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31 Cards in this Set
- Front
- Back
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TJC |
The Joint Commission |
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CAP |
College of American Pathologists |
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The Joint Commission |
* voluntary, non-governmental agency * Oldest and largest healthcare standards * Establishes standards for operation of hospitals and other health-related facilities and services * Seeks to improve healthcare for public through evaluation * Focuses on improving safety for patients and residents * 4 scoring categories |
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The Joint Commission 4 categories |
* Direct Impact Standards Requirement * Indirect Impact Standards Requirement *Situational Decision Rules *Immediate Threat to Health Safety |
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Direct Impact Standards Requirement |
may pose an immediate risk to patient |
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Indirect Impact Standards Requirement |
Less of an immediate risk to patient safety and quality care but over time may put patients at risk Ex.) Lack of documentation for ongoing education of the staff |
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Situational Decision Rules |
Ex.) Finding unlicensed personnel working in a facility in a state where license is required, misrepresenting information to the TJC * Preliminary Denial if Accreditation (PDA) will be recommended |
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Immediate Threat to Health and Safety |
Ex.) Blood bank fridge temp. not in range, serious problems with specimen labeling or Patient ID * Preliminary Denial Accreditation (PDA) would be issued until corrective action was validated |
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NPSGs |
National Patient Safety Goals * Overseen by safety panel, physicians, nurses, risk managers, and other healthcare professionals |
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CLIA 88 |
Clinical Laboratory Improvement Amendments of 1988 |
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Clinical Laboratory Improvement Amendments of 1988 |
* Establish quality standards that apply to all labs Ex.) Quality assurance, quality control, proficiency testing, Lab records, personnel qualifications **Specimen collection** |
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Clinical and Laboratory Standards Institute (CLSI) |
* global, non-profit, standards-developing organization * Mission: to develop and promote best practices in clinical and lab testing * Develops voluntary guidelines and standards for all area of the lab |
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Tort |
A wrongful act against person, property, or reputation Ex.) Assault, battery, fraud, invasion of privacy, breach of confidentiality, malpractice |
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Avoiding lawsuits |
* aquire information consent before collecting specimens * Respect a patients right to confidentiality * Strictly adhere to accepted procedures and practices * Use proper safety containers and devices * Listen and respond appropriately to patient's request * Accurately and legibly record all patient info * Document incidents or occurrences * Participate in continuing education to maintain proficiency * Perform at prevailing standard of care * NEVER PERFORM PROCEDURES YOU ARE NOT TRAINED TO DO |
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Informed consent |
* Requires voluntary and competent permission * Requires adequate information given to patient * Non-technical term * Obtained before procedure |
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Expressed consent |
* Should be specific and cover all procedures to be performed * Verbal: should be followed be entry in patients chart * Written: gives best possible protection, must be signed by provider and patient, must be witnessed by 3rd party |
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Implied consent |
* Patient's actions imply consent * May be necessary in emergencies * Laws very from state to state |
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HIV consent |
*Most states have legislation for consent for HIV tests * Clients must be advised on test and it's purpose, how test will be used, and meaning of test and it's limitations |
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Consent for minors |
* minor can't give consent * Only parent or guardian can * Violation are liable for assault and battery |
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CMS |
Centers for Medicare and Medicaid Services |
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NAACLS |
National Accrediting Agency for Clinical Laboratory Sciences |
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Threshold values |
A level of acceptable practice beyond which quality patient care cannot be assured |
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The Litigation Process |
Phase 1: when a patient incident occurs or a prior possible injury Phase 2: injured party consults attorney Phase 3: trial phase Phase 4: appeal |
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Quality Assurance (QA) |
Refers to processes used to create standardization for quality service or product and prevention of problems |
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Quality Control (QC) |
Specific activities and techniques that are performed to fulfill the requirements for a quality service or products |
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Incident Report |
Is to be completed when an occupational injury or exposure has occurred Ex.) Accidental needle stick, delayed medical condition |
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Assault |
An act or threat causing another to be in fear or immediate battery (harmful touching) |
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Battery |
An intentional harmful or offensive touching of, or use of force on, another person without consent |
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Fraud |
A deceitful practice or false portrayal of facts either by words or by conduct, often done to obtain money or property |
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Invasion of Privacy |
The violation of one's right to be left alone Ex.) Physical intrusion, unauthorized publishing, release of private information |
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Breach of Confidentiality |
The failure to keep privileged medical information private |
