Standards of Conduct
Chapter 2
Legal Aspects of Health Care
• Laws, standards, and guidelines
• Patient is an autonomous individual
• Concepts related to legal aspects of medicine
Traditional Principles
Doctrine of Borrowed Servant
• The one controlling or directing the employee has greater responsibility than the one paying the employee
• Surgeon is liable for any negligent act committed in their presence
• Captain of the Ship doctrine
Doctrine of Personal Liability
• Each person is responsible for his or her own tortuous conduct
• Others may be liable as well
• Physicians assure the medical professional will take responsibility for an action
Intentional Torts
• Assualt
– an act that causes another person to fear that they will be touched in an offensive manner w/o consent
• Battery
– the actual act of harmful contact w/o consent
• Defamation
– slander (oral) or libel (written) - reputation or good name
Intentional Torts
• False Imprisonment
– Illegal detention w/o consent
• Intentional Infliction of Emotional Distress
– Disparaging remarks
• Invasion of Privacy
– Disclosure of private information
Unintentional Torts
• Individuals make mistakes
• Most common type of patient indiscretions by OR personnel include
– Negligence: breach of duty
– Malpractice: wrongful conduct
Errors That Can Occur
• Patient misidentification
• Incorrect procedure
• Foreign bodies left in patient
• Patient burns
• Falls or positioning errors
• Improper handling of specimen
• Incorrect drugs or administration
Errors (continued)
• Harm secondary to use of defective equipment/instruments
• Loss of or damage to patient’s property
• Harm secondary to a major break in sterile technique
• Exceeding authority or accepted functions
• Abandonment of a patient
Consent for Surgery
• Permission being given for an action
• Granting party must have authority
• Voluntary and informed act
• Nonconsensual touching = battery
Consent for Surgery
• Express
– Direct verbal or written statement granting permission for treatment
• Implied
– Manifested by action or inaction of silence that assumes consent has been authorized
Written Informed Consent
• Physician’s responsibility:
– Information must be given in understandable language
– There can be no coercion or intimidation of the patient
– The proposed surgical procedure or treatment must be explained
– Potential complications must be explained
Written Informed Consent
• Potential risks and benefits must be explained
• Alternative therapies and their risks and benefits must be explained
Written Informed Consent
• A proper consent form should contained the following:
– Patient’s legal name
– Surgeon’s name
– Procedure to be performed
– Patient’s legal signature
– Signature of witness(es)
– Date and time of signatures
Who Can Give Informed Consent
• Competent adult
• Parent or legal guardian of a minor
• Guardian in case of physical inability or legal incompetence
• Temporary guardian
• Hospital administrator
• Courts
Consents
• Witnesses for a consent signature
– Physician/surgeon
– Registered nurse
– Other hospital employee
• Once given a consent can be taken away
Documentation
• Placing information into a patient’s medical record (chart)
• Combined account of interaction between the patient and health care providers
Documentation
• Hospitals are mandated to report certain items to other authorities:
– Disease of the neonate
– Child abuse
– Elder abuse
– Communicable diseases
– Births and deaths
Documentation
• Any suspicious deaths
• Any known criminal acts
• Professional misconduct
• Incident reports
Additional Information
• Advanced directives
– Rights of self-determination
• Ethical and moral issues
– Concepts of right and wrong
• Bioethics
– Study of ethical implications of biological research and applications in medicine
Patient’s Bill of Rights
• Adopted by American Hospital Association 1972 and revised in Oct 1992
• Requires collaboration between
– Patients
– Physicians
– Other health care professionals
• Establishes patient as consumer of health care
Patient’s Bill of Rights
• Hospital must respect the pt’s rights and role in health care decision making
• Hospital must be sensitive to culture, racial, linguistic, religious, age, gender, and other differences including disability
Ethics
• Surgical technologists will be exposed to many issues that may create discomfort
• Decide what type of situations you cannot participate in and act upon your decision
• Respect other viewpoints
Ethics
• Elective sterilization
• Fertilization procedures
• Elective abortion
• Human experimentation
• Animal experimentation
• Organ donation/transplantation
• Quality vs. quantity of life
• Substance abuse
• Gender reassignment
• HIV and AIDS pts
• Newborns w/severe disability
• Good Samaritan law
• Assisted suicide
• Genetic engineering
• Refusal of treatment
• Termination of care & right to die
Surgical Conscience
• Personal moral authority to accept responsibility
• Committed to maintaining confidentiality
• Nondiscriminatory treatment
• Personal values, feelings, and principles are secondary
Surgical Conscience
• Basis
– If you or someone else in the case breaks sterile technique, admit it or acknowledge it
– If someone says that you have broken sterile technique, take them at their word
– Above all: do not argue, do not give excuses
The Surgical Patient
By Javier Espinales, CST
The STSR and the Surgical Patient
The ST’s contact with the patient occurs preoperatively, intraoperatively and postoperatively.
No matter what role the ST is playing you must be aware of the pt, other team members, surrounding environment, and care and safety issues.
The STSR and the Surgical Patient
Every health care employee is morally obligated.
No one is excused.
Physical, Psychological, Social, and Spiritual needs of the PT
For a pt to go through surgical intervention, the physical, psychological, social and spiritual are major events for them.
The pt may presume good care – but the pt inner self may haunt them before and after surgery.
Physical, Psychological, Social, and Spiritual needs of the PT
The pt has a life before surgery and the question remains after.
The health care professional needs to care for the pt well being or they need to find another profession.
Causes for Surgical Intervention
All surgical pt’s have one thing in common – they rather not be there.
Most have surgery due to trauma, disease, genetic factor that can only be corrected by surgery.
Prioritizing Needs
Maslow’s Hierarchy
– Physiological Needs
– Safety Needs
– Love and Belonging Needs
– Esteem Needs
– Self-actualization
Prioritizing Needs
Guidelines and Constraints
– The OR team must recognize the pt’s physical needs but the team has to also understand that the pt has certain rights to refuse surgery.
What can an ST do?
Help establish an environment that communicates care and concern.
– Discuss with the circulator if there are any issues with the pt that you need to know.
– Plan simple actions for the pt
– Introduce yourself professionally
– If the pt ask what you do, explain in simple language.
Cultural and Religious Influences
Every culture has different beliefs.
You must be aware that different pts react differently due to their beliefs.
Patients Bill of Rights
American Hospital Association – adopted the Patients Bill of rights in 1972.
These assumptions are for the protection of the patient.
The bill was later reinforced with The Patient Self-Determination Act of 1990
– It says that each patient has the right under state law to make decisions concerning his/her care, including the right to refuse treatment.
Consent for Surgery
JCAHO’s definition – A person who receives health services from a health care provider and who gives consent for the provider to provide those services.
To perform surgery without consent is liable to be charged with battery.
Consent for Surgery
Consent
Battery
Expressed
Implied
Informed Consent
Principles of Documentation
Surgical records that will also go into the pt’s record
– Informed consent, surgical procedure
– Anesthetic procedure – response to anesthesia and post anesthetic care
As far as the OR Nurse
– Pt’s condition before, during and after the case
Principles of Documentation
– Time of initiation and termination of case
– Proper counts, implants, drains, dressings and so on
– Specimen/lab report
Principles of Documentation
Mandated reportable items to proper authority
– Disease of Neonate
– Child Abuse
– Elder Abuse
– Communicable disease
– Births and Deaths
Principles of Documentation
– Any suspicious death
– Any known criminal acts
– Professional misconduct
– Incident reports
Legal and Ethical Considerations
AST Code of Ethics
Legal and Ethical Considerations
Bioethical Situations
– Elective Sterilizations
– Fertilization Procedures
– Abortion
– Human Experimentation
– HIV and Other Infections
Legal and Ethical Considerations
– Animal Experimentation
– Organ donation/transplant
– Quality of life
– Euthanasia
– Right to Die
– Death and Dying
Legal and Ethical Considerations
Possible mistakes in the OR
– PT mis-ID
– Performing incorrect procedures
– Foreign bodies left in the pt
– Burns by ESU
– Falls or positioning mistakes
Etc, etc.
Chapter 2
Legal Aspects of Health Care
• Laws, standards, and guidelines
• Patient is an autonomous individual
• Concepts related to legal aspects of medicine
Traditional Principles
Doctrine of Borrowed Servant
• The one controlling or directing the employee has greater responsibility than the one paying the employee
• Surgeon is liable for any negligent act committed in their presence
• Captain of the Ship doctrine
Doctrine of Personal Liability
• Each person is responsible for his or her own tortuous conduct
• Others may be liable as well
• Physicians assure the medical professional will take responsibility for an action
Intentional Torts
• Assualt
– an act that causes another person to fear that they will be touched in an offensive manner w/o consent
• Battery
– the actual act of harmful contact w/o consent
• Defamation
– slander (oral) or libel (written) - reputation or good name
Intentional Torts
• False Imprisonment
– Illegal detention w/o consent
• Intentional Infliction of Emotional Distress
– Disparaging remarks
• Invasion of Privacy
– Disclosure of private information
Unintentional Torts
• Individuals make mistakes
• Most common type of patient indiscretions by OR personnel include
– Negligence: breach of duty
– Malpractice: wrongful conduct
Errors That Can Occur
• Patient misidentification
• Incorrect procedure
• Foreign bodies left in patient
• Patient burns
• Falls or positioning errors
• Improper handling of specimen
• Incorrect drugs or administration
Errors (continued)
• Harm secondary to use of defective equipment/instruments
• Loss of or damage to patient’s property
• Harm secondary to a major break in sterile technique
• Exceeding authority or accepted functions
• Abandonment of a patient
Consent for Surgery
• Permission being given for an action
• Granting party must have authority
• Voluntary and informed act
• Nonconsensual touching = battery
Consent for Surgery
• Express
– Direct verbal or written statement granting permission for treatment
• Implied
– Manifested by action or inaction of silence that assumes consent has been authorized
Written Informed Consent
• Physician’s responsibility:
– Information must be given in understandable language
– There can be no coercion or intimidation of the patient
– The proposed surgical procedure or treatment must be explained
– Potential complications must be explained
Written Informed Consent
• Potential risks and benefits must be explained
• Alternative therapies and their risks and benefits must be explained
Written Informed Consent
• A proper consent form should contained the following:
– Patient’s legal name
– Surgeon’s name
– Procedure to be performed
– Patient’s legal signature
– Signature of witness(es)
– Date and time of signatures
Who Can Give Informed Consent
• Competent adult
• Parent or legal guardian of a minor
• Guardian in case of physical inability or legal incompetence
• Temporary guardian
• Hospital administrator
• Courts
Consents
• Witnesses for a consent signature
– Physician/surgeon
– Registered nurse
– Other hospital employee
• Once given a consent can be taken away
Documentation
• Placing information into a patient’s medical record (chart)
• Combined account of interaction between the patient and health care providers
Documentation
• Hospitals are mandated to report certain items to other authorities:
– Disease of the neonate
– Child abuse
– Elder abuse
– Communicable diseases
– Births and deaths
Documentation
• Any suspicious deaths
• Any known criminal acts
• Professional misconduct
• Incident reports
Additional Information
• Advanced directives
– Rights of self-determination
• Ethical and moral issues
– Concepts of right and wrong
• Bioethics
– Study of ethical implications of biological research and applications in medicine
Patient’s Bill of Rights
• Adopted by American Hospital Association 1972 and revised in Oct 1992
• Requires collaboration between
– Patients
– Physicians
– Other health care professionals
• Establishes patient as consumer of health care
Patient’s Bill of Rights
• Hospital must respect the pt’s rights and role in health care decision making
• Hospital must be sensitive to culture, racial, linguistic, religious, age, gender, and other differences including disability
Ethics
• Surgical technologists will be exposed to many issues that may create discomfort
• Decide what type of situations you cannot participate in and act upon your decision
• Respect other viewpoints
Ethics
• Elective sterilization
• Fertilization procedures
• Elective abortion
• Human experimentation
• Animal experimentation
• Organ donation/transplantation
• Quality vs. quantity of life
• Substance abuse
• Gender reassignment
• HIV and AIDS pts
• Newborns w/severe disability
• Good Samaritan law
• Assisted suicide
• Genetic engineering
• Refusal of treatment
• Termination of care & right to die
Surgical Conscience
• Personal moral authority to accept responsibility
• Committed to maintaining confidentiality
• Nondiscriminatory treatment
• Personal values, feelings, and principles are secondary
Surgical Conscience
• Basis
– If you or someone else in the case breaks sterile technique, admit it or acknowledge it
– If someone says that you have broken sterile technique, take them at their word
– Above all: do not argue, do not give excuses
The Surgical Patient
By Javier Espinales, CST
The STSR and the Surgical Patient
The ST’s contact with the patient occurs preoperatively, intraoperatively and postoperatively.
No matter what role the ST is playing you must be aware of the pt, other team members, surrounding environment, and care and safety issues.
The STSR and the Surgical Patient
Every health care employee is morally obligated.
No one is excused.
Physical, Psychological, Social, and Spiritual needs of the PT
For a pt to go through surgical intervention, the physical, psychological, social and spiritual are major events for them.
The pt may presume good care – but the pt inner self may haunt them before and after surgery.
Physical, Psychological, Social, and Spiritual needs of the PT
The pt has a life before surgery and the question remains after.
The health care professional needs to care for the pt well being or they need to find another profession.
Causes for Surgical Intervention
All surgical pt’s have one thing in common – they rather not be there.
Most have surgery due to trauma, disease, genetic factor that can only be corrected by surgery.
Prioritizing Needs
Maslow’s Hierarchy
– Physiological Needs
– Safety Needs
– Love and Belonging Needs
– Esteem Needs
– Self-actualization
Prioritizing Needs
Guidelines and Constraints
– The OR team must recognize the pt’s physical needs but the team has to also understand that the pt has certain rights to refuse surgery.
What can an ST do?
Help establish an environment that communicates care and concern.
– Discuss with the circulator if there are any issues with the pt that you need to know.
– Plan simple actions for the pt
– Introduce yourself professionally
– If the pt ask what you do, explain in simple language.
Cultural and Religious Influences
Every culture has different beliefs.
You must be aware that different pts react differently due to their beliefs.
Patients Bill of Rights
American Hospital Association – adopted the Patients Bill of rights in 1972.
These assumptions are for the protection of the patient.
The bill was later reinforced with The Patient Self-Determination Act of 1990
– It says that each patient has the right under state law to make decisions concerning his/her care, including the right to refuse treatment.
Consent for Surgery
JCAHO’s definition – A person who receives health services from a health care provider and who gives consent for the provider to provide those services.
To perform surgery without consent is liable to be charged with battery.
Consent for Surgery
Consent
Battery
Expressed
Implied
Informed Consent
Principles of Documentation
Surgical records that will also go into the pt’s record
– Informed consent, surgical procedure
– Anesthetic procedure – response to anesthesia and post anesthetic care
As far as the OR Nurse
– Pt’s condition before, during and after the case
Principles of Documentation
– Time of initiation and termination of case
– Proper counts, implants, drains, dressings and so on
– Specimen/lab report
Principles of Documentation
Mandated reportable items to proper authority
– Disease of Neonate
– Child Abuse
– Elder Abuse
– Communicable disease
– Births and Deaths
Principles of Documentation
– Any suspicious death
– Any known criminal acts
– Professional misconduct
– Incident reports
Legal and Ethical Considerations
AST Code of Ethics
Legal and Ethical Considerations
Bioethical Situations
– Elective Sterilizations
– Fertilization Procedures
– Abortion
– Human Experimentation
– HIV and Other Infections
Legal and Ethical Considerations
– Animal Experimentation
– Organ donation/transplant
– Quality of life
– Euthanasia
– Right to Die
– Death and Dying
Legal and Ethical Considerations
Possible mistakes in the OR
– PT mis-ID
– Performing incorrect procedures
– Foreign bodies left in the pt
– Burns by ESU
– Falls or positioning mistakes
Etc, etc.
posted by Ms. Carpenter | 10:22 PM
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