Clinical Ethics, Patient Safety, and Medication Administration

Vocabulary flashcards covering clinical ethical decision-making steps, ethical principles, malpractice elements, SBAR, workplace violence, safety/body mechanics, medication administration guidelines, dosage calculation rules, and quality improvement tools.

Clinical Ethics Decision-Making Sequence

The five-step process: Assess situation, Frame the question, Perform ethical analysis, Share and negotiate, and Learning/preventive ethics review (Assess -> Frame -> Analyze -> Share -> Learn).

Step 1 of Clinical Ethics Decision Making

Assess situation: clarify facts and identify decision makers.

Step 2 of Clinical Ethics Decision Making

Frame the pending medical decision and ethical question (formulating the 'should' or 'ought' question).

Step 3 of Clinical Ethics Decision Making

Perform ethical analysis: explore principles, values, motivations, and conflicting interests, and define the options.

Step 4 of Clinical Ethics Decision Making

Share and negotiate: give perspectives and balance principles and interests to reach a resolution.

Step 5 of Clinical Ethics Decision Making

Learning and preventive ethics review: ask how this could be avoided in the future.

Non-maleficence

The ethical obligation to cause no harm.

Beneficence

The ethical duty to act for the patient's benefit.

Fidelity

Keeping commitments and staying faithful to professional responsibilities.

Veracity

Truth-telling in healthcare practice.

Autonomy

Respecting the patient's right to self-determination.

Confidentiality

Not disclosing a competent patient's diagnosis to family members if the patient has asked for that privacy.

Four Elements of Malpractice

The legal components required to prove malpractice: duty, breach of duty, causation, and damages.

SBAR

A standardized communication framework standing for: Situation, Background, Assessment, and Recommendation.

Horizontal / Lateral Violence

Aggressive behavior between peers, such as rumors, intimidation, uncooperative conduct, and social media abuse.

Vertical Violence

Hostile or inappropriate behavior between different authority levels (e.g., manager to staff, staff to manager).

Third-Party Violence

Violence directed toward healthcare staff originating from a patient, family member, or visitor.

External Perpetrator

A perpetrator of workplace violence who has no relationship to the facility or staff (e.g., a robber or gunman).

Professional Confrontation of Unsafe Behavior

An interaction that is respectful, private, and focused on behavior and patient safety; it is NOT considered bullying.

Lifting Body Mechanics

Guidelines to prevent injury: maintain a wide, stable base, bend knees, keep load close, do not twist at the waist, and raise the bed to a workable height.

Protocol for Damaged Electrical Equipment

Remove the equipment from service, label it, and send it for repair.

RACE

Fire safety response protocol: Rescue (anyone in immediate danger), Alarm, Contain (close doors), and Extinguish / Evacuate.

ER / XR / SR Medications

Extended-release or sustained-release formulations that must be swallowed whole; NEVER crush, chew, or split them.

Scored vs. Unscored Tablets

Scored tablets can be split; unscored tablets are not assumed to be split (clarify or get a different strength).

Suspension

A liquid medication formulation that must be shaken well prior to administration.

Reconstituted Liquid

A medication reconstituted with diluent; calculate doses using the final concentration on the label, NOT the volume of water added.

Feeding Tube Medication Administration

Administer liquid forms whenever possible; NEVER place an intact tablet directly into a feeding tube.

Single-Dose Vial

A vial intended for one patient and one use only; any remainder must be discarded.

Multiple-Dose Vial

A vial that can be accessed and used more than once, only if stored and dated properly.

Controlled Substance Labeling

Indicated by the letter 'C' combined with a Roman numeral indicating its schedule (e.g., 'CII').

Two Patient Identifiers

Acceptable identifiers include full name, date of birth (DOB), ID band, and the MAR. Room number, patient appearance, and relatives are NOT acceptable identifiers.

Three Medication Checks

Verification of medication: before preparing the medication, after preparing it, and at the patient's bedside.

Protocol for Unfamiliar Medications

Look up any unfamiliar medication in an approved drug reference guide or formulary before administration.

Bedside Medication Rule

NEVER leave medications at the bedside; return the medication if the patient cannot take it at that time.

Medication Error Action Steps

Assess the patient -> notify the healthcare provider -> document/file an incident report. NEVER mention the incident report inside the patient chart.

Dosage Calculation Formula

$(D \div H) \times Q = \text{Amount to give}$, where $D$ is desired dose, $H$ is dose on hand, and $Q$ is quantity.

Leading and Trailing Zero Rules

Always include a leading zero before a decimal (e.g., $0.5$); NEVER include a trailing zero after a decimal (e.g., $.50$).

Metric Weight and Length Equivalents

$1\,\text{kg} = 1,000\,\text{g}$; $1\,\text{mg} = 1,000\,\text{mcg}$; $1\,\text{g} = 1,000\,\text{mg}$; $1\,\text{cm} = 10\,\text{mm}$.

Metric and Household Volume Equivalents

$1\,\text{L} = 1,000\,\text{mL}$; $1\,\text{tsp} = 5\,\text{mL}$; $1\,\text{Tbs} = 15\,\text{mL}$; $2\,\text{tbs} = 1\,\text{oz}$; $1\,\text{oz} = 30\,\text{mL}$.

Root Cause Analysis (RCA)

A retrospective review conducted AFTER an error occurs to identify system-level causes.

Failure Mode and Effects Analysis (FMEA)

A prospective analysis conducted BEFORE harm occurs to locate potential failures in a process.

Continuous Quality Improvement (CQI)

A process that examines existing processes and events surrounding errors before creating corrective fixes.

IOM Quality Dimensions

The six healthcare quality aims defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable.

Incident Report Requirements

Must contain objective facts only (patient ID, date, time, location, description of what happened, patient condition, and reporter name) with NO blame, opinions, or assumptions; used strictly for risk management and quality improvement, NOT placed in the chart.