...claimed injury. 2. The hospitals rules, regulations, and policies do not establish a standard of care. However, a hospital’s failure to follow its own rules, regulations, and policies is evidence of negligence. 3. Discharge instructions can be construed to be part of a hospital’s rules, regulations and policies. 4. Unclear, or ambiguous discharge instructions can place the hospital at risk for increased liability for negligence if a casual connection can be made to a patient’s injury. Therefore, to protect itself, hospitals should be proactive in establishing clear discharge protocols and individualized discharge instructions. IV. Review of the Law In the case of Earline Therry, et al v. State of Louisiana, through the Department of Health and Hospitals and University Medical Center of Lafayette, Louisiana, a summary judgment was granted for the defendants based upon the plaintiff’s inability to establish a causal connection between a breach of the standard of care and any resultant injuries. In this case, Mrs. Therry accused the Defendants of negligence for allowing her to develop digitalis toxicity due to a one-day delay in returning to the hospital. Mrs. Therry’s discharge instructions stated to return to the emergency room if she had any problems. Mrs. Therry was discharged on two diuretics, possibly causing dehydration, which as one medical panel review board member concluded, could be a possible cause of the...
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...Rasmussen Medical Center Policy: Health Record Documentation Requirements Approval Date: xx/xx/xxxx Policy Group: Medical Staff Bylaws ------------------------------------------------- All medical staff and health care providers shall: History & Physical 1. A complete history and physical examination shall, in all cases be done no more than 7 days before or 24 hours after the admission of a patient. Physical examinations may be used from the previous hospitalization if the examination was within 30 days. A physical examination may be accepted from a physician’s office if the examination was within 30 days and meets the standards as defined by hospital policy and procedure. If the patient was transferred from another hospital, the physical examination may be accepted if the examination was done within 30 days, provided they are updated within 24 hours of admission or registration by the attending physician. In the above three cases, the attending physician must validate the examination in the medical record (on the physical exam) by noting that there are no significant findings or changes and signs and dates the report. Guidelines for contents of a complete History & Physical include: a. The Emergency Room documentation form may not be used as a History and Physical. b. A complete history and physical examination shall be recorded before the time stated for operation or the operation shall be canceled unless the attending surgeon indicates it is an emergency...
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... The Johns Hopkins Hospital instituted the Health Insurance Portability and Accountability Act of 1996 (HIPAA) on April 14, 2003. This legislation changed the way many medical facilities handled a patient’s protected health information (PHI) in a variety of ways. This paper will review the subject of the way the Johns Hopkins Hospital handles PHI within its organization. The Health Insurance Portability and Accountability Act completely changed the way a medical facility handles a patient’s health record. Before HIPAA was put in place, a patient’s rights would be different depending on the state he or she resided in. HIPAA has standardized the way PHI is handled and is the same regardless of the state of residence. If a facility uses PHI in a manner not in line with the HIPAA regulations, the facility can receive many different sanctions depending on the extent of the misuse of information. HIPAA was created in 1996, but before then only about half of the United States had regulations that allowed a patient to get copies or even see his or her own medical records. Many states have initiated legislation that gives additional security to protect a patient’s medical record; all states must follow the rules of HIPAA even with the additional security measures. Protected health information (PHI) is any information that provides the ability for others outside the organization...
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...Case Study 3: The Scope of Practice Decision Making Framework Case Study 2 An enrolled nurse was delegated the task of removing a patient’s wound drain. Although educationally prepared , the enrolled nurse had not performed the procedure before but was prepared to undertake the procedure. Choose one of the scenarios above and use the Scope of Practice Decision Making Flowchat, evaluate each step to determine if the action take was appropriate 1. Identified client need/benefit 2. Regulated nursing practice 3. Accepted nursing or midwifery practice 4. Organisational support 5. Within the scope of practice 6. Appropriate to proceed Answer In Healthcare environment where change is a constant feature, nurses are expected to be flexible and to respond to change in ways that benefit health consumers. When making decisions nurses need to consider that individual have differences in the education , experience and competnece and their respective profession’s scope of practice. According to Nursing practice decisions summary guide by Nursing and Midwifery Board of Asutralia first the nurse need to identify client need /benefit and nurse need to reflect on scope of practice and nursing practice standards before making decision and nurse need to consider context of practice/ organisational support and last not the least nurse need to select appropriate and competent person to perform the activity. In this case study the enrolled nurse was educationally prepared but...
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...hospital. The manager is dealing with a lot: The nursing staff has expressed burnout because of an increase of terminal cancer patients. In one extreme case, Nurse Nancy, feeling empathy for a rapid decline in one of the patient’s health (a 30-year-old single mother), wants to give an extra dose of narcotic that could potentially end the patient’s life – and what Nurse Nancy perceives as her suffering. Needless to say, concepts including end-of-life rights, death with dignity and right to life apply to this particular case. In examining this particular case, we’ll find that the nurse is trying to act with the purest of motives. However, what she is doing could skirt ethical decision-making, while being blatantly against the law. Additionally, it could provide a negative view of the cancer center. Though many people might support the idea of dying with dignity, others might take a dim view of a nurse who, in her zeal to prevent a patient’s suffering, would deprive children of their mother. Patient Bill of Rights The Patient Bill of Rights, sponsored by Senators John McCain, John Edwards and Ted Kennedy (S.1052), guarantees patients the right to access to health care specialists when necessary and requires continuity of care protections to patients so they don’t have to change health care providers in the middle of their treatment (Summary, 2001). The bill, unfortunately, failed, but many of its requirements make sense. For the patients of this particular cancer center, it means their...
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...often brought into consideration in ethical dilemmas. Healthcare professionals often use these ethical principles as a premise to make morally sound judgements on care provision. Ethical dilemmas surface when these principles conflict with one another. The correct course of action is not clearly defined and the decisions made may be challenged. Decisions made on moral grounds are often intrinsically complex and intricate. This essay will cover the principles of distributive justice, autonomy, and beneficence. Drawing from personal experience, three individual case pertaining to each principle are provided to illustrate how each principle is either observed or breached. A conclusion is presented at the end of each case study to summarize the ethical reasoning and concepts discussed. A final conclusion will also be presented at the end of the essay to provide closure to the discussion. Distributive Justice Case Study: Dr Adams is a physician working in an acute medical ward. During his shift, he reviewed two critically ill patients. Patient A was an 80-year old lady with thrombocytopenia secondary to lymphoma with a low haemoglobin level. She had been receiving palliative care prior to admission. Patient B was a 50-year old man with an actively bleeding peptic ulcer. His haemoglobin had dropped significantly and was passing malena stools. Dr Adams decided to transfuse both patients but received notification from the Blood Transfusion Unit that they were in severe shortage...
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...Case Summary The patient, a 23-year-old male (date of birth September 30, 1994), presented to the facility’s Emergency Department on February 27, 2018, with a history of schizophrenia, seizure disorder, polysubstance abuse (ETOH, marijuana, heroin and BZDs), opiate intoxication, depression and suicidality. The patient was admitted to the Medical Center on February 27, 2018. The following diagnoses were submitted: Admitting Diagnosis of altered mental status; Principal Diagnosis of seizure disorder; Secondary Diagnoses: enterocolitis due to Clostridium difficile; suicidal ideation; sedative hypnotic or anxiolytic dependence with withdrawal; opioid dependence with withdrawal; other psychoactive substance use unspecified with mood disorder;...
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...HIPAA Summary Janine Yoder HCS/320 March 3, 2015 Lynn Bell HIPAA Summary Going to the doctors or hospital is scary enough, so they try and make it easier, so you are worried about multiple things. They work and take your privacy and rights out of it and have it protected. The Federal Act of 1996, Health Insurance Portability and Accountability Act. This act is to help people be able to keep health insurance a little easier and protect our information from being given away. The confidentiality and security of our health care information, and it controls the cost of administrative in the health industry. You can go to the doctors and not have to worry about them sharing your information with anyone without your permission because of the HIPAA law. Protecting the patient’s rights is the number one priority when it comes to the Health Insurance Portability and Accountability Act (HIPAA). Even though, the cost of administrative, privacy and right because security of health care information and confidentiality. The implications for health communications, the Health Insurance Portability and Accountability Act (HIPAA) has different types. Civil and criminal penalty and violations up to but not limited to two hundred and fifty thousand in fines and up to ten years in prison. This information is crucial because you do not want to be giving out someone’s information on accident. Plus you would not want your information out there if it did not have to be. That is how people...
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...The Scope of Practice of a Physician Assistant The term scope of practice has been defined as “The definition of the rules, the regulations, and the boundaries within which a fully qualified practitioner with substantial and appropriate training, knowledge, and experience may practice in a field of medicine or surgery, or other specifically defined field. Such practice is also governed by requirements for continuing education and professional accountability” (Defining Scope of Practice, n.d.). Physicians, nurses and all other medical professionals are required to know what their particular scope of practice includes and to adhere to those guidelines at all times. Many different types of healthcare professionals are found in an Emergency Room facility, and they will all have a scope of practice that they must adhere to. One such healthcare professional would be a PA or a Physician Assistant. A PA must work under the supervision of a Physician who is ultimately responsible for the PA’s performance and professional conduct with the patient. Any medical procedures that the supervising Physician performs in his scope of practice may be delegated to the PA, as long as the PA has had the necessary training and competency to successfully perform the procedure (Rogers, 2007). In an Emergency room setting a PA may be responsible for such patient care activities as evaluating incoming patients through the process of obtaining a complete and accurate health history, conducting physical...
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...have been in place through our hospital based system since 2006 and implemented throughout the facility in 2007. Some of the benefits of these records are the convenience of having the patient's information available for you at all times, records are not lost or unavailable at times when they are really needed such as the case with paper charts. The EMR also contains pertinent information such as allergies, a past medical history, and a medication history just to name a few more benefits that are available for those directly involved in the patient's care to view. According to the U. S. Department of Health and Human Services, “an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health organization” (Agency for Health Care Research, 2013). There are challenges that include the possibility of security breaches and continued advancement of technology in the health care system itself. The solutions for these challenges include accountability for our own actions which include logging off of your computer before leaving your work station, never sharing your passwords, and never allowing a patient’s medical record to be in plain view for people that are not involved in the patient’s care, and keeping an open mind regarding staying current with technology. The standards in place for maintaining security is the Health Insurance Portability and Accountability Act of...
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...A physician should not be totally immune from liability in cases in which the patient's contribution to the harm suffered was as great as the person whom contributed to it. In this case, I feel that there were factors that both sides neglected to handle so that the procedure that was done would be a success. There were testing (vascular testing) that could have been done to determine if the patient was in a good enough condition to be able to go through the surgery that was used to remove the diseased toenail that was infected. The jury found Dr. Azzara acted negligently by removing Ms. Ostrowski's toenail without adequate consideration of her vascular condition (Ostrowski v. Azzara 545 A.2d 148 (1988) Summary). I also feel that Dr. Azzara should have made sure that there was a review of the patients’ internal medicine records from her internist for her diabetes and blood pressure problems. The patient was at fault by not following up with her internist about her high sugar levels and hypertension that were determined by testing by Dr. Azzara. It is difficult to heal when there are high sugar and high blood pressures problems going on after surgery. Also smoking slows down the healing process in patients that have had recent surgery or injuries. Nicotine, which is in cigarettes, causes blood vessel constriction, reducing blood supply to the skin. When doctors perform a surgery, the incisions that are left may reduce normal blood flow to the area that is being worked on...
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...first things we learn in nursing school is in regard to a patient’s privacy and the confidentiality we are to abide by when caring for them. We learn the rules and regulations of the “Privacy Rule” and HIPPA (Health Insurance Portability and Accountability Act of 1996). These were put in place to ensure confidentiality and accountability in cases where patient’s health information is compromised, (U.S. Department of Health & Human Services, 2014). During an episode of the television series “ER” a main character, “Nurse Hathaway”, struggles with an ethical dilemma in which she must decide whether or not to break confidentiality with her patient who is also a minor in the name of the law. This patient’s diagnosis turns out to be a serious condition, cervical cancer. The author will discuss this dilemma in terms of ethical implications, ethical theories, alternative solutions, if any, as well as the author’s position on this dilemma. The author will also refer to a landmark case, “Tarasoff vs. Regents” in which “a psychologist failed to warn a woman or her family when his patient threatened to murder the woman,” (Nathanson, 2000) to discuss confidentiality ethics. Ethical Implications of a Breach of Confidentiality There are several implications when referring to the dilemma of a nurse who must decide whether to break confidentiality in order to protect the rights of the community as a whole. In this case, the patient’s behavior did not only affect herself, but also that of minors...
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...Administrators: uses the data to evaluate care, monitor the use of resources, and receive payment for services rendered. Administrators analyze financial and patient case mix information for business planning and marketing activities - Third party payers: the data become the basis for determining the appropriate payment to be made. - Utilization and case managers: uses it to coordinate care so that the patient is cared for in the most clinically cost-effective manner. - Quality of care committees: use the information as a basis for analysis, study, and evaluation of the quality of care given to the patient. - Accrediting, licensing, and certifying agencies: use the record to provide public assurance that quality health care is being provided. - Governmental agencies and public health: to determine the appropriate use of the governmental financial resources for health care facilities and educational and correctional institutions - Health information exchanges: provides patient centered care that improves quality, safety, efficiency, timeliness and accessibility - Employer: used to access job related conditions and injuries and to determine occupational hazards that may impede effective performance in the work place. - Attorney and Courts: use the records as documentary evidence of a patient’s course of treatment to protect the legal interest of...
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...ASSESSING IMPACT OF DRUG THEFT IN THE HEALTH CARE SERVICE: A CASE OF BLANTYRE CHAPTER ONE 1.1 INTRODUCTION Different authors have defined drug theft differently depending on the context in which they are discussing. Drug theft could be summarized as: “The act of stealing drugs and selling them or using them for other benefits instead of the core purpose of helping the needy (poor) Malawians.” Recently, there have been a lot of cases of drugs stolen from public hospitals in Malawi and other neighboring countries which are either sold in Malawi or outside the country. Some of the drugs are being sold in Tanzania, Mozambique or even overseas. Of late, it has been noted that the county referral hospitals, health centers and dispensaries are the worst hit. Additionally, there are some unscrupulous medical workers in our country who are smuggling drugs from public hospitals to Tanzania through the boarders. In Summary, Once sold, the drugs are then stocked in private clinics. They are mainly sold in Tarime District of Mara Province across the border in Tanzania. Medicines leave the stores as soon as they arrive. Drugs stolen from public hospitals in our country are now finding their way into Tanzania. Unscrupulous medical workers are smuggling the drugs through the border point before selling them to Tanzanian traders. Once sold, the drugs, according to Nation investigations, are then stocked in private clinics, in Tarime District of Mara Province across the border in Tanzania. The...
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...Discharge planning is a process that aims to improve the coordination of services after discharge from hospital by considering the patient’s needs in the community. It seeks to bridge the gap between hospital and the place to which the patient is discharged, reduce length of stay in hospital, and minimise unplanned readmission to hospital.1 Discharge planning is an established part of hospital care, but the process varies and is not entirely evidenced based. A Cochrane review analysed 11 randomised controlled trials looking at discharge planning in over 5000 patients and failed to show a reduction in mortality among elderly medical patients, lower readmission rates, or a shorter length of hospital stay.1 However, two trials in the review did report greater satisfaction of patients and carers when discharge planning was used.2 3 The Cochrane review concluded that discharge planning remains important as a small improvement, not detected by the studies performed so far, could still yield highly significant gains in health care with huge resource implications and better use of acute hospital beds.1 Unfortunately, none of the included trials assessed communication with primary care staff about patient transfer of care. This is an important aspect of discharge planning and another potentially important advantage for patients. On a patient’s initial contact with health services, discharge planning should be started.4 This is often difficult to achieve when acutely unwell patients...
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