Midterm 1

Communication, Professionalism, Legislation, Consent

Therapeutic relationships

Goal-directed/purposeful relationships b/w pt, family, HCP

NOD

Name

Occupation

Duty

Concept of care

Taking interest, inquisitive, pt-centered care, empathetic

Patient-centered care

• ethical & legal aspect

• Safety

• Pre-op & procedure

Diagnosis → F/U: Rad Therapy

1. Referral - physician

2. Consult - physicial

3. CT sim.

4. planning/dosimeter

5. Treatment

6. Post-rad f/u

Diagnosis → F/U: Nuclear Med

1. Referral → physician

2. Check-in

3. Pt interview

4. Injection

5. Imaging

6. Results → physician

Diagnosis → F/U: Rad Tech

1. Referral → physician

2. Pt prep → physician

3. Check-in

4. Pt-interview

5. Imaging

6. Results → physician

Communication Techniques

1. review chart pre-pt

2. NOB

3. Identification verification: name, DOB, addy

4. Explain procedure & what is expected

Communication rapport

• caring & empathetic

• read verbal & non-verbal cues

SBAR vs 3-way repeat back vs Clarifying

SBAR

• Situation, Background, assessment, recommendation

3-way repeat

• Receiver repeat info

• Sender acknowledges accuracy

• Receiver writes info

Clarifying

• ask 1-2 questions re: incomplete or unclear info

Geriatrics

• > 65 years old

Geriatrics: Concerns

• acute vs chronic illness

• depression vs dementia vs alzheimers

• abuse

Geriatrics: Assistance

• assess physical needs

• DO NOT talk down to them

Pediatrics

Infant - 0-1

Toddler 1-3

Preschooler 3-5

Schooler 6-12

Adolescent 12-19

Infant strategies

• consistency

• parental involvement

• comfort*

• teaching

Toddler strategies

• play*

• reward

• simple communication

• reassurance

Preschooler strategies

• play

• reward

• honesty

• teaching*

School strategies

• consider social, educational, physical needs

• dependence

Adolescents strategies

• independence

• sexuality

• adult treatment

CMRITO protected titles

must be member of CMRITO

“Acts” vs “acts”

Acts - legislation

acts - technical or professional procedure

RHPC

“Regulated Health Professionals Act”

• no person shall perform a controlled act set out in subsection (2) in the course of providing health care service to an individual unless,

  (a) person is member authorized by health professional act to person the controlled act OR
  (b) the performance of controlled act has been delegated to person by member decree in clause (a)

RHPA: MRT

• administer forms of E

• Administer injection or inhalation

• Administer contrast media, instrument, hand beyond pelvic organ openings

• tracheal suctioning

• procedure on tissue below dermis

MRITA

“Medical Radiation Imaging and Technology Act”

• Use of IR, EM, sound waves, etc. for diagnostic and therapeutic purposes, procedural images, data evaluation, and pt assessment before, during, after procedure

PPA

“Protecting Patients Act”

• Public register

• Name, specialty, place of practice

• zero sexual abuse tolerance

PPA: MRT

• explain procedure beforehand

• Where and when patient will be touch

• consent

PHIPA

“Personal Health Information Protection Act”

• require consent

• maintain confidentiality and security

• right to access and correct personal info

• right to deny sharing info

• guidlines for fundraiser, marketing, research

CMRITO: Public Protection

ICRC

FTP

• Revoke and suspend certification

• Impose conditions

Discipline committee

• Give reprimand

• Request fine, paid to Minster of Finance

Bill C-45

“Criminal Negligence and Medical Malpractice”

• 2004 amendments to Criminal Code of Conduct of Canada makes it easier for hospitals and workers to be prosecuted for pt injury or harm

• Every person is criminally negligent who shows wanton or reckless disregard for live and safety of others

HCCA

“Health Care Consent Act”

• When proposing treatment, the proposer must ensure the pt:

  (a) is capable and has given consent OR

  (b) incapable and another person has given consent

HCCA: Emergency Exceptions

• Pt experiencing severe suffering

• Risks of serious bodily harm

Capable vs Incapable Factors

Capable

• Psychiatric or neuro diagnosis

• Disability (oral or verbal)

• Treatment refusal or aternative

• Age

Incapable

• Confusion, delusion, indecisive

• Severe pain, fear, anxiety

• Depression

• Drug or alcohol impairment

Types of concert

• Oral

• Written or electronic

• Implied

Decision-making Hierarchy

Count-appointed guardian

Attorney of personal care

Consent and Capacity board appointed rep

Spouse or partner

Children or Primary custody parent

Siblings

Relative

Public guardian and trustee

Legal consent

• Specifically related to treatment

• Informed

• Voluntary

MRI consent guidlines

• Perform procedure on basis of physician order

• Verify consent received

• Explain procedure

• Refer physician reassessment

MRTA: Professional Misconduct Regulation

• Doing any treatment which consent is required, without such consent

Professional liability

• no engagement in practice unless insured under Professional Liability Ins. Policy

Order

Authorized statement (Rx, Dr note)

Delegation

Transfer authority (You watch, we do, you do)

Sexual abuse

Intercourse, touching, remarks of genitals, anus, breast, buttocks

EMR

“Electronic Medical Records”

Electronic paper record maintained by pt and dr

EHR

“Electronic Health Record”

Maintained by hospital, regional authority, government

Custodian

Collect, use, disclose person info with consent

Consent

Pt has right to be informed re: procedure and risks

Proposer

Health practitioners (ordering physician) deciding treatment, info for informed consent, answer questions

Treatment

Therapeutic, preventative, palliative, diagnostic, cosmetic, ionizing radiation

Capable

Understand info and appreciate consequences

Expressed consent

Explicit and direct

Implied consent

Coming to hospital and cooperating

Tort Claim

Lawsuit of damages of committee negligence act

Duty, breached standards, damage