CVT 1001 Exam 2

What are the job duties of a Registered Cardiovascular Technologist?

• Assisting with Invasive Procedures: RCISs collaborate with physicians during invasive procedures, such as cardiac catheterization, where catheters are inserted into the heart to diagnose and treat blockages. They are also responsible for monitoring these procedures.

• Patient and Equipment Preparation: They ensure patients are ready for procedures and that all necessary equipment and instruments are prepared.

• Operating Imaging Systems: RCISs operate imaging systems, like X-ray fluoroscopy and cineangiography, to help guide the procedure and visualize blood vessels.

• Monitoring Patient Vital Signs: Throughout procedures, they continuously monitor patients' vital signs to ensure their safety.

• Providing Post-Procedure Care: RCISs assist in patient recovery after procedures, carefully monitoring for any complications.

• Patient Education: They may also educate patients about their procedure and the subsequent post-procedure care.

How is the legal framework determined within scope of practice?

It's primarily determined by state laws (often called "practice acts") and the rules and regulations adopted by relevant licensing boards for each profession. This means the scope of practice can vary from state to state for the same profession.

How is education and training connected to the scope of practice?

The scope of practice is directly tied to the education, training, and demonstrated competency of the professional. You can't perform a procedure or service unless you've been properly trained and educated to do so.

What is patient safety and public protection within the scope of practice?

The primary purpose of defining a scope of practice is to protect the public. It ensures that patients receive care from qualified individuals who have the necessary knowledge and skills for the services they provide.

What are boundaries and limitations within scope of practice?

It sets clear boundaries for what a professional can and cannot do. For example, a dental hygienist cannot perform the work of a dentist, and in many states, a nurse practitioner's scope of practice might differ from a physician’s.

What is the evolution in scope of practice?

Scope of practice can evolve over time due to advancements in healthcare, changes in workforce needs, and new research. This often leads to ongoing discussions and sometimes legislative efforts to expand or adjust the scope of practice for various healthcare professions.

What is collaboration and supervision within scope of practice?

Some healthcare professionals are authorized to practice independently within their scope, while others may be required to work under the supervision or in collaboration with another, typically more extensively trained, professional (like a physician).

RCIS First Surgical Assistant’s role

▪ Prepare Patient Access Sites

▪ Drape Patient in Proper Sterile Fashion

▪ Set Up Contrast Delivery Systems

▪ Set Up and Prepare Sterile Instruments and Surgical Table

▪ Assist Physician with Catheter and Wire Exchanges, Placements, and Utilization of Interventional Devices

▪ Administer Local Anesthetic (if appropriate)

▪ Obtain Vascular Access (based on hospital policy)

▪ Manipulate X-ray System for Imaging

▪ Obtain Blood Samples

▪ Assist with obtaining Cardiac Output and Hemodynamic Measurements

▪ Inject contrast Medium into the Vessels

▪ Administer Medications as Appropriate

▪ Manipulate and Deploy Interventional Devices

RCIS Circulator role

▪ Assist other team members in transferring the patient to the procedural table

▪ Attach the patient to the monitoring systems (EKG, Blood Pressure, Oxygen Saturation, Etc.)

▪ Insert/Maintain IV as necessary

▪ Assist the surgical team by retrieving and opening surgical instruments

▪ Receive blood samples and run tests as appropriate

▪ Assists with preparing procedural equipment

▪ Administers Medications as required

▪ Maintains direct observation and assessment of the

patient, intervenes as necessary and as appropriate

▪ Monitors patients’ vital signs and attends to patients’ needs during the procedure.

RCIS Monitor role

▪ Record patient demographic information, H&P, Lab Values, ETC.

▪ Record and interpret hemodynamic data

▪ Record all medications administered

▪ Assess and update the team about the patient’s vital sign status

▪ Document all catheters

▪ Replay and control X-ray image playback

▪ Provide preliminary impressions of the diagnostic procedures

▪ Records ALL procedural information

▪ Performs “Procedural Time Out”

What is liability?

The quality of being obligated according to law or equity (Law of Agency). Being held legally and financially responsible for harm, injuries, or property damage caused by your actions or negligence.

What is an agent?

Someone who is authorized to act for or in the place of another (employees are agents of their employer, allied health professionals are ALSO agents of the physician)

What is an agency?

The capacity, condition, or state of acting or exerting power (the employee has agency granted to her by the employer)

What is a Respondeat Superior?

“Let the master answer”. Legal doctrine making an employer liable for the wrong of an employee or agent if an act is committed within the scope of employment (scope of practice)

What is Res Ipsa Loquitur?

“The thing speaks for itself”. The principle that the situation of the accident implies negligence (doctorine of common knowledge)

What factors cause someone to be liable?

• All competent adults are considered personally liable (responsible) for the acts they take

• When someone is acting as an agent (employee) of an institution, the employer may also be liable for the actions the agent takes

• The responsibility of the employer for the acts of the employee is legally referred to as the rule of Respondeat Superior

• The employee MUST be acting as an agent for the employer to be sued using the Responeat Superior doctrine to apply

When is the healthcare employer liable for the acts of the employees?

• Injury to the patient occurred when the employee was working for the employer (“on the clock”)

• The injury was caused by something that is normally in the scope of practice for the employee

• The employer received a benefit from the care of the injured individual (usually financial benefit)

• The injury can be Physical, Emotional, Financial, or a combination of the three

What is the Reasonable Person Standard?

• Defined as the level of performance that is expected from a health care worker when carrying out her professional duties

• While practicing according to her professional scope of practice

• Standard of care is considered as the acts of a “reasonable person”

• Imaginary being

• A “reasonable person” is not to be considered the same as an “average” person

• A “reasonable person” is imagined to be an individual who would always act in accordance to how society would expect her to act

• The individual is judged in relation to a “reasonable person” within their professional field of practice

What is negligence?

Is the area of civil law that involves harm caused by acting in an improper manner, failing to act as one should, or performing an act that is not allowed/improper.

What is malfeasance?

Performing a wrongful or prohibited act

• Practicing medicine without a license, working outside the scope of practice

What is misfeasance?

Performing an allowed act in an improper manner

• Poor aseptic technique when preparing a patient for a procedure

What is nonfeasance?

Failing to act as you should

• Failing to check pulses before an invasive procedure

Proofs required to prove negligence (Four D’s)

• Duty to Care

• Dereliction

• Damage

• Direct Cause

What is Duty to Care?

The person who is negligent had a duty to care for the individual injured

What is Dereliction?

There was a breach in the duty to care for the individual

What is Damage?

The individual was harmed in some way as a result of the dereliction (physically, emotionally, financially)

What is Direct Cause?

The breach of duty to care was the direct cause of the damage

What is meant by the word “ETHICS”?

•The discipline dealing with what is good and bad and with moral duty and obligation

•What “ought” to be done? What is our “obligation” to an individual? What does society say we should do? – Normative Ethics

What is Ethical Principlism?

Belief that there is a common morality that is shared universally by human society

What is Respect for Autonomy?

• Based on Immanuel Kant’s theory of ‘respect for person’.

• Individuals are endowed with a unique dignity which is expressed by their autonomy

What is Beneficence?

• Working towards the good of the individual

• Mercy, kindness, charity

• Act for the benefit of the individual

What is Nonmaleficence?

• Primum non nocere (Above all do no harm): Hippocratic tradition

• Avoid causing unnecessary harm and suffering

What is Justice?

• Distributive: fair and equitable distribution of benefits and burdens

• Preference for the poor and vulnerable

Who can EXPAND scope of practice?

Only the profession itself.

Who can LIMIT scope of practice?

Federal, state, and hospital.

What is Virtue Ethics?

Character of the person which makes her “good” or her work “well done”

What are the Disposition of Character?

• Fidelity to trust

• Suppression of self-interest

• Intellectual honesty

• Compassion

• Courage

• Prudence (act so that the best choice is made regarding the technical and perceived good of the person SERVED)

What does Virtue Ethics require of us?

• ALL acts, periprocedural and procedural, are performed for the benefit of the patient. We must always be patient advocates!

• Technical Prep

• Room Set-Up

• Documentation

• Medication Administration

• Monitoring set-up

What is Pellegrino’s Warning?

“[T]heir power is linked to mastery of impersonal instruments, tests, procedures, and medications which can too easily be used in injurious ways, or to advance professional rather than public interest.”

“Humans in these compromised existential states are eminently vulnerable and exploitable. Persons in that state are invited to trust the professional and, indeed, must trust him in order to be helped or healed…the character of the professional is the final safeguard. In each case, the end of the professional activity is the good of the person in need of help.”

What are the benefits of an “ethically safe” environment?

Ethics cannot work in an individual vacuum. There is a need to develop an ‘ethically safe’ environment which will allow all team members to work for the benefit of the patient.

• Interdisciplinary teams need to function as a whole unit; hierarchies of power and position are detrimental to team dynamics and impede the ethical nature of medicine!!

What does H.I.P.A.A stand for?

The Federal Health Insurance Portability & Accountability Act of 1996/ 2003

Why were HIPAA rules invented?

To balance between improving the flow of information while protecting the privacy of patients.

In regards to HIPAA, the patient has the right to…

• Request access to health info.

• Request to amend their health info.

• Request restrictions to information sharing.

• Request accountability of disclosures.

HIPAA rules require us to…

• Treat all things we learn about patients as confidential

• Provide more control to patients over their personal health information

• Punish those who misuse patient information by imposing criminal and civil penalties

HIPAA rules say…

• You can’t talk about patients outside of the office with anyone

• Clinicians should only access the medical information that is needed for their job/clinical experience.

• We need patients to give permission before we can give information to others on their behalf.

• Keep medical records in a secure place-both paper & electronic.

If you are using electronic medical records…

• You should have a unique password-don’t share with others

• Do not access information on yourself, your family, your friends, staff or any other person.

• You have a duty to report any breach in confidentiality to your supervisor.

• Remember most computer systems can track all access to records.

• Inappropriate access is punishable by federal and state law.

What is the HIPAA Privacy Rule?

− Requires safeguarding of protected health information (PHI): paper, conversations, faxes, emails, in systems, etc.

− Limits how PHI may be used and disclosed

− Provides patients with rights in respect to their PHI

What is the HIPAA Security Rule?

− Ensures the confidentiality, integrity, and availability of all electronic protected health information (ePHI) we create, receive, maintain, or transmit:

• In computer systems/ applications

• On portable devices

• In transactions

Privacy Rule covers Protected Health Information (PHI) — health info that:

− Is created or received by a health care provider, health plan, employer, or clearinghouse; and

− Relates to an individual’s health or condition, provision of care, or payment for care

Examples: doctors’/nurses’ notes, X-ray films, lab reports, billing and payment info

Key sections of the Privacy Rule

1. Uses & Disclosures of PHI

2. Notice of Privacy Practices

3. Right to Access & Request Amendments of Records (by patients/guardians)

4. Rights to Request Protections of PHI

5. Right to Request an Accounting of Disclosures

6. Administrative Requirements (e.g. training, documentation, sanctions, etc.)

Key sections of the Security Rule

1. General Rules

2. Administrative Safeguards

3. Technical Safeguards

4. Physical Safeguards

5. Organizational Requirements

6. Policies & Procedures and Documentation Requirements

What are covered entities under HIPAA?

• Health care providers who electronically transmit health information

− Hospitals, clinics, physicians, dentists, etc.

• Health plans

− Individual and group plans that pay for care

− Health insurers, employer-sponsored plans, and government programs such as Medicare and Medicaid

• Health care clearinghouses

What are business associates?

• Perform functions or services on behalf of Covered Entities that involve the use or disclosure of PHI

• Examples: auditors, attorneys, accountants, IT/IS vendors, third party administrators, billing services, etc.

• Business Associates now required to comply with most provisions of HIPAA

Penalties for HIPAA Violations

Four-tiered penalty scheme for violations:

− Did Not Know

− Reasonable Cause

− Willful Neglect, Corrected in 30 Days

− Willful Neglect, Not Corrected

Penalties range from $100 to $50,000 for each violation, up to $1.5 million/year

HIPAA Security Policies & Procedures:

• Risk analysis/assessment

• Information security policies

• Security incident management

• Business continuity/disaster recovery

• Data backup/destruction/encryption

• Internal auditing controls

• Physical security

HIPAA Privacy Policies & Procedures

• Notice of privacy practices

• Uses and Disclosures of PHI

• Treatment, payment, & health care operations

• Individual rights: access, amend, accounting

• Minimum necessary requirement

• Business associate agreements

• Complaints/sanctions

HITECH Act

• Enacted as part of the American Recovery and Reinvestment Act of 2009

• Made significant changes to HIPAA Privacy and Security Rules

• Established Breach Notification requirements:

• — Determining when a Breach of “Unsecured” PHI has occurred

• — How, when, and to whom such a Breach must be reported

What is an Encryption?

• Encryption: Transforming data into a form in which there is a low probability that it can be understood by unauthorized persons

• Recipient must possess correct key to decrypt the encrypted data

• Provides safe harbor for incidents that would otherwise result in breaches

— Will not be required to notify affected individuals or HHS if PHI is encrypted

Respect for autonomy is not extended to person’s who cannot act autonomously…

• Immature

• Incapacitated

• Ignorant* (if informed and still refuses new information, the individual may not be “ignorant”)

• Coerced

• Exploited

What is Capacity?

Medical concern: Patient able to understand the risks and benefits of a decision

What is Competency?

Legal determination. Long-term consideration. Possible reduction of rights

• Properly defined as the ability to perform a task

• A healthcare professional’s judgement of competency may affect the patient’s freedom to make choices regarding their care

• If competence is doubted, the healthcare practitioner may turn to informal surrogate decisionmakers, court appointed guardian, or seek institutionalization and paternalistic decision-making rights

• Physicians do not have the power to declare a patient incompetent, but may have the power to “override or constrain patients’ decisions about care based on assessment of limited capacity”

What determines level of competency?

• Inability to express or communicate a preference or choice

• Inability to understand the situation and potential consequences

• Inability to understand relevant information

• Inability to give a reason for his/her decision

• Inability to give a RATIONAL reason for his/her decision

• Inability to reach a reasonable decision based on information provided

What does Informed Consent do?

Helps protect hospital from getting sued for assault and battery, and performing a procedure the patient didn’t want

• Was originally supposed to make patient feel safe

What is the competence for minors?

• Minors under the age of 18 in most districts are not considered competent to make decisions regarding their health care*

• This is dependent on state statute regarding the age of reason

What is assent for care?

• Patients aged 7 to 14 may be asked to “assent” to care

• The individual is not consenting, as that is reserved for their guardians

• Assent means the patient is willing to participate in the decision the parents made

• No legal requirement, parents can still consent or refuse procedure

What is a mature minor?

• Depending on assessment of competency, patients 14 to 18 may be identified as a “mature minor” able to consent to or refuse procedure

• Differs based on state law

What is informed consent NOT for?

• Protection of physician or hospital from cases of negligence and assault

• A means to prove patient accepted the risks associated with the procedure

• A way to ensure patients will follow through with therapies provided

What are the requirements for informed consent?

• Patient is competent to make decisions regarding their medical care

• The patient is doing so voluntarily and is not being coerced or manipulated by environment or others

• Patient receives necessary information to make an informed decision

• • Process of the procedure

• • Benefits of procedure

• • Possible complications and risks associated with procedure

• • Expected outcomes

• • Alternatives

• How much information? Two standards (determined by states)

• • Professional Practice

• • Reasonable Patient

-centesis

Surgical puncture to remove fluid

-plexy

Surgical fixation or suspension

-malacia

Softening

-sclerosis

Hardening

-rrhage, -rrhagia

Bursting forthm excessive flow

-meter

Instrument used to measure

-metry

The act of measuring

-iatry / -iatrics

Medical treatment or specialty

-stomy

Creation of a new permanent opening

-stenosis

Narrowing or constriction

-genic

Producing, originating, or causing

-lysis

Loosening, dissolution, or separation

-pnea

Breathing or respiration

-ectasis

Dilation or expansion

-ptysis

Spitting (usually blood)

-osmia

Sense of smell

-phonia

Sound or voice

Technology

Scientific or industrial process, invention, method, or the like

Diagnostic

• Serving to identify or characterize

• Device or substance used for the analysis or detection of disease or medical contradictions

Angiography

To image blood vessels (usually with x-rays)

Fluoroscopy

Live x-ray imaging that can show movement (not recorded)

• Used for positioning

• Low power x-ray

Cineangiography

Recorded x-ray image of moving structures (digital angiography)

• High power x-ray

Transluminal

Passing across of performed by way of a lumen

• Involving the passage of a catheter along the lumen of a blood vessel — the opening of the blood vessel

Coronary

Artery feeding the heart

Angioplasty

Repair or unblocking of a blood vessel, typically referring to balloon procedures

Angia Pectoralis

Chest pain

Stable Angia Pectoralis

Chest pain is predictable, cause by exertion (usually), relieves with rest

• Elective cases (scheduled) — majority of cases (~80%)

Unstable Angia Pectoralis

Chest pain usually caused by exertion, does not relieve with rest in a reasonable amount of time, reacts to nitroglycerine

• Urgent cases (ASAP) (AKA non-STEMI)

Acute Coronary Syndrome (Angia Pectoralis)

Chest pain does not have to relate to exertion, does not relieve with rest, often does not react to nitroglycerine

• Emergent cases (AKA STEMI) ~3% - 4% of cases

Ischemia

Tissue hypoxia (lack of oxygen) due to insufficient blood flow. Typically caused by atherosclerosis (plaque) in vessel lumen

• O2 delivery < O2 use (consumption)

— Caused by alterations in muscle function

— Muscle returns to normal quickly if blood is restored

Atherosclerosis

Process caused by an Atheroma

• Fatty hardening

• Fatty lesion

Arteriosclerosis

Hardening of the arteries

— Due to loss of vessel elasticity