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

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

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 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,

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 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

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 white-out 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 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 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

Ethical Issues Moral Issues AST Code of Ethics Patient Bill of Rights Surgical Consents Principles of Documentation Legal Issues Operating Room Incidents Sentinel Events