Resolving Ethical Dilemmas in the Alternate-Site Setting. Top 5 Things to Know for CE: Ethics defined. 3/31/10

Transcription

1 Resolving Ethical Dilemmas in the Alternate-Site Setting Barbara Prosser, RPh Vice President Clinical Services Critical Care Systems Top 5 Things to Know for CE: 1. Make sure your BADGE IS SCANNED each time you enter a session, to record your attendance. 2. Carry the Evaluation Packet you received on registration with you to EVERY session. 3. If you re not applying for CE, we still want to hear from you! Your opinions about our conference are very valuable. 4. Pharmacists and Nurses need to track their hours on the Statement of Continuing Education Certificate form as they go. 5. FOR CE: At your last session, total the hours and sign your Statement of Continuing Education Certificate form. Keep the PINK copy for your records. Place the YELLOW and WHITE copies in your Evaluation packet Make sure an evaluation form from each session you attended is completed and in your Evaluation packet Put your name on the outside of the packet, seal it, and drop it in the drop boxes in the NHIA registration area at the convention center Ethics defined. Eth-ics / e [unvoiced]iks/ pl. n. 1. [usu. treated as pl.] moral principles that govern a person s or groups behavior: Judeo Christina ethics. the moral correctness of specified conduct: the ethics of euthanasia 2. [usu. Treated as sing.] the branch of knowledge that deals with moral principles. Derivitives: th I cist/ e[unvoiced]isist/ n. The Oxford Pocket Dictionary of Current English Copyright The Oxford Pocket Dictionary of Current English 2009, originally published by Oxford University Press Accessed January 22,

2 The Six Values of Medical Ethics 1. Autonomy the patient has the right to refuse or choose treatment 2. Non-maleficence do no harm 3. Beneficence act in the best interest of the patient 4. Justice scare resources, who gets them? The Six Values of Medical Ethics 5. Dignity the patient and the caregiver have the right to dignity 6. Truthfulness and honesty informed consent Administrative Ethics: A Guide for Home Care Providers HCMA, Ltd The Home Care Helper Resources for Providers Home Care Management Associates, Ltd. Copyright 1998, 1999 HCMA, Ltd. Accessed January 22, 2010 Ethics must begin at the top of a organization. It is a leadership issue and the chief executive must set the example. Edward Hennessy thinkexist.com/quotation/ ethics_must_begin_at_the_top_of_an_organization/ html Accessed January 22,

3 Setting the Tone for Ethical Practices Accrediting body requirements Professional Organizations Compliance Standards Contractual agreements Philosophical relationships Religious institutions Cultural needs Company standards Setting a Code of Conduct Leading by example Compliance programs Ethics Committee Polices and procedures/standards of Practice Codes of Conducts Organization vs. Professional Compliance policies Reference published codes ASPH APhA ANA INS 3

4 Ethics Committee Provide guidelines for the organization Establish the tone Act as a resource for leadership and clinicians Act a facilitator for issue resolution Membership Compliance Officer Legal Counsel Clinical Leadership Human Resources Field Representative P&Ps / SOPs End of Life Care Refusal of Treatment Informed Consent Admission Criteria Withholding/Withdraw of Care I can do no other than be reverent before everything that is called life. I can do no other than to have compassion for all that is called life. That is the beginning and the foundation of all ethics. Albert Schweitzer Accessed January 22,

5 Common Issues faced in Home Infusion Non-compliance Caregiver Abuse Substance Abuse End of Life All the above can lead the patient to request to withdraw therapy. Withholding/Withdrawing Care Process Develop a policy to address the process Consider Role of the Ethics Committee Escalation process Local vs. ethics committee Patient refusal of delivery Inappropriate patients Case conferences with the patient, physicians and caregivers Withholding/Withdrawing Care Process DNR procedures Informed consent consequences of discontinuing therapy Obtaining physician orders Advance Directives Address patient understanding at the start of care, identify the populations to address End of life Palliative Care Chronic Diseases Life sustaining therapies Document, document, document 5

6 A Request to Stop Therapy.may come in many forms Refusal of the delivery Non - compliance Missed appointments Unresponsiveness to the therapy Caregiver concern Patient comments to drivers/psrs Obstacles Family/Caregivers members that are in denial of a diagnosis/prognosis Caregivers that are trying to protect/shield a patient from a diagnosis/prognosis Parents of minor children Case Conference Upfront education sets the stage Include all caregivers, physicians and clinicians on the care team Include any agencies that you are working with Always include the patient Informed consent Physician s role orders/prescriptions 6

7 Case conferences Establish the patients wishes Understand the consequences of stopping treatment Develop a plan to begin withdrawal of treatment Obtain orders The Challenging Patient. Does not meet admission criteria Home safety Support Non-compliance Substance abuse Patient Caregiver Patient Challenges - Obstacles Physician refusal Lack of prescribing physician Enabling caregivers/support Inaccessible patient Patient abandonment 7

8 Approach to Withdrawing Care and Services Case Conference Patient Contracts Non-compliance to medication Non-compliance to the care plan Inappropriate use of IV access Physician conference Establish Rights and Responsibilities for all parties Options Prescription refill Do not accept refills or new prescriptions Transfer to another level of care Hospital Re-admission Establish new physician contact Refuse readmission to home care services Managing Risk Engage Legal Counsel Document, Document, Document Physician orders are always necessary Engage the caregivers and family Set expectations Educate staff regarding the process mandatory in-services 8

9 Even the most rational approach to ethics is defenseless if there isn t the will to do what is right Alexander Solzhenitsyn thinkexist.com/quotation/even_the_most_rational_approach_to_ethics_is/ html Accessed January 22, 2010 Common Issues Facing the Home Infusion Provider Caregiver is abusing the patients controlled substances Patient has exhausted the physician and they are refusing to provide any additional orders Patient not present for appointments Chronic patient is exhausted and wants to stop therapy Cancer patient is ready to stop treatment TPN patient is draining TPN rather than administering the medication Patient is using the IV access to administer street drugs Q&A 9