3Professional Practice of Imaging Legal Responsibilities And Risk Management.Privacy And ConfidentialityConsentProfessional Communications
4DefinitionMuch of the work defining patient safety and practices that prevent harm have focused on negative outcomes of care, such as mortality and morbidityThe services rendered by members of the health profession and non-professionals under their supervision for the benefit of the patient. (From Dorland, 28th ed, p269)Fundamentally, patient safety refers to freedom from accidental or preventable injuries produced by medical care. Thus, practices or interventions that improve patient safety are those that reduce the occurrence of preventable adverse events (AHRQ PSNet Patient Safety Network. Patient safety. [Accessed October 20, 2007]. http://psnet.ahrq.gov/glossary.aspx#P.
5Legal ResponsibilityDepartmental policy and procedure DPP provide guidelines for technologist to provide patient with safe, comfortable, fast and efficient health service as well as protect technologist from any allegations.A tort is a an action that wrongly causes harm to someone but that is not a crime and that is dealt with in a civil court.
6An unintentional Torts An unintentional tort is an act not intended to do harm but that still results in damage to person or propertyNegligence is an example of unintentional tortNegligence is the failure to take the care that a responsible person usually takesFor a technologist to be found negligent, the following must be proven:The patient was in the technologist’s careThe technologist failed in their duty toprovide proper careThe patient suffered an injuryThe patient's injury was a result of thetechnologist’s failure to provide proper care
7Intentional TortsAn intentional tort is defined as an act performed with the intention of inflicting harm on another.Examples of intentional torts include:assaultbattery (a wrongful touching)false imprisonmentintentional infliction of emotional distress
8Intentional Torts cont’d Assault is the crime of trying or threatening to hurt someone physicallyA statement such as "I'm going to get this x-ray one way or another,“ could be interpreted by the patient as assaultBattery is the crime of hitting or touching someone without their consent and in a way that is meant to cause harm or injuryBattery may be claimed if a patient is palpated for positioning (i.e. palpating the symphysis pubis or chest)False imprisonment is the unlawful detention or confinement of a personThe inappropriate and unnecessary use of physical restraints is a common example of false imprisonment
9Quasi-intentional Torts Quasi-intentional torts are voluntary acts, without intention to injure or distress a patient, but that still result in injury or damageTypes of quasi-intentional torts are:–Defamation of character (statement that causes people to have a bad opinion of someoneSlander (making a false spoken statement) Libel (publishing a false statement)– Invasion of privacy
10Legal Responsibility Summary of torts Type of tort Definition Example Unintentional tortAct not intended to do harm but that still results in damage to person or propertyNegligenceIntentional tortAction performed with the intention of inflicting harm on anotherAssault, battery, false imprisonment.Quasi intentional tortAction that does not mean to hurt but still cause damageDefamation of character.Invasion of privacy.
11Risk ManagementRisk management is the process of identification, analysis and acceptance or mitigation of service in medical imaging.Risk management aimed to provide patient with safe and efficient imaging service.Therefore it is crucial for technologists to be aware of risk situations specific to their profession.
12Risk SituationsOccupational hazards (e.g., accidental radiation exposure, high voltage, chemicals, back injury, repetitive stress injury)Demands or requests that a technologist engage in tasks or duties that fall outside of his or her job specifications and/or professional qualificationsInadequate information/documentation to perform the requested taskDemands or requests that thetechnologist believes areinappropriate or “unreasonable”
13Restraints Restraints are used to control or limit a person’s activity They can be either physical restraints or chemical restraintsReasonable judgement should be used to decide whether restraints are necessaryIf necessary, the least restrictive restraints that provide adequate safety should be used.Old fashion of riskmanagement
14Restraints PolicyHospitals, and care facilities such as nursing homes, generally follow a policy of least restraintThis means that all possible interventions must have been tried and been unsuccessful before deciding to use a restraintIt is acceptable to use physical restraints for safety reasons with the patient’s permissionUse of restraints will ensure the patient does not injure themselves or others, or disengage therapeutic lines or devices
15Physical Chemical Does not need physician order: RestraintsPhysicalNeed physician order:Wrists, ankles, vestDoes not need physician order:Side rail, wheelchair belt, compression bandChemicalIt always need physician order:Lorazepam
16Mandatory ReportMandatory reporting means that as a health professional, you are required by law to file written reports if you are witness to “unsafe, incompetent or unethical practice”Issues may include:Professional malpracticeProfessional negligenceIncompetenceIncapacitySexual Harassment
17Privacy and Confidentiality Privacy act: all patient’s information are considered private.Confidentiality: is to ensure private, personal information will be withheld from all, except those professionals directly involved in care.Privacy Act: is a law that regulate disclosing private information.Consent.Purpose for collection of personal information.Any secondary user will be involved.
18Privacy and Confidentiality in medical imaging Technologists must practice in a manner that protects patient privacy at all timesThis is an important aspect of working in health care as a medical radiation technologistPrivacy can be applied by:Keep request in private areaImaging screen should be blank of anypatient images and information if not in useDiscuss patient condition only with relevanthealth care providerPatient medical file is under your custody,privilege people only could review it
19Exceptions of Confidentiality Examples of conditions that may be exceptions to confidentiality include:Certain wounds (gun shots, sharps)Suspected abuseCommunicable disease (TB, AIDS)RTAIndustrial accidents (explosion, chemical spills)Birth defectDrug addiction
20ConsentBefore a health care practitioner undertakes any sort of procedure or treatment on a patient, consent must be obtained from that patientBefore the patient gives consent, it is important that the procedure is fully explained to them and their decision to undergo the procedure is an informed decisionThe only time a procedure may beperformed without consent is in anemergency situation where consentcannot be obtained due to timeconstraints or patient condition
21Types of Consents Consents Expressed Implied Written Oral presentation at the emergency department or at the hospital for admission implies consent for ordinary diagnostic and treatment measuresExpressedobtained when any medical procedure is to be undertaken on a patientWrittenauthorization for use of drugs, sedation or contrast mediaOralobtained in the presence of a witness when written consent is not available
22Validity of the Consent Age and mental status:the patient must be old enough and mentally capable of making such a decisionVoluntarily given:Be given voluntarily without coercion or threatRight for withdrawal :any time without any cost or punishmentConsidered for explained procedure:the patient must understand the nature and reason for the treatment, risks and benefitBe informedthe patient must understand the consequences of not having the procedure or treatment, and must also have received information on alternatives
23Who should obtain a consent? Ordering Physician ???!!!(has the responsibility to explain the procedure and alternatives)RadiologistTechnologist(specially in a busy environment)
24Consent in Emergency Situation The patient is too ill or too injured to provide a signed informed consent.No legal relative is available to provide consent on behalf the patient'sUrgent treatment is crucial to prevent the danger to life or serious impairment.There is obvious risk of serious impairment.There is obvious danger to the patient's life
25Refusal of ConsentWhen a patient refuses treatment, the practitioner may be confused or frustratedThe right to refuse treatment may seem irresponsible or irrational action from the patientBut the practitioner must respect the patient’s decisionIt is important to keep in mind that the patient should never be forced or coerced into accepting treatment they are not comfortable with