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62 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Legislation is....?
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forward looking
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What is Statutory law?
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state laws...who may practice, scope of practice
A system of law based on legislative enactments |
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Who is in charge of the executive branch?
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President or State Governor
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What does the Attorney General do?
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gives advice to administrative agencies by Interpreting the laws-not binding but....
tells how the the attorney general’s client, the executive branch will act. |
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Dagmar Nelson?
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Tried in criminal court....
for practicing medicine WON |
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Standard of Care?
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level of care generally practiced by members of the profession in the same or similar circumstances, a deviation from which represents a risk of injury to the patient/plaintiff
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Why is there only one Standard of Care in Anesthesia?
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These is only one standard of care in anesthesia because there is only one quality of care. Studies have shown that anesthesia incidents tend to occur because of human error or failure, not because of lack of education
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doctrine of res ipsa loquitur ...
(3 things must be met) |
1.) negligence must have occurred
2.) the injury was caused by something in the direct control of the defendant 3.)the injury could not be caused by any voluntary action or contribution on the part of the plaintiff |
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How do you defend yourself against Res Ipsa Loquitor?
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1.)Introduce proof that whatever instrumentalities were in the defendant’s exclusive control during the operation were not those that caused the injuries, and/or
2.) There were ways in which the incident could have occurred other than as a result of the anesthetist’s negligence 3.) In anesthesia cases, the jury chooses the believe the defendant’s expert witness or the plaintiff’s expert witness as to whether the injury would have occurred with or without negligence |
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What is common law?
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Common law is a system of law based on the principles of legal precedent
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Professional responsibility of the CRNA is usually under what 2 types of law?
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common law and civil law
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What is the federal court required to do in diversity cases?
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federal courts are obligated to try to reach the same result as would the state court
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What is a "diversity case"?
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tried in Federal court because
ammt >$50k plantiff and defenant are from different states |
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What is the Doctrine of Preemption?
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If both the federal and state govern. Enact legislation, the federal act prevails
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Why is the Doctrine of Preemption important?
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The doctrine of preemption ensures that the purpose of federal legislation will be carried out and not be affected by inconsistent state laws. In some cases, Congress may permit states to adopt their own regulations.
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Economic (compensatory)
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Economic (compensatory)- all things lost to the plaintiff as a result of the alleged negligence & resultant injury that can be measured
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Noneconomic
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intangible elements of life such as pain, suffering, loss of enjoyment of life & disfigurement, loss of sexual relations
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Punitive - Punitive damages -
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Damages awarded by a court against a defendant as a deterrent or punishment to redress an egregious wrong perpetrated by the defendant. (get a lawyer)
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How do CRNA's help their lawyer prepare for trial
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-Because of your expertise, you can suggest local anesthetists who are familiar with the standard of care, are articulate, and are not intimidated by direct questioning
-Review the medical records and know their contents -Read depositions of all witnesses before the trial begins -Take notes on aspects of testimony that can be improved upon or attacked -Assist in gathering anesthesia equipment, anatomical models or other models/items that will help educate the jury about your role as an anesthetist -Juries appreciate a witness who takes time and effort to teach them about the subject matter -Your testimony has a much greater impact on the jury when you demonstrate you are knowledgeable about the equipment and procedures -Avoid flashy clothing, jewelry and driving an expensive car to the courthouse!!!!!!!!! |
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Mother of Anesthesia?
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Alice Magaw
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how to avoid litigation
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begins with anesthesia education
Attitudes of respect for the patient and caution in treatment decisions set the stage for your career you can't prevent a patient from suing, but one can be in the best possible position to defend oneself should a suit be filed this attitude and manner of conducting oneself may deter some attorney from actually filing the lawsuit |
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What are 3 means to testify?
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1.) what you remember
2.) actual documentation 3.) habitual conduct |
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What does a deposition involve?
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at lawyer's office
court recorder..swearing in Q&A |
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Regarding litigation...broad statement..memorize
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Documented communication with families as a primary defense against malpractice litigation, but only when accompanied by comprehensive and legible documentation of perioperative events
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What are the five elements of informed consent?
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1.) explanations about the nature of treatment
2.) risks 3.) possible complications 4.) expected benefits and outcomes (never make guarantees about outcome) 5.) alternative forms of treatment |
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Retroactive coverage
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from a given date to present
If a professional desires to change insurance companies, often the new insurer will take over the predecessor insurance company's responsibilities by writing its policy retroactively over the previous insurer. It picks up the retroactive date, the first date of coverage, offered by the previous insurer and charges a premium based on the number of previous years of coverage needed. |
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Tail Coverage
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an add on to a claims made policy (without this the ins company pays only for claims made during the policies active period)
to protect against claims not known about at the end of the policy period. For example, a doctor retires, allows her insurance policy to lapse, and a claim comes in six months later. In order to protect herself, the doctor purchases tail coverage. |
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What can an anesthetist do to avoid lawsuits?
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*Have an acute awareness of national standards of care, a patient’s individual circumstances and an in-depth knowledge of the specialty area that can be applied at a moment’s notice to a given factual circumstance. Complete documentation of all events and vigilant monitoring provide support for the anesthetist’s case.
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Both time and care should be taken by the CRNA to meticulously document his/her standard of care, become familiar with the deposition and trial testimony and know how to effectively support the attorney’s effort to procure a positive outcome for the provider
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neglegence
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Failure to use reasonable care that is recognized as acceptable and appropriate given the circumstances
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assault
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unlawful THREAT of actions by a person intended to inflict, by force, corporal injury
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Battery
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Unlawful constraint or physical violence inflicted on a person without his consent
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Respondeat Superior
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is based on a tort law
let the master answer master is the hospital! |
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Components of Medical Negligence
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Duty – plaintiff must prove that a duty to exercise reasonable care existed between the defendant
BREACH of the anesthetist’s duty to exercise reasonable care with the patient. This is the negligent act, error or omission part of the formula The anesthetist must act within the appropriate standard of care in providing anesthesia services to the patient The patient’s petition or complaint filed to initiate the lawsuit generally sets out the allegations of negligence. The breach must have caused physical injury to the plaintiff or their decedent Plaintiff asserts that several actions were carried out improperly or were omitted, thus making a claim that these actions, error and/or omissions constituted negligence on the part of the anesthetist |
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What is integrity?
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Critical thinking
Broad based perspectives Careful evaluation of consequences Competent justification An understanding and commitment to honest, forthright, value-driven behavior. Any action taken by a clinician must be characterized by an intent to achieve excellence, and to do so within an ethical context |
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Professionalism incorporates....
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Incorporates global vision that incorporates views of others
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Integrity in professional life
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Commitment to maintain competence
Maintain highest possible standard of care Communicate effectively both to patients and to other providers Too often professional arrogance results in written and oral communication that is misinformed |
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professionalism
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is a commitment to serve expertly and unselfishly, to advocate knowledgeably, and to act responsibly.
a state of mind and a commitment to action |
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How is professionalism is manifested?
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Professionalism is manifested in a variety of ways, including clinical competence. However, clinical competence alone is an insufficient ingredient to secure continued success of CRNAs or SRNAs as a viable entity in the workplace. It demands professionalism.
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What are values?
How are shared values developed? |
held by a group of people are part of the unique culture that binds them together
Shared values are result of coping with common problems |
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Nurse anesthesia has characteristic attitudes and behaviors that have proven successful in dealing with external challenges to the profession
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self-confidence
self control, assertiveness compulsive behavior |
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cultural norms are
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Acceptance of certain rules of behavior as norms by a group of people and transmitting that knowledge to the next generation is characteristic of a culture.
Cultural norms serve as unwritten guidelines to show individuals how to act appropriately in a variety of situations. |
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Cultural Norms specific to CRNA's are
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certain attitudes and behaviors to facilitate the provision of effective patient care.
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Dominant Rules of Behavior of Nurse Anesthesia in the United States
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Able to control and manage stressful clinical situations
Able to make independent judgments quickly Accepts a high degree of responsibility Belongs to a professional organization Committed to life-long learning of scientific facts Demonstrates self-confidence Effective in using assertiveness to facilitate role as patient advocate Engage in political activities Enjoys short-term patient care Functions effectively and calmly in life and death situations Ability to be organized with meticulous attention to detail Possesses intelligence and current knowledge Technically skilled, efficient, and clinically competent Upholds patient care values Willing to work hard and dedicate long hours to the job |
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What are Values held by CRNAs?
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Achievement
Goal attainment Assertiveness Materialism Technology Equal rights Action orientation Reliance on scientific facts |
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What are traits that set CRNA's apart from other nurses?
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Autonomy
Education and continuing education Achievement Group Identity Political Activism Technology Identity as a CRNA Technology efficient |
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Autonomy
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valued by CRNA's
making split second decisions |
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Political Activism
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Nurse anesthesia has learned to value and embrace politics as an important factor in thinking, decision making and actions
Politics influence the behavior of nurse anesthetists at federal, state and local levels and within work environments |
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What are unwritten Moral Codes?
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Unwritten moral codes set the boundaries for accepted behavior in any culture.
This is also true for CRNAs who function with a moral code and action patterns that support that code. note Loyalty to colleagues helps maintain cohesiveness of the organized group. Little evidence of jealousy among nurse anesthesia in contrast to nurses that have a power hierarchy |
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What unwritten moral codes apply to CRNA's
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Patient care values must be honored
Nurse anesthetists must be honest Nurse anesthetists are loyal Nurse anesthetists believe in equal opportunities for individuals |
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Detailed examples of the MORAL code of CRNA's
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-Patient care values must be honored
-Nurse anesthetists must be honest Admit mistakes Be able to say, “I don’t know”. Accept personal resp for actions Tell the truth at all times Nurse anesthetists are loyal Allegiance to the larger group NA Supportive of individual colleagues in a crisis Supportive of accomplishments of colleagues -Nurse anesthetists believe in equal opportunities for individuals Equality for gender and sexual preference Equality for race & religion |
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Patient Care Values of CRNAs
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Individualized care
Serving as a patient surrogate Protective care Surveillance and vigilance Using touch to communicate caring |
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Influence of Healthcare Changes on CRNA roles
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Technology
Evolution of drastic diseases Scarcity of healthcare resources Increasing demand for new and unmet services |
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Emerging roles for CRNA's
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Pharmaceutical or manufacturing companies
Agencies that deal with healthcare products and services Education, marketing or sales Advisors to public and private agencies Entrepreneurial enterprises CRNA owned practices Seminar providers Marketing of computer software Research |
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Skill based errors
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Generally referred to as “slips”, representing unconscious glitches in automatic activity (errors of action)
Knowledge-based error – Occurs in a rare situation or one not previously encountered where the provider lacks knowledge or because of misinterpretation of the problem |
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Rule based errors
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Arise when a wrong rule is applied in a particular situation.
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Knowledge-based error
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Knowledge-based error – Occurs in a rare situation or one not previously encountered where the provider lacks knowledge or because of misinterpretation of the problem
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It is not just the individual who error'd
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These “errors” are comprised of many factors, including but not limited to time constraints, material resources, financial considerations, politics, education, training, and technology
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JCAHO uses sentinel events and various “indicators” to track errors and outcome
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Airway, General, CV, Pulmonary
specific to anesthesia |
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Examples of Care Management Problems
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Incorrect treatment given
Treatment applied to wrong body site Incorrect protocol applied Failure to properly supervise learner Not seeking help or consultation when necessary Failure to follow standard protocol Failure to execute preoperative checklist Failure to note faulty equipment Inadequate information provided during transition of care to another provider Incorrect risk assessment Delay in appropriate diagnosis Failure to monitor, observe or act |
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Most common type of error
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Omission errors continue to be error that occurs the most
#2 Wrong dose or wrong drug follows Insulin, heparin, morphine |
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Safety-Oriented Initiatives
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Decreasing the reliance upon human memory
Improved information access Error proofing e.g. – hypoxic mixture, vaporizers Standardization Carts, pumps, trays, IV set-ups all the same in an institution Training and continuing education Simplification Attention to psychological precursors |
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Ways to prevent wrong site surgery..
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preop evaluation
have MD mark the site or patient surgical team verify in room time out at bedside |
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