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

2. 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??

3. 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

4. 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?

5. 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?

6. 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

7. 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

8. 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

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

10. 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

11. 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?

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

13. Common Reasons for Malpractice Suits

14. 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

15. Confidentiality
HIPAA

16. HIPAA
Health
Insurance
Portability and
Accountability
Act

17. 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

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

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

20. 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

21. 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

22. 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

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

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

25. 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

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

27. 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

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

29. 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

30. “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

31. Clinical Laboratory Improvement Amendments
CLIA

32. 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

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

34. 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

35. 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

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

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