DMS 200- Unit 4

Ethics

Systems of valued behaviors and beliefs that govern proper conduct and character to ensure the protection of individuals rights

Nonmaleficence

Do no harm

Beneficence

Do good- looking for doing good by our patients

Autonomy

• A persons capacity to formulate, express, and carry out value-based preferences

• The right to make one’s own decisions and to be independent and self governing

Code of Conduct/Ethics Role

To promote excellence in patient care by fostering responsibility and accountability among diagnostic medical sonographers

Professionalism

Being involved in and worthy of the high standards of a profession

• Integrity

• Honesty

• Compassion

• Devoid of self interest

• Psychosocial well-being of pts

Informed consent

Permission that must be obtained form the patient to have a test or procedure performed after the patient has been fully informed of the test or procedure

• Teach back method

• “Time out”

Types of Informed Consent

• Written

• Oral

• Implied

Implied consent

Consent that is not explicitly stated but inferred due to a patients actions, inaction, or the surrounding circumstances (ex. if pt was unconscious and needed medical intervention)

Pregnant patient (mother) obstetrical sonography obligations

To protect the autonomy and beneficence of the individual

Fetus (baby) obstetrical sonography obligations

To protect the beneficence of the individual

Informed Consent Validity

• Legal age

• Mentally competent

• Gives consent voluntarily

• Is adequately informed

Ethical obligations owed to baby

• Continuing pregnancy to term

• Protect and promote fetal interest

• Prevention of premature death/demise

• Prevention of disease or disability

• Prevention of unnecessary pain and suffering

Beneficence

Mother has a _____________- based obligation to the fetal patient as well

Fiduciary

Mother has moral _________ for baby, as well as protection of fetal/child interests

Role of Sonographer in Abortion

1. Neutrality in the autonomy of patient’s decision

2. Withdrawal from involvement, protecting your own autonomy

Competence

Providing accurate and reliable information from sonographic examination

• Rigorous standard of training

• Skill proficiency

• Continuing education

Failure of competency

• Mistaken dx

• Incomplete or inaccurate info

• Creates lack of beneficence or nonmaleficence

Two ethical clinical challenges

• Maintain standards of general competence

• Disclosure of inadequate exams/practices

Principle

The US operates on the _________ of beneficence whereas UK & others operate on standard obstetrical care

What routine US screening must answer

• What the exam can and cannot define

• Uncertain interpretation

• Timing relevant to desired information

Normal

___________ anatomy may be disclosed by the Sonographer

Physician

Any anomalies need to be disclosed to the patient by the _____________.

Heartbeat

Ask your facility, but most can let the patient know if baby has no ______________

Discloser of Images

• Most facilities will have a way to get a pt images or can give printed ones

• Can help pts accept ultrasound but can also extend scan time/distract the sonographer

• There is written policy per institution on whether phones/video is allowed

• Many forget this is not a time for entertainment but a time to ensure health of baby

Accreditation for regulation

SDMS, ASRT, ACR, AIUM, FDA

Examples of things needing to be disclosed

• Communicable disease

• Spousal abuse

• Drug abuse (if not implied on chart already)

• Other forms of abuse

4C’s of Medical Malpractice prevention

• Caring- do no harm, work to improve condition, sincerity

• Communication- listen, speak calmly/clearly

• Competence- professionalism, credentialed, continuing education

• Charting- as though the pt will read his or her own record

Noncompliance

It is crucial to chart patient refusal or _______________, all things that may effect the quality of the scan

Integrity

Adherence to moral and ethical principles

• What you think

• What you say

• What you do

Veracity

• Truthfulness

• Accuracy, honesty

• We have restrictions but still be truthful on how you say things

Justice

Fair distribution of benefits and burdens

• Treat all patients equally

• Individual vs societal

• Essential vs elective

Medical malpractice

Occurs when a negligent act or omission by medical professional results in harm to patient

The 4 elements to prove medical malpractice

• Duty- required standard

• Breach- failure to meet

• Harm- injury suffered

• Causation- reason for injury

Liability

A legal responsibility for the consequences of one’s actions

Master-servant negligence doctrine

Employer held responsible liability

Ostensible agency negligence doctrine

Healthcare facility liability

Res ipsa loquitur

“the things speaks for itself”

Trained

Do not perform any scans or procedures for which you have not been __________

Procedure

Insists on written requests and ensure the patient understands the __________ and why it is being performed

Chaperone

Determine if a __________ should be present, if something feels off never be afraid to ask another tech or employee to sit in on the scan with you

1st trimester

0-12 weeks gestation

2nd trimester

13-26 weeks gestation

3rd trimester

27-40(2) weeks gestation

Postterm

> 42 weeks gestation

Maternal risk factors

• Maternal age (AMA is 35 y.o)

• abnormal MSAFP

• maternal disease

• pregnant uterus (too small or large for dates)

• previous child with chromosomal disorder

• exposure to known teratogenic drug or infectious agent known to cause birth defects

Questions to ask prior to exam

• LMP

• Any current meds (BC, IUD?)

• Any clinical problems (bleeding, decreased fetal movement, pain)

• Any problems with previous pregnancies

• Any cervical procedures that will put you at risk for cervical incompetence

ALARA

As low as reasonably achievable

• US must be performed for valid medical reasons and must be ordered by a provider

AIUM

American institute of ultrasound in medicine

• Multidisciplinary association dedicated to advancing the safe and effective use of US in medicine

ACR

American College of Radiology

• To serve pts and society by maximizing the value of radiology, radiation oncology, interventional radiology, nuc med, and medical physics by advancing the science of radiology

ACOG

American college of Obstetrics and Gynecology

• Serving as a strong advocate for quality health care for women

• Maintaining highest standards of clinical practice and continuing education for its members

• Promoting pt education and stimulating pt understanding of and involvement in medical care

• Increasing awareness among its members and the public of the changing issues facing women’s healthcare

FIGO

International Federation of Gynecology and Obstetrics

• Only organization that brings together professional societies if obstretricians and gynecologists on a global basis

• Currently has member societies in 130 countries/territories

• For women to achieve the highest possible standards of physical, mental, reproductive, and sexual health and wellbeing throughout their lives

Guidelines for OB US

1. Standardize obstetric studies

2. Optimize detection of fetal growth abnormalities

3. Detect fetal abnormality

4. Use combination of TV and TA trx (first tri)

TA Guidelines

• Overall view

• Cervix to fundus

• Ovaries and adnexa

• Free fluid

TV Guidelines

• Embryo

• Yolk sac

• Amnion

• Chorion

• Gest sac

CRL

TV view of the embryo is the best method to measure ____

First

The most accurate dating of the fetus is the ______ trimester CRL

Documentation guidelines of OB US

• Patient name

• Date

• Image orientation

• Document cardiac activity

• Measurements

• Written report

Uterus first tri imaging anatomy

Uterus:

• Gest sac location, size, number

• Embryo CRL, number, cardiac activity

Yolk sac first tri imaging anatomy

• Area of placenta

• Uterine echotexture

Adnexa first tri imaging anatomy

Ovaries- corpus luteum? Masses?

Cul-de-sac first tri imaging anatomy

• Free fluid

• Masses?