SECTION III PROFESSIONAL ISSUES IN IMAGING RADT 1022 INTRODUCTION TO RADIOLOGIC TECHNOLOGY 1
CRITERIA FOR A PROFESSION Extended training and education of its members based on a liberal foundation Theoretical body of knowledge leading to strictly defined skills, abilities, and principles of action Provides a specific service 2
CRITERIA FOR A PROFESSION Profession implies a vocation or occupation requiring extended training and education of its members, who have skills and serve a specific social need All professions have a code of ethics and professional organizations which influence the standards for education and practice requirements of its members. 3
EDUCATION: Evolving to meet the criteria of a profession Previously was hospitalbased then to hospitalbased and college/university-based Certificate or Associate Degree - basic entry level into practice BS degree - a requirement for professional level of practice RADT 1022 Section III: Professional Issues In Imaging 4
AMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGISTS (ARRT) Develops and administers certification examinations for eligible applicants in Radiologic Technology Requires continuing education to maintain competency Establishes standards Principles of Professional Conduct for Radiologic Technologists (page 9-11 textbook) Application for Certification will be provided near completion of radiography program http://arrt.org RADT 1022 Section III: Professional Issues In Imaging 5
CONTINUING EDUCATION (CE) FOR RADIOGRAPHERS Mandated in 1995 for those possessing an ARRT certification. Requires 24 continuing education units earned every 2 years. Achieved through seminars, conferences, lectures, departmental in service education, directed readings, home study and college courses. RADT 1022 Section III: Professional Issues In Imaging 6
AMERICAN SOCIETY OF RADIOLOGIC TECHNOLOGISTS (ASRT) Mission statement: Is to lead and serve its members profession, other health care providers and the public on all issues that affect the radiologic sciences. National professional organization for radiologic technology 7
ASRT Design preparatory education for a radiographer Develops position descriptions Develops the Scope of Practice (page 5 textbook) Develops code of ethics governing professional behavior (page 8 textbook) Provides continuing education for the profession Publications Professional journal - Radiologic Technology Membership application in Student Handbook and on-line http://asrt.org 8
State: UTAH SOCIETY OF RADIOLOGIC TECHNOLOGISTS (USRT) Provide continuing education for the profession Annual meeting Improve the welfare and socioeconomic status Monitors and assists in legislative activities License - protects public from unnecessary radiation Membership application (free to students) for USRT is located on-line at: http://www.usrt.net RADT 1022 Section III: Professional Issues In Imaging 9
ASSOCIATION OF COLLEGIATE EDUCATORS IN RADIOLOGIC TECHNOLOGISTS (ACERT) Annual Meeting in February Educational sections for faculty, clinical instructors, and students Student essay competition Student scholarship Posts employment opportunities WSU Radiologic Sciences - Institutional Member http://acert.org RADT 1022 Section III: Professional Issues In Imaging 10
STANDARDS OF PROFESSION Responsibility Accountability Competence Judgment Ethics Professionalism Life-long learning 11
Describe members of the health care team with whom the radiographer frequently interacts. 12
Discuss the purpose of professional organizations and list the reasons why a radiographer should become a member. 13
PURPOSE OF PROFESSIONAL ORGANIZATION Provide Members Opportunities Remain current in constantly changing technological fields expand knowledge base. Technical growth Leadership skills Interaction and networking 14
PROFESSIONAL ORGANIZATION MEMBERSHIP Allows the radiographer to Continue providing quality health care to patients Maintain the standards of his/her profession 15
Explain Practice of Standards and professional growth in radiologic technology. 16
PRACTICE STANDARDS AND PROFESSIONAL GROWTH IN RADIOGRAPHY Practice Standards for Medical Imaging and Radiation Therapy is a guide for the appropriate practice of medical imaging. These standards are used to define the practice and establish general criteria to determine compliance. Judge and evaluate quality of practice, service and education 17
Define ethics and discuss ethics as it applies to radiologic technology. Discuss confidentiality. 18
DIFFERENTIATE BETWEEN ETHICS, MORALITY, AND VALUES Ethics The system or code of conduct and morals advocated by a particular individual or group. Morality Concerned with relations between people and how they ought to behave towards one another in order to live in peace and harmony. Values Qualities or standards desirable or worthy of esteem in themselves; they are expressed in behaviors, language, and standards of conduct. 19
PROFESSIONAL ETHICS Ethics is defined as a set of moral principles governing ones course of action. Moral principles are a set of standards that establish what is right or wrong All individuals have a personal code of ethics that evolves based on their cultural and environmental background. COMBINATION OF ATTRIBUTES Honesty Integrity Fairness Caring Respect Fidelity Accountability RADT 1022 Section III: Professional Issues In Imaging 20
BIOETHICS Branch of ethics established because of the advancing technical methods of prolonging life. Pertains solely to ethics in the field of health care Narrows ethical inquiry to the moral oughts of those who work in professional clinical practice, basic research, or the education of health care professionals O Neil, 1995 RADT 1022 Section III: Professional Issues In 21 Imaging
CODE OF ETHICS - DEVELOPED, REVISED, AND ADOPTED BY ASRT AND ARRT Standard of Ethics - made up of 2 parts Code of Ethics Intended to assist RTs and candidates in maintaining a high level of ethical conduct and in providing for the protection, safety, and comfort of patients. Rules of Ethics These are mandatory and directive specific of minimally acceptable professional conduct for all RTs and applicants RADT 1022 22 Section III: Professional Issues In Imaging
ETHICAL PRINCIPLES DERIVED FROM ETHICAL 1. Utilitarianism (consequentialism) 2. Deontology 3. Virtue PHILOSOPHIES 23
UTILITARIANISM (CONSEQUENTIALISM) Decisions are based on the consequences or outcomes of a given act The good of an activity is evaluated based on whether immediate harm is balanced with future benefits. Imminent Domain 24
DEONTOLOGY Bases decision making on individual motives and morals rather than consequences Rules are followed at all times by individuals Examines the significance of actions themselves It would not be ethical to kick someone out of their homes in order to build a high rise building for profit. 25
DEONTOLOGY Deontologic problem solving uses personal rules of right and wrong derived from individual actions, relationships of all kinds, and society Advocates principles of autonomy, nomaleficience, beneficence, and justice 26
VIRTUE Using wisdom rather than emotional and intellectual problem solving Incorporates principles of both utilitarianism and deontology to provide broader view of issues Analysis, review consequences, and social rules 27
ETHICAL PRINCIPLES To resolve ethical dilemmas, one may apply the established set of principles: Autonomy Beneficence Confidentiality Justice Nonmaleficence Paternalism Sanctity of life Veracity Respect for property DOUBLE EFFECT Fidelity RADT 1022 Section III: Professional Issues In Imaging 28
AUTONOMY ETHICAL PRINCIPLES Patients are to be treated as individuals and informed about procedures to facilitate appropriate decisions Respects patients right to make their own decisions 29
BENEFICENCE ETHICAL PRINCIPLES Performance of good acts Planning patient care to assure safety Goal is to do good and is achieved through active process 30
CONFIDENTIALITY ETHICAL PRINCIPLES Duty owed by health care providers to protect the privacy of the patient and their information 31
DOUBLE EFFECT ETHICAL PRINCIPLES Knowing that performing an act may produce good effects and has bad effects or risk Four criteria must be met before action is ethically permissible 1. The act (action) must be good or morally indifferent (neutral) in itself. Example: A proposed imaging procedure must help the patient or at least not cause harm. 32
DOUBLE EFFECT ETHICAL PRINCIPLES 2. The intent is good, not evil, although a bad result may be foreseen. Example: The radiographer must intend for the imaging procedure to aid in the health care process, not to injure the patient or to cause pain. 33
DOUBLE EFFECT ETHICAL PRINCIPLES 3. The evil effect cannot be a means to the good effect. Example: The patient may believe the imaging procedure to be a bad effect; however, to gain a diagnosis, or good effect, the patient may have to undergo an unpleasant examination. 34
DOUBLE EFFECT ETHICAL PRINCIPLES 4. Proportionality must exist between good and evil effects. Example: The good of the procedure must at least balance with the unintended pain or discomfort. 35
FIDELITY ETHICAL PRINCIPLES Duty to fulfill commitments and to keeping promises stated and implied. Example: cannot promise results for the patient that the radiographer cannot achieve. 36
JUSTICE ETHICAL PRINCIPLES Treat all patients equally All patients will receive equal benefits according to need 37
NONMALEFICENCE ETHICAL PRINCIPLES The avoidance and prevention of evil. Duty to abstain from inflicting harm. Goal is to do no harm (avoid evil) and is achieved through passive omission 38
PATERNALISM ETHICAL PRINCIPLES A health care model (priestly) that casts the care giver in the omniscient, paternalistic role of making decisions for patients rather than with patients. Examples: Radiographer dismisses patient s need to know more information by telling patient not to worry, everything will be fine. Radiographers who think they know best and tend to dismiss patient s feelings. 39
SANCTITY OF LIFE ETHICAL PRINCIPLES The obligation not to take human life. Life is the highest good Nobody has the right to judge another person s quality of life as so poor that his/her life is not of value and should be terminated. 40
VERACITY (TRUTHFULNESS) ETHICAL PRINCIPLES The obligation to tell the truth and not to lie or deceive others (veracity). Being honest with patients, coworkers, and self. 41
RESPECT FOR PROPERTY ETHICAL PRINCIPLES Keeping the patient s belongings safe Avoiding careless behavior or intentionally damaging or wasting equipment or supplies. 42
ETHICAL ISSUES IN RADIOGRAPHY Expected to conduct yourself in a professional manner Reliable Be a team player Treat all patients with dignity and worth 43
Explain the legal obligations radiographers have to patients, peers, and other members of the health care team. 44
LEGAL RESPONSIBILITY Provide the patient with good care Act professional around peers and the health care team Provide information regarding anything unusual 45
PRACTICE STANDARDS Define the practice and establish a criteria to determine compliance with the law as it applies to radiologic technology. Divided into 3 sections. 1. Professional Performance 2. Clinical Performance 3. Quality Performance RADT 1022 Section III: Professional Issues In 46 Imaging
LAW A body of rules of action or conduct prescribed by controlling authority and having binding legal force 47
COMMON LAW Encompasses principles and rules based on ancient usage and customs Common law regarding negligence was established through custom and judicial decisions supporting that custom 48
STATUTORY LAW All laws and statutes put into place by elected officials Federal government State government County government City government 49
CASE LAW Previous judicial decisions on cases Required either interpreting statutes or adopting common law principles 50
BRANCHES OF LAW Administrative Law Criminal Law Civil Law 51
ADMINISTRATIVE LAW Deals with licensing and regulation Penalties for violation can include suspension and revocation of license 52
CRIMINAL LAW Addresses wrongs against the state Penalties for violation can include fines, restriction, community service, and incarceration 53
CIVIL LAW Addresses wrongs committed by one party harming another Penalties for violation can include monetary damages to compensate for loss and to punish 54
FELONY A crime of serious nature punished by incarceration for more than 1 year and in extreme cases by the death penalty MISDEMEANOR A crime of a less serious nature punished by a fine or incarceration for less than 1 year 55
Violations of civil law. TORTS It is considered personal injury law The same conduct may constitute both a tort and a violation of the criminal law 56
TWO TYPES OF TORTS 1. Those resulting from intentional action Intentional Misconduct (commit) 2. Those resulting from unintentional action Unintentional Misconduct (omit) 57
INTENTIONAL MISCONDUCT (TORT) SINS OF COMMISSION There are several situations in which a tort action can be brought against the health professional It is a purposeful deed committed with the intention of producing the consequences of the deed. Example: Causing extreme emotional distress resulting in illness through outrages or conduct 58
INTENTIONAL MISCONDUCT (TORT) Other forms of intentional misconduct include: a. Invasion of privacy b. Defamation c. False imprisonment 59
UNINTENTIONAL MISCONDUCT (TORT) SINS OF OMISSION A radiographer is negligent in the performance of patient care and the patient is injured as a result. Improper marking radiographic images Omitting to apply gonadal shielding Handing the Radiologist the incorrect syringe during a procedure with the incorrect medication Leaving a patient unattended with bed rails down and having the patient fall off the gurney 60
UNINTENTIONAL MISCONDUCT (TORT) NEGLIGENCE Defined as a breach or a failure to fulfill an expected standard of care STANDARD OF CARE Degree of care that would be used by a "reasonable person" under the circumstances For health care professionals, however, the standard of care is modified somewhat and is determined by the degree of care or skill that a reasonable health care professional would exercise under the circumstances 61
NEGLIGENCE Four elements must exist for civil proceedings. 1. The standard of care owed to the injured person. The radiographer must exercise the care that a reasonable radiographer is expected to exercise under the same circumstances. 2. Breach of the standard of care. A breach is failure to exercise reasonable care. Example: The radiographic image was of poor quality and did not provide diagnostic information resulting in a patient's condition deteriorating because the physician could not properly interpret the radiograph. 62
NEGLIGENCE 3. The radiographer s negligence must be shown to be the direct cause of the patient s injury. Example: If a radiographer left a patient alone when he/she has the duty to make sure that a dizzy or semiconscious patient does not fall from the examination table. A jury hearing the tort action likely would agree the radiographer's breach of duty (negligence) caused the injuries. 4. The patient sustains actual injury. A personal injury case or tort will not be successful in establishing liability if there are no damages. Example: Mislabeling images resulting to surgical removal of the wrong kidney, 63
respondeat superior Latin - "let the master answer Requires that an employer pay the victim for the torts committed by its employees. Although the employing hospital may be jointly liable with an employee, this does not mean a radiographer is immune from damage suits or relieved of personal responsibility for breach of duty. All people are responsible for their own injurious conduct. 64
res ipsa loquitur Latin - "the thing speaks for itself." Applies to a case that is built around evidence that demonstrates that an injury could not have occurred if there had been no negligence. Example, it is discovered that a pair of forceps has been left in the patient's abdomen after surgery. 65
Define the Patient Care Partnership and A Patient s Bill of Rights. 66
PATIENT RIGHTS The professional radiographer has a legal, ethical and professional responsibility to relate to your colleagues, other members of the health care team, and the patient in a manner that is respectful of each person with whom you interact while you adhere to the Patient s Bill of Rights, known today as Care Partnership. Because all health care workers are required to adhere to the provisions of this bill, all must be familiar with it. Textbook: Display 1-5 and 1-6, pages 13-15. RADT 1022 Section III: Professional Issues In 67 Imaging
PATIENT RESPONSIBILITIES 1. Provide accurate health history 2. Keeping appointments 3. Refusing treatment 4. Financial obligations 5. Following hospital rules and regulations 6. Being considerate of the rights and property to others 68
RADIOGRAPHER RESPONSIBILITIES Cannot act as diagnosticians Cannot give results of diagnostic imaging examinations Must obtain the proper consent from women of child-bearing age before performing procedure Must obtain a complete history before administering an iodinated contrast agent Identify the correct patient before performing an exam Must explain a diagnostic procedure before the examination takes place Must document technical factors used to facilitate dose calculations for a procedure 69
IMMOBILIZATION TECHNIQUE Patients may not be immobilized for imaging procedures simply as a matter of convenience. The method of immobilization must be the least restrictive to the patient s movement and freedom. An order for patient immobilization for a defined period of time to protect the patient's safety must be obtained from the patient's physician. When used, the reason for use, the type used, and the length of time it was used must be documented. 70
IMMOBILIZATION TECHNIQUE Improperly using immobilization without a physician's orders can be considered false imprisonment and legal action can be taken. Only when all other safe methods of obtaining a radiograph are exhausted should immobilizing the patient be considered. Call security to assist in immobilization if a combative patient threatens you. 71
IMMOBILIZATION TECHNIQUE The use of medication as a restraining technique occurs only in extreme cases and is done by a physicians order only. Unauthorized use of immobilization techniques can be construed as false imprisonment a tort. 72
INFORMED CONSENT Patient s written assent to receive a proposed treatment. Adequate information is essential for the patient to give truly informed consent. Many imaging procedures require special consent forms to be signed by the patient or parent/guardian. A consent is a contract wherein the patient voluntarily gives permission to perform a service. 73
INFORMED CONSENT The patient must also be informed of all aspects of the procedure prior to signing a consent. At this time the patient may choose to continue with the exam or refuse all together. Radiographer is responsible to Check the patient's chart to be sure that special consent forms have been signed Notify physician if the patient, parent, or legal representative denies knowing about the procedure 74
INCIDENT REPORTS (UNUSUAL OCCURRENCE REPORTS) Documents any injury received by a patient as soon as possible. Incidents must also be reported by the supervisor of the department to the institution's insurance company. An injury to a patient or any error made by personnel in the diagnostic imaging department, must be documented in an incident report as soon as it is safe to do so. 75
INCIDENT REPORTS (UNUSUAL OCCURRENCE REPORTS) The incident report should be factual regarding the nature of the injury or situation and signed by all who participated in or witnessed the event. All incident reports must be completed and submitted according to department policy and procedure. 76
PATIENT SAFETY REPORTING The Patient Safety and Quality Improvement Act of 2005 was signed by President Bush and enacted to amend title IX of the Public Health Services Act The law provides for the improvement of patient safety and to reduce the incident of events that adversely effect patient safety. 77
GOOD SAMARITAN LAWS State statutes to protect health care professionals (radiographers) who stop to help at the scene of an accident from liability for any adverse results of his actions These laws were enacted to protect persons who give medical aid to persons in emergency situations from civil or criminal liability for their actions. 78
Explain the need for professional malpractice insurance. Malpractice is a wrongful act by a physician, lawyer, or other professional which injures a patient or client. A radiographer named in a law suit may not have complete coverage for legal expenses for defense council. RADT 1022 Section III: Professional Issues In Imaging 79
MALPRACTICE INSURANCE Radiographers should verify protection from employment Radiographer should investigate carrying their own malpractice insurance in case the legal expenses for his/her defense are not covered completely by his employer. Available through ASRT. 80
Describe the patient s need for confidentiality and the legal implications for the radiographer. Explain the need for accurate documentation in health care and the radiographer s obligation in this aspect of health care. 81
MEDICAL RECORDS AND DOCUMENTATION Kept to transmit information about patients from one health care worker to another Protect patients from medical errors and duplication of treatments Provides information for medical research Protects health care workers in cases of litigation Provide information concerning quality of patient care for institutional evaluation teams 82
DOCUMENTATION Radiographic images are part of the patient s medical record and can be used in legal evidence in the event of a law suit. The following must be correct: Patient s name Patient s identification number Name of the facility Correct placement of L or R marker Date RADT 1022 83 Section III: Professional Issues In Imaging
DOCUMENTATION A consent written or signed by the patient or legal guardian must be presented prior to any release of patient records. Original radiographs or digital copies must never leave the hospital; however, if a patient is asking for radiographs, copies can be given. Follow Policy and Procedure. Be aware, patients have a right to access all medical records which includes radiographers RADT 1022 84 Section III: Professional Issues In Imaging
COMPUTER TECHNOLOGY IN RADIOGRAPHIC IMAGING One of the most common computer applications in radiologic imaging departments is Picture Archiving and Communication Systems (PACS), or Teleradiology systems. Benefits Immediate access to images from all areas of hospital. No more lost images Physicians are able to work off site RADT 1022 85 Section III: Professional Issues In Imaging
CONFIDENTIALITY, PRIVACY, THE HEALTH PORTABILITY AND ACCOUNTABILITY ACT IN RADIOLOGIC TECHNOLOGY In 1996, Congress recognized the need for national patient privacy standards. For this reason, the Health Portability and Accountability Act of 1996 (HIPAA) was enacted. In November 1999, the Department of Health and Human Services (DHHS) published proposed regulations to guarantee patients new rights and protection against the misuse or disclosure of their health records. RADT 1022 86 Section III: Professional Issues In Imaging
OBLIGATIONS OF THE RADIOGRAPHER Maintaining radiographs as these are considered a part of a patient's record and may be used as legal evidence in an lawsuit Labeling radiographs with correct patient's name, identification number, name of facility where taken, and a marker that is correctly placed 87
Questions? 88
RADT 1022 Section III: Professional Issues In Imaging 89