Week 4- Legal and Ethical Issues in Quality Improvement

            Before beginning this unit, I expected to learn about legal and ethical issues affecting quality improvement in healthcare. I actually learned a great deal about legal and ethical issues. Our group discussed a case study about a young girl, named Elsa, who was diagnosed with fibromyalgia shortly after obtaining her dream job as an elementary education teacher. We concluded her life would be negatively impacted with this new diagnosis, leading to depression and suicidal ideation. Sadly, suicide would be a viable option for Elsa. Although, as her nurse, we would focus all our efforts on preventing Elsa from doing this by helping her find value in her life and coping with this disease. I researched different support services that would be available to Elsa. I was surprised to find social media support groups, in-home physical therapy assistance, and countless online resources educating a person all about fibromyalgia and how to live with it. There are many ways to live a fulfilling and successful life, even with the disease. Pain management and emotional/mental support via counseling are two areas of focus for the nurse to keep Elsa’s spirits uplifted.

            The discussion asked if assisted-suicide was a viable option for Elsa. I did some research and found that it was not. Only certain states in the U.S. allow assisted-suicide, including Oregon, Washington, and Vermont (Oregon Public Health Division, 2015). Certain criterion must be met in order to be considered, including age over 18 years, being of a sound mind, and being diagnosed with a terminal illness with six months left to live. This, of course, is determined by the physician. A lethal dose of medication would then be prescribed to be ingested by the patient at home.

            I also researched an article on legal and ethical issues in quality improvement. The article discussed legal issues from the implementation of Electronic Health Records (EHRs) in countries around the world and in Emergency Departments specifically (Ben-Assuli, 2015). EHR systems require more time being dedicated to charting and less to the patient experience. Initially when learning the system, clinicians often will make personal mistakes in how they enter information leading to adverse medical events and errors. When charting in EHRs clinicians may copy and paste data obtained from other clinicians, give inadequate discharge summaries, accidentally send information to unintended places, easily get authorship misnomers, and the efficiency of EHRs can lead to carelessness in charting and harmful shortcuts (i.e. lacking patient specific information and giving over-generalized information to save time via pasting information). This results in poorer care for the patient, since all of their needs/issues may not be getting addressed with these charting shortcuts. This is something, I personally, have witnessed in the Emergency Department. Charting electronically seemed redundant at times and became less patient-specific due to time constraints and the ease of copying and pasting information. Even though EHRs have contributed to easy sharing of patient information and storage, it is still important to remember care is always patient-centered and requires clinicians to pay special attention to details to prevent errors and continue improving the quality of care delivered, whether electronically or in person.

            I also learned about an 85 year old female patient with walking pneumonia who got up to use the restroom and then “eased herself to the ground” due to feeling light-headed. The World Health Organization (WHO) defines a fall as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level” (2015). According to this criteria, this patient experienced a fall. Many different factors contribute to falls including, but not limited to, age, patient impulsivity/confusion/disorientation, certain medical diagnoses, vital signs outside of normal parameters, morbidly obese or frail patients, and moderate to maximum assist patients. It is essential that nurses document event forms when falls occur so process improvement measures can be implemented to lead to better outcomes. Some of these measures can include ensuring beds are in the lowest position, at least two side rails are up, a bed alarm is on and hooked to the patient, the patient is educated to ask for help, the call light is within reach and signs are on the door.

            My personal feelings about the material covered are that with all process improvement endeavors, there will be legal and ethical issues associated with them. These issues can be addressed by understanding the complex nature of processes and implementing quality improvement models such as Plan-Do-Check-Act, by W. Edward Deming, to fix and evaluate processes to improve them even more. Healthcare will always consist of continuous quality improvement.             

References

Ben-Assuli, O. (2015). Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments. Health Policy, 119(3), 289- 297. doi: 10.1016/j.healthpol.2014.11.014

Oregon Public Health Division (2015). FAQs about the Death with Dignity Act. Retrieved from https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/Deathwit            hDignityAct/Pages/faqs.aspx

World Health Organization (2015). Falls, fact sheet. Retrieved from             http://www.who.int/mediacentre/factsheets/fs344/en/