risks, benefits, possible complications, and alternative treatment options

documentation

used broadly to refer to the placing of information into a patient’s medical record (chart).

The medical record

is the combined account of the interaction between the patient and the health care providers during a given incidence of illness or treatment.

Medical Record Includes

• • Identification of the patient
  • Identification of the physician(s), nurse(s), and other health care providers involved in the patient’s care (e.g., the operating room record will name each member of the surgical team)
  • Patient’s medical history and physical examination
  • Diagnosis
  • Treatment plan, details, and results
  • Medication record
  • Physical findings during the hospital stay
  • Discharge condition
  • Possible follow-up treatment plan

legal record

of all births and deaths that take place there. Patient charges are made part of the record, and patients and insurance providers receive detailed reports of charges. Department order forms are used to secure items for patient care and to verify the accuracy of the charges.

Incident reports

Mechanism for reporting an incident, usually by completing a document describing what happened, related to any adverse patient occurrence. constitute much of the information used by the hospital in risk management. Falls, medication errors, intraoperative burns, and loss of specimens are examples of events that would require reporting.

advance directive

Written instructions expressing the patient’s wishes concerning the types and amount of medical treatment to be rendered in the event the patient can no longer make those types of decisions

Two examples of advanced directives are a living will and a durable power of attorney.

Risk management objectives for a hospital are to:

• Minimize risks to patients, visitors, and hospital employees.
• Avoid or control financial loss to the hospital.
• Identify actual or potential causes of patient and employee accidents through risk detection, evaluation, and prevention.
• Implement programs, policies, and procedures to eliminate or reduce occurrences.
• Collect and use data to decrease harm to patients and staff or damage to property.

Two issues that have an impact on the hospital’s risk management policies and plans

reduced staffing and employee rights.

Medical Errors

• In-patient error reduction in medicine began to gain attention in the second half of the 1990s with the release of the Institute of Medicine’s (IOM’s) To Err Is Human: Building a Better Health System.
• The IOM claimed that more people die each year from medical errors than from car accidents, AIDS, and breast cancer combined (making medical errors the country’s eighth leading cause of death).

Best Weapon for Reduction of Medical Errors

Technology

technologies include bar-coded medications and identification strips, handheld wireless devices, and computer drug-order-entry systems. A study at two Veterans Administration (VA) hospitals in Kansas found that these devices reduced medication error rates by 70% over a 5-year period.

How can surg techs reduce medical errors

closely following written policies and procedures and by following standard precautions related to the use of personal protective equipment. be aware of the location and proper use of all emergency equipment

Safe Medical Device Act

Established in 1990, this act requires medical device users to report to the manufacturer and/or FDA incidents that reasonably suggest that there is a probability that a medical device has caused or contributed to the death, serious injury, or illness of a patient

Examples of Medical devices

includes, but is not limited to, electronic equipment such as ventilators and monitors, implants, syringes, needles, catheters, and disposables.

Malpractice Insurance

Hospital employees who commit negligent acts are typically covered by insurance polices provided by the facility, as long as the negligent act was committed within the scope of the institution’s policies and procedures.

Health Insurance Portability and Accountability Act (HIPAA)

the first federal act to establish privacy standards to protect patients’ medical records and other health-related information. It took effect on April 14, 2003. The standards were developed by the Department of Health and Human Services (HHS).

Standards of HIPAA

provide the ability for patients to easily access their medical records and have more control over how their personal health information is disclosed. HIPAA standards represent a major step forward in providing additional privacy protections and control to the health consumers across the United States.

Key Provisions of HIPAA

Access to medical records, notice of privacy practices, limits on use personal medical info, prohibition on marketing, confidential communications, complaints

3 main objectives of HIPAA

1. Ensure health insurance portability even in the face of preexisting medical conditions.
2. Guarantee the privacy of health information of all patients.
3. Decrease the incidences of fraud and abuse in the health care community.

moral principles

Guides for ethical decision making that include the concern individuals have for the well-being of others, respect for individual autonomy, basic justice, prevention of harm to others, and refusal to take unfair advantage

codes of ethics

provide rules of conduct and standards of behavior that include principles such as impartiality, objectivity, duty of care, confidentiality, and full disclosure. Surgical technologists should be trustworthy and honest.

Guidelines, usually expressed in a series of statements, that provide ethical standards of conduct for a profession

In 1985 the AST established

Morality

dictates codes of conduct, which are put forward by a society and used as a guide to behavior by the members of that society

Ethics

defines what is good for the individual and for society and establishes the nature of duties that people owe themselves and one another.

system of moral principles and rules that become standards for professional conduct, and should not be confused with morality

Scope of practice

Professional duty limits based on state and federal law and on an individual’s education and experience

Federal law
Federal agencies
State law and regulations
Legal precedent
Hospital policy
Professional organizations

credentialing

Process by which an agency or organization establishes a minimum knowledge base for a given health care profession and awards a credential to individuals who meet the minimum knowledge level. does not verify competency because competency is an ongoing evaluation.

examples of credentialing

• Registration: Formal process by which qualified individuals are listed in a registry
• Certification: Recognition by an appropriate body that an individual has met a predetermined standard
• Licensure: Legal right granted by a government agency in compliance with a statute that authorizes and oversees the activities of a profession

Accreditation

Process whereby businesses, educational institutions and programs, and health care organizations are determined to meet standards and performance criteria as established by an accrediting agency

CAAHEP put out a new curriculum every 4 years or so

Patient Bill of rights

In 1972 the AHA adopted the 12 rights known as the Patient’s Bill of Rights that emphasized collaboration between patients, physicians, and hospitals is essential to optimal patient care.

Is now called Patient Care Partnership: contains plainer language that informs the patient about what he or she should expect during a hospital stay with regard to his or her rights and responsibilities.

6 rights of patients

• High-quality hospital care
• A clean and safe environment
• Involvement in the patient’s care
• Protection of patient privacy
• Help when leaving the hospital by preparing the patient and family
• Help with bill and insurance claims

when and how was the patient care partnership reinforced

The Patient Care Partnership is reinforced in The Patient Self-Determination Act of 1990. This act says that each patient has a right under state law to make decisions concerning his or her care, including the right to refuse treatment.

Factors for ethical decision making

• Personal values
• Accountability for one’s actions
• Responsibility for one’s actions
• Religious beliefs
• Cultural beliefs
• Corporate integrity
• Method(s) of problem solving

Issues that may create personal or vocational discomfort

• Animal experimentation
• Assisted suicide
• Care of individuals with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) or other communicable diseases
• Elective abortion
• Elective sterilization
• Gender reassignment
• Genetic engineering
• Good Samaritan law
• Human experimentation
• Newborn with a severe disability
• Organ donation/transplantation
• Quality versus quantity of life
• Refusal of treatment (especially for a child)
• Reproductive procedures
  • In vitro fertilization
  • Artificial insemination
• Stem cell research
• Substance abuse
  • Self
  • Knowledge of impaired health care provider
• Termination of care and right to die
• Workplace violence

What is the AST Code of ethics

1. To maintain the highest standards of professional conduct and patient care
2. To hold in confidence, with respect to the patient’s beliefs, all personal matters
3. To respect and protect the patient’s legal and moral rights to quality patient care
4. To not knowingly cause injury or any injustice to those entrusted to our care
5. To work with fellow technologists and other professional health groups to promote harmony and unity for better patient care
6. To always follow the principles of asepsis
7. To maintain a high degree of efficiency through continuing education
8. To maintain and practice surgical technology willingly, with pride and dignity
9. To report any unethical conduct or practice to the proper authority
10. To adhere to the Code of Ethics at all times with all members of the health care team