Methods of Patient Care RSMI 242 طرق العناية بالمريض 242 أشعة

1. Methods of Patient Care RSMI 242طرق العناية بالمريض242 أشعة Unit 2: Professional Practice (Part 1) • Prepared By: • Dr. Ahmad H. Abu Raddaha, PhD, RN-BC • @ Prince Sattam Bin Abdulaziz University’s • College of Applied Medical Sciences

2. Introduction Much of the work about patient safety and practices that prevent harm have focused on negative outcomes of caresuch as mortality (death) and morbidity (being unhealthful by having a disease or a symptom of disease). Patient Safety:Freedom from accidental or preventable injuries produced by medical care. • Practices or interventions that improve patient safety = Practices or interventions that reduce the occurrence of preventable adverse events (such as mortality or morbidity).

3. Professional Practice of Imaging

4. 1. Legal Responsibility and Risk Management

5. Legal Responsibility المسؤولية القانونية • Departmental policy and procedure (DPP) provide guidelines for Radiologic Technologist to: • Provide patient with: Safe, Comfortable, Fast, and Efficient health service, and • Protecttechnologist from any legal allegations (ادعاءات قانونية). • A tort (ضرر): 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. • Also called civil wrong (خطأ مدني ينتج عنه ضرر)

6. Types of Torts • Unintentional tortضرر غير مقصود • Intentional tortضرر مقصود • Quasi-intentional tortضرر شبه مقصود

7. An unintentional tort: An act not intended to do harm but that still results in damage to person or property. • The negligence إهمالis an example of unintentional tort. • Negligence: The failure to take the care that a responsible person usually takes. • The negligenceconduct occurs when his or her conduct fell short of the standard of care. • Or, in other words, he or she did not act like a reasonable person would have.

8. For a technologist to be found negligent, the following must be proven: • The patient was in the technologist’s care. • Duty: Exists when a technologist undertakes the care or treatment of a patient. • The technologist failed in their duty to provide proper care. • Breach: When technologist failed to perform the relevant standard of care. • The patient suffered an injury. • Damages: sustained injury as a result of the radiologist's negligence. • The patient's injury was a result of the technologist’s failure to provide proper care. • Causation: The breach of duty was a proximal cause of the injury.

9. An intentional tort: An act performed with the intention of inflicting harm on another. • Examples of intentional torts (civil crimes) include: • Assault • Battery (a wrongful touching) • False imprisonment

10. 1. Assault تهجم is a threat or physical act that creates a reasonable apprehension of imminent harmful or offensive contact. • A statement such as "I'm going to get this x-ray one way or another,“ could be interpreted by the patient as assault. • 2. Batteryاعتداءis a physical act that results in that harmful or offensive contact, or touching someone without their consent (an unwanted contact) in a way that is meant to cause harm or injury. • Battery may be claimed if a patient is palpated for positioning (i.e. palpating the symphysis pubis or chest).

11. 3. False imprisonment is the unlawful detention or confinement of a person • The inappropriate and unnecessary use of physical restraints is a common example of false imprisonment.

12. Quasi-intentional torts: Voluntary acts, without intention to injury or distress a patient, but that still result in injury or damage. Examples of quasi-intentional torts include: • Defamation of character تشويه السمعة(statement that causes people to have a bad opinion of someone). • Slander افتراء(making a false spoken statement) (breaching orally) • Libel تشهير(publishing a false statement) (breaching in writing) • Invasion of privacy.

13. Summary of Torts

14. Risk Management • Risk management: 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.

15. Risk Situations • Occupational hazards. • Examples: 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 job specifications and/or professional qualifications. • Inadequate information/documentation to perform the requested task. • Demands or requests that the technologist believes are inappropriate or “unreasonable”.

16. Restraints • Restraints are used to control or limit a person’s activity. • They can be either physical restraints or chemical restraints. • Reasonable judgement should be used to decide whether restraints are necessary. • If necessary, the least restrictive restraints that provide adequate safety should be used.

17. Restraints Policy • Hospitals, and care facilities such as nursing homes, generally follow a policy of least restraint. This means that all possible interventions must have been tried and been unsuccessful before deciding to use a restraint. • It is acceptable to use physical restraints for safety reasons with the patient’s permission. • Use of restraints will ensure the patient does not injure themselves or others, or disengage therapeutic lines or devices.

18. Need physician order: • wrists, ankles, vest • Physical • Does not need physician order: • side rail, wheelchair belt, compression band • Restraints • Need physician order: • Lorazepam • Chemical

19. Examples of Chest Vest Restrains

20. Examples of Wheelchair Belt Restrains

21. Mandatory Report • Mandatory 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 malpracticeسوء الممارسة الصحية . • Professional negligence. • Incompetence. • Incapacity. Physical or mental inability to do something or to manage one's affairs. • Sexual Harassmentتحرش .

22. Professional Practice of Imaging

23. 2. Privacy and Confidentiality

24. Privacy: All patient’s information are considered private. • Confidentiality: It is to ensure private, personal information will be withheld from all, except those professionals directly involved in care. • Privacy Act: A law that regulates disclosing private information. • Consent. • Purpose for collection of personal information. • Any secondary user will be involved.

25. Radiation technologists must practice in a manner that protects patient privacy at all times. • Privacy can be applied by: • Keeping request in private area. • Imaging screen should be blank of any patient images and information if not in use. • Discussing patient condition only with relevant health care provider. • Patient medical file should be under your custody, privilege people only could review it.

26. Exceptions of Confidentiality • Examples of conditions that may be exceptions to confidentiality include: • Suspected abuse • Certain wounds (gun shots, sharps) • Communicable disease (TB, AIDS) • Industrial accidents (explosion, chemical spills) • Road Traffic Accidents (RTA) • Drug addiction • Birth defect

27. Professional Practice of Imaging

28. 3. Consent

29. Before a health care practitioner undertakes any sort of procedure or treatment on a patient, consent must be obtained from that patient. • Before the patient gives consent, it is important that the procedure is fully explained to the patient, and his/her decision to undergo the procedure is an informed decision. • The only time a procedure may be performed without consent is in an emergency situation where consent cannot be obtained due to time constraints or patient condition.

30. Types of Consents • 2. Expressed • Obtained when any medical procedure is to be undertaken on a patient • 1. Implied • Presentation at the emergency department or at the hospital for admission implies consent for ordinary diagnostic and treatment measures • A. Written • Authorization for use of drugs, sedation or contrast media • B. Oral • Obtained in the presence of a witness when written consent is not available

31. Validity of the Consent • Age and mental status The patient must be old enough and mentally capable of making such a decision. • Voluntarily given Be given voluntarily without coercion or threat. • Right for withdrawal At anytime without any cost or punishment.

32. Validity of the Consent • Considered for explained procedure: The patient must understand the nature and reason for the treatment, risks and benefit. • Be informed The patient must understand the consequences of not having the procedure or treatment, and must also have received information on alternatives.

33. Ordering Physician • (Has the responsibility to explain the procedure and alternatives) Who should obtain a consent? • Radiologist • Technologist • (Especially in a busy environment)

34. Consent 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's. Urgent 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.

35. Refusal of Consent • When a patient refuses treatment, the practitioner may be confused or frustrated. • The right to refuse treatment may seem irresponsible or irrational action from the patient, but the practitioner must respect the patient’s decision. • It is important to keep in mind that the patient should never be forced or coerced into accepting treatment they are not comfortable with.