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Spartanburg Regional Healthcare System, South Carolina

Spartanburg Regional Healthcare System, South Carolina. No Commercial Disclosures One Non Commercial Disclosure.

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Spartanburg Regional Healthcare System, South Carolina

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  1. Spartanburg Regional Healthcare System, South Carolina

  2. No Commercial DisclosuresOne Non Commercial Disclosure On May 5, 1945, a young man, only married a few months, with the soldiers of the 41st Recon Squad of the US 11th Armored Division helped liberate Mathausen-Gusen Concentration camp. That man was my father. His stories profoundly affected my life. So, it is not strange coincidence, I am a patient, hospital and physician advocate.

  3. From the Nuremberg Trials—Informed Consent was conceived • Informed Consent= • Informed Choice • Can be expressed in Advance Directives such as a: • Living Will • Healthcare Power of Attorney or DPA

  4. Aviation and Medicine “An airline accident is almost always the end result of a causal chain of events. If any one link was different, the outcome may have been different. Almost no accident was the result of just one problem.” Capt. Chesley “Sully” Sullenberger in “Highest Duty”

  5. "Integrity means doing the right thing even when it is not convenient." Capt. Chesley "Sully" Sullenberger --Highest Duty

  6. Origination Check List • 6 Tasks

  7. Before Start Check List • Back and forth-Pilot to First Officer • 24 Tasks

  8. Check and Weight Balance Check List • Includes Engine Start • 6 Tasks

  9. After Start Engine Checklist • 14 Tasks

  10. Take Off—Constant Communicationwith Read Back

  11. 18,000 Feet-Climbing 4 Task Check List

  12. Aviation-at any given moment roughly 5,000 planes are in the air in the United States alone. • Complex Systems • Changing Weather Conditions at • Each altitude • Each location • Mechanical Failure • Passenger Emergencies

  13. Medical Errors • 1 in 4 Hospitalized Patients are victims of a medical error (Health Affairs, April 19, 2011) • $17 Billion Extra Medical Costs • Over 2.25 million American Deaths (source Consumer Reports—August 2012)

  14. SABM Standard 2 • Informed consent is vital, should be standardized and consistently delivered • Patient autonomy-a legally protected right • Advance Directivescommunicate wishes of patient declining transfusion.

  15. MULTIPLE CONSIDERATIONS • Regulatory (TJC/CMS) • Legal • Ethical • Practical

  16. AMA Definition Informed Consent Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention. In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:

  17. An Advance Directive is Life on Your Terms Whether you're 18 or 80, documenting your wishes today means your family won't have to make heart-wrenching decisions later The American Medical Association—Put It In Writing

  18. Five Fundamental Principles of Clinical/Medical Ethics • Autonomy – patient’s perspective • Veracity – truth-telling • Beneficence – MD’s doing good • Non-maleficience – doing no harm • Justice – being fair

  19. Basic Elements of Informed Consent • Consent is a Process • Consent Requires Comprehension by Patient • Consent Must Be Voluntary and Free from Coercion • Consent May be Revoked at Any Time • Consent is Prospective

  20. SABM Standard 2 • Policy regarding Advance Directives • Informed Consent • Addresses Minors-(not one shoe fits all) • Education to medical staff regarding alternatives • New Nursing Orientation • Grand Rounds • Nursing In-Service • Blood Management Awareness Week

  21. Crew Management Resource • Bloodless/Patient Blood Management Program • Admissions • Advance Care Planning Program/Palliative Care • Chaplain Services

  22. Transfusion Informed Consent

  23. Please Note • Patient Not Competent—Next of kin decision maker • Urgent situations-no kin or advance directive---Implied Consent • One consent per hospitalization • Elective Surgery patients informed beforehand if transfusion expected • Nursing will not accept verbal orders concerning informed consent

  24. “Health literacy is a significant problem in the United States, with nearly nine out of 10 adults lacking all the skills and knowledge they need to use and understand health information, according to the National Assessment of Adult Literacy.”—May 2012 Healthzone.com Hospital should provide document to help adults with capacity

  25. Multiple Redundant Communication BLOOD/BLOOD PRODUCTS RELEASE OF LIABILITY FORM 1487 (Rev. 01-09)

  26. “Stay our of court with proper documentation”—Sally Austin, JD, ADN, BGS, April/Nursing2011 • Notes that are sloppy, incomplete, inconsistent, illegible, or have gaps • Entries not times or dated or that appear out sequence • Lack of documentation of patient education • Failure to communicate and monitor is red flag—document conversations— • Mayo example—”Think like a jury.”

  27. Must Include Transfusion Education for Anyone Ordering a Liquid Transplant

  28. Provide Education to Patient’s

  29. Process to allow clinical staff to easily ID patients that refuse transfusion

  30. It Includes • The patient's diagnosis, if known; • The nature and purpose of a proposed treatment or procedure; • The risks and benefits of a proposed treatment or procedure; • Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance); • Therisks and benefits of the alternative treatment or procedure; • The risks and benefits of not receiving or undergoing a treatment or procedure. • In turn, your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention. • This communications process, or a variation thereof, is both an ethical obligation and a legal requirement spelled out in statutes and case law in all 50 states.

  31. Both TJC and CMS Require… …that inpatients and outpatients are informed of their rights. TJC guidelines give more details on what that looks like.

  32. CMS (R1.01.01, EP 1-2, 4-10, 12) • Patient rights are supported and respected by the hospital, and patients are informed of their rights. These include the right to dignity/respect, effective communication, cultural and personal beliefs/values, religious and spiritual accommodation, access to information or disclosure of health information, and pain management.

  33. Standards PC.2.20 and PC.3.120EP 2 As appropriate to the patient’s age and specific clinical needs, the psychosocial assessment includes information about the following: (among other things) • The patient’s religion and spiritual orientation.

  34. PC 2.20 • The hospital defines in writing the data and information gathered during assessment and reassessment.

  35. PC 2.20 EP 4 • This information includes…for patients receiving end of life care, the social, spiritual, and cultural variables that influence perceptions and expressions of grief by the patient, family members, or significant others

  36. Legal Constraints • Title VII Civil Rights Act of 1964 Prohibits discrimination on the basis of race, color, religion, sex or national origin

  37. ETHICALLY SPEAKING “Ethics of Reciprocity” in 21 world religions • “Do unto others as you would have them do unto you” (Christianity) • “This is the sum of duty: do not do to others what would cause pain if done to you” (Hinduism) • “None of you [truly] believes until he wishes for his brother what he wishes for himself." (Islam) • “What is hateful to you, do not to your fellow man. This is the law: all the rest is commentary.“ (Judaism)

  38. Growth in Religious Diversity and What it Means for Hospitals • The number of adherents of non-Christian religions is growing at an exponential rate • People of diverse expressions of faith are working in the same space • Patients often adhere to beliefs that are different than mainstream

  39. Major Religions of the WorldRanked by Number of Adherents Top Twenty Religions in the United States, 2001 Religion 2001 Est. % Change ‘90 – ’01 Christianity 159,030,000 +5% Nonreligious/Secular 27,539,000 +110% Judaism 2,831,000 -10% Islam 1,104,000 +109% Buddhism 1,082,000 +170% Agnostic 991,000 -16% Atheist 902,000 no figures kept in ‘09 Hinduism 766,000 +237% Unitarian Universalist 629,000 +25% Wiccan/Pagan/Druid 307,000 no figures kept in ‘09 Spiritualist 116,000 no figures kept in ‘09 Native American Religion103,000 +119% Baha'i 84,000 +200% New Age 68,000 +240% Sikhism 57,000 +338% Scientology 55,000 +22% Humanist 49,000 +69% Deity (Deist)49,000 +717% Taoist 40,000 +74% Eckankar 26,000 +44% (my underlining of those nine with greater than 100% growth) Source is http://www.adherents.com/

  40. Recommendations • Use Clear Language (not Medical Language) • Ask patients to prepare in advance (staff ask patients to bring their written questions) • Learn to understand cultural differences • Avoid appearing judgmental • Use the Teach Back Method (SBAR)

  41. A HealthGrades study revealed hospitals whose patient ratings for communication between physicians and nurses were at the top 10% appeared to be less prone to medical errors than those rated in the bottom 10%, suggesting that better communication boosts patient safety and satisfaction. BeckersHospitalReview.com (5/22/2012)

  42. Former Supreme Court Justice Harlan Stone jokingly suggested "The Jehovah's Witnesses ought to have an endowment in view of the aid which they give in solving the legal problems of civil liberties." “ Like it or not,“ observed American author and editor Irving Dilliard, "Jehovah's Witnesses have done more to help preserve our freedoms than any other religious group." Professor C. S. Braden wrote: “ They have performed a signal service to democracy by their fight to preserve their civil rights, for in their struggle they have done much to secure those rights for every minority group in America."

  43. Recommended Reading • Informed Consent in Blood Transfusion and Cellular Therapies….Patients, Donors and Research Subjects---Edited by Christopher Stowell and • Kathleen Sazama

  44. Table 3-1. Elements of Informed Consent • Information provided to the patient • Explanation of the intervention • Benefits • Risks • Alternatives • Opportunity for questions/clarification • Availability of choices (including refusal) • Autonomous patient decision • Documentation of the process

  45. Why Hospitals Should Fly-John J. Nance, JD

  46. "Integrity means doing the right thing even when it is not convenient."  Capt. Chesley "Sully" Sullenberger

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