CHAPTER REVIEW QUESTIONS WEEK 4

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CHAPTER 19

Legal Reporting Requirements

Learning Objectives (1 of 2)

Describe various forms of child abuse, how to recognize it, and reporting requirements.

Describe various forms of elder abuse, how to recognize it, and reporting requirements.

Describe common signs of spousal abuse and what steps staff members can take to address their concerns with patients.

Explain why it is important to report communicable diseases, adverse drug reactions, and infectious diseases.

Learning Objectives (2 of 2)

Discuss the importance of reporting births and deaths.

Explain how and why physician incompetence is reported.

Understand the importance of incident reporting, sentinel events, and the purpose of root cause analyses.

Abuse

Abuse in the healthcare setting often occurs to those who are most vulnerable and dependent on others for care.

Abuse can take many forms, such as physical, psychological, medical, and financial.

Abuse is not always easy to identify because injuries can often be attributed to other causes.

Child Abuse

Intentional serious mental, emotional, sexual, and/or physical injury inflicted by family or other person responsible for care

Child Abuse Prevention and Treatment Act (CAPTA)

Minimum standards states must incorporate in their statutory definitions of child abuse and neglect

Child Abuse: Who Should Report

Healthcare setting

Administrators, physicians, interns, registered nurses, chiropractors, social service workers, psychologists, dentists, osteopaths, optometrists, podiatrists, mental health professionals, and volunteers in residential facilities

Penalties for failure to report

States vary on penalties.

Child Abuse: How to Detect (1 of 2)

Physical indicators

Bruises

Sprains

Fractures

Cigarette burns

Child Abuse: How to Detect (2 of 2)

Behavioral indicators

Diminished psychological or intellectual functioning

Failure to thrive

No control of aggression

Self-destructive impulses

Decreased ability to think and reason

Acting out and misbehavior

Habitual truancy

Child Abuse: Cases

Good faith reporting

Psychologist Immune to Liability

Failure to report child abuse

Psychologist’s Failure to Report Abuse

Nurse’s Failure to Document and Report

Physician Entitled to Immunity

Child Abuse Can Be Elusive

Senior Abuse

Mistreatment: Results in harm or loss

Can involve:

Physical and sexual abuse

Domestic and psychological abuse

Financial abuse

Neglect

Failure to provide needed care

Signs of Senior Abuse (1 of 4)

Prescribed treatment or dressings neglected

Presence of dementia or delirium

Evasive caretaker; explanations not plausible

Delay in seeking treatment

Disparity between caregiver and patient accounts

Patient unduly fearful, nervous, withdrawn

Signs of Senior Abuse (2 of 4)

Caregiver unwilling to meet patient needs

Prescribed meds not given or given incorrectly

Elder lacks need supervision at home

Signs of Senior Abuse (3 of 4)

Multiple bruises in various healing stage

Multiple recurring fractures

Malnourishment, dehydration

Dirty or unkempt

Signs of Senior Abuse (4 of 4)

Missing personal belongings, such as silverware or jewelry

An untreated medical condition

Patient unable to speak for himself or herself or see others, without presence of caregiver

Senate Select Committee on Aging (1 of 2)

Elder abuse less likely to be reported than child abuse

Most instances of senior abuse

Repeated events

Not one-time occurrences

Senate Select Committee on Aging (2 of 2)

Victims are often 75 years of age or older.

Women are more likely to be abused than men.

Seniors often are ashamed to admit their loved ones abuse them.

May fear reprisals if they complain.

Family members are resentful of a frail and dependent senior parent.

Majority of abusers are relatives.

National Center on Elder Abuse

The National Center on Elder Abuse (NCEA), directed by the U.S. Administration on Aging, is committed to helping national, state, and local partners in the field be fully prepared to ensure that older Americans will live with dignity, integrity, and independence, and without abuse, neglect, and exploitation.

Preventing Abuse: Policies and Procedures

Prohibition of mistreatment

Description of reporting procedures regarding alleged abuse

Maintenance of evidence of alleged abuse

Investigation of alleged abuse

Prevention of further potential abuse while investigation is in progress

Documentation and Reporting (1 of 2)

Suspected abuse should be defined clearly and objectively.

Witnesses: Reporters of abuse must describe statements made by others as accurately as possible.

What actions were taken, by whom, when, where, etc.

Information should be included about how witnesses may be contacted.

Documentation and Reporting (2 of 2)

Photographs: It may be necessary to photograph wounds or injuries.

Hospital emergency room or the police department can be asked to photograph in emergency situations.

Spousal Abuse

Domestic violence

Abuse can be physical, sexual, or psychological in nature.

Sings of Spousal Abuse (1 of 3)

Bruising in the chest and abdomen

Multiple injuries

Minor lacerations

Ruptured eardrums

Delay in seeking medical attention

Sings of Spousal Abuse (2 of 3)

Patterns of repeated injury

Stress-related illness

Anxiety, panic attacks, stress, and/or depression

Drug abuse, including tranquilizers and alcohol

Chronic headaches, asthma, vague aches and pains

Sings of Spousal Abuse (3 of 3)

Abdominal pain, chronic diarrhea

Sexual dysfunction, vaginal discharge

Joint pain, muscle pain

Sleeping and eating disorders

Suicide attempts, psychiatric illness

Communicable Diseases

Reported to protect citizens from infectious diseases

Reporting required by statutes

AIDS

State-required reporting

Mandatory testing

Births and Deaths

Reportable by statute

Necessary to maintain accurate census

Medical examiner

Suspicious deaths

Determines cause of death

Adverse Drug Reactions

Harmful drug reactions

Result of administration of a drug or combination of drugs

MedWatch

FDA program for reporting harmful reactions

Physician Competency

Health Care Quality Improvement Act

Authorizes National Practitioner Data Bank to collect and release information on professional competence and conduct of healthcare practitioners

National Practitioner Data Bank

Created by Congress as national repository of information with primary purpose of facilitating a comprehensive review of healthcare practitioners’ professional credentials

Operates under authority of the Secretary of DHHS

Established to protect public by restricting ability of unethical or incompetent practitioners from moving state to state without disclosure or discovery of previously damaging or incompetent performance

National Data Bank Reporting

Reporting requirements

Required queries

Required reporting

Data bank queries

Query fees

Penalties for failing to report

Confidentiality

Incident Reporting (1 of 3)

States’ reportable incidents

Serious injury or death

Hospital-acquired infections

Fires

Loss of power

Employment strikes

Incident Reporting (2 of 3)

The Deficit Reduction Act, amended in 2008, cites hospital-acquired infections Medicaid and Medicare will not reimburse hospitals for:

Catheter-associated urinary tract infections

Surgical site infections following bariatric surgery

Surgical site infections following certain elective surgeries

Incident Reporting (3 of 3)

Incident/occurrence reports discoverable

Incident reports

Should not be placed in the medical record

State-Reportable Incidents

Communicable diseases

Infections

Unusual or an unexpected cluster of patients

Symptoms/diseases or exposures suggestive of a health emergency or terrorism event

Managers must be aware of state reporting requirements.

Hospital procedures for reporting patient care incidents must comply with state regulations.

Sentinel Events (1 of 2)

Unexpected occurrences involving:

Death

Permanent harm

Severe temporary harm

Suicide of any patient

Unanticipated death of a full-term infant

Discharge of infant to wrong family

Abduction of any patient receiving care, treatment, and services

Sentinel Events (2 of 2)

Suicide

Unanticipated death of a full-term infant

Infant abduction

Rape

Hemolytic transfusion reaction

Surgery on the wrong patient or wrong body part

Root Cause Analysis (1 of 2)

Process for identifying basic or causal factors that underlie the variation in performance, including the occurrence or possible occurrence of a sentinel event

Root Cause Analysis (2 of 2)

Thorough

Credible

Investigation involves general and special causes

Researching literature

Search for best practices

Implementing and monitoring change

Review Questions (1 of 2)

Describe various forms of child abuse, how to recognize it, and reporting requirements.

Describe various forms of elder abuse, how to recognize it, and reporting requirements.

Describe the signs of spousal abuse and the role of nurse in addressing the patient’s safety needs.

Describe what actions hospitals should take to ensure that caregivers addresses suspicions of spousal abuse.

Discuss importance of reporting births and deaths.

Review Questions (2 of 2)

Explain why it is important to report communicable diseases, adverse drug reactions, and infectious diseases.

Explain how and why physician incompetency is reported.

Explain the importance of incident reporting, sentinel events, and the purpose of root cause analyses.

CHAPTER REVIEW QUESTIONS WEEK 4

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