E. Stanton MSN/Ed, RN, CEN,CCRN CFRN Ethics and Laws E. Stanton MSN/Ed, RN, CEN,CCRN CFRN

Ethics Set of principles or values based on Religious, values or moral teachings Examples: It is wrong to lie It is ok to cheat on a test if no one knows??

LAWS Collection of rules to enforce order in a community, state or other group Actions can be moral but not legal Actions can be legal but not moral

Questions? Can you give an example of an action that is moral but not legal? Can you give an example of an action that is legal but not moral?

When faced with a difficult situation Is this action legal? Does it foster a win –win situation? How would I feel if I read about this decision in a newspaper? Can I live with myself after making the decision?

Due Care/ Standard of Care Due Care- level of care expected by a person of ordinary intelligence and good sense under the circumstances Standard of care- level of skill and care that is expected to provide due care Performing duties as any other reasonable and prudent person with the same training

Why do I need to know about legal issues? Lawsuits against healthcare workers are significantly high Patients are better informed of their rights Understanding patient rights and your responsibilities can lessen the chance of a successful lawsuit

negligence Failure to provide proper care that results in injury to another Most cases against phlebotomists are due to negligence Examples- mislabeled specimen Incorrect identification of the patient Not removing a tourniquet Failure to follow SOP

Assault Attempting to touch a person without permission The threat to touch a person without permission Proper consent must be obtained

Battery Intentional touching without permission Carrying out physical harm Examples: Tying down a child for a blood draw without parental permission Forcing an alert and oriented person to have blood drawn by force

Standard of Care Measuring stick that represents the conduct of the average health care worker What would a prudent phlebotomist do in the same circumstance?

Malpractice Improper care of a pt by a health care worker that results in injury Professional negligence

Common Reasons for Malpractice Suits

Common Negligent Acts Wristband or identification error Hematomas Abscess at puncture site Patient falls (failure to raise the side rail after venipuncture) Nerve damage Emotional distress Vascular damage from forgetting to release tourniquet

Confidentiality HIPAA

HIPAA Health Insurance Portability and Accountability Act

HIPAA provides federal protections for personal health information and gives patients an array of rights with respect to that information Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes

Key Points Maintain confidentiality of all pts information, including tests to be performed Keep computer passwords secure Computers should face away from public viewing

Confidentiality Abuse of a pts confidentiality can result in negligence Only the pt can release results without a clinical “need to know”

HIV exposure and confidentiality Need to know depends on the state that you are practicing in NJ allows health care workers in the home to know HIV status- only those with potential exposure

HIV exposure and confidentiality If directly exposed to body fluids or needle stick you can know the HIV status and if other infectious diseases exist Notify manager immediately after washing the exposed area thoroughly

If exposure occurs… Cleanse the site immediately with soap and water (betadine scrub) If eyes involved- use eye wash Notify manager Go to the ED or occ health immediately

exposure Fill out an incident report Manager will obtain consent from pt for testing Follow up with occupational health regarding incident as per policy

All the time- every time Following proper procedures All the time- every time Will decrease chances Of contamination

Informed Consent Voluntary permission by the pt to allow touching examination or treatment Pts have the right to decide what procedures they want and don’t want Must be told of risks and benefits

Implied Consent Pts actions or condition indicate consent rather than a written or verbal statement Example: unconscious pt

Medical Records To monitor for continuous pt care To provide a record of illness and treatments Communication between health care providers To provide a legal document used by pts hospitals and health care workers to protect from lawsuits To demonstrate to regulatory agencies compliance

Maintaining Medical Records Write neatly and legibly Write down the facts Do not add personal observation- “pt crabby” Document only what you observe

Documentation Document pre- procedure, intra procedure and post procedure responses- “dsd applied to venipuncture site no bleeding or or Hematomas noted“ If called to court- you will not remember the pt 3 years later – your notes will be your only guide

“Don'ts” regarding confidentiality Discuss pts info with family members Throw out papers with pt information in regular trash Forget to take lab reports off printer Discuss pts condition with anyone not directly involved in pts care Discuss pts with co- workers on the elevator, hallway cafeteria

Clinical Laboratory Improvement Amendments CLIA

CLIA ’88’ objective of CLIA - to ensure quality laboratory testing Applies to every clinical laboratory in the U.S. Determines if labs use methods that lead to accurate, reliable and good quality testing Annual CLIA inspections Most CLIA violations occur in the pre analytical phase

CLIA Categorizes certificates for labs according to complexity of testing Higher complexity of testing = more stringent CLIA requirements

Regulatory agencies National Accrediting Agency for Clinical Laboratory Sciences (NAACLS)-approves phlebotomy programs Clinical Laboratory Standards Institute-(CLSI)-National agency for standards of phlebotomy procedures

Regulatory agencies Joint Commission of Health care Accreditation Organization- (JCAHO) Provides accreditation for healthcare organizations Occupational Safety and Health Administration- (OSHA) mandates safe working conditions for employees

Quality Control Procedures that ensure quality in testing Assures that procedures are performed correctly

Quality Control Procedures Examples: checking expiration dates documenting equipment maintenance recording refrigerator temp strict labeling requirements frequent personnel competency checks