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Clinical exam 2 - prof aspects of practice

What we are ALLOWED to do is (slide 1-4): Scope of practice
What we MUST do is (slide 1-4): Standards of care
What we SHOULD do is (slide 1-4): Ethics
3 levels of statements defining what we do are: clinical practice standards (highest), clinical practice guidelines, position statements
Clinical practice standards are (slide 5-2): rules or minimum req'mnts for clinical practice of the professional; represent behaviors that MUST BE EXERCISED BY THE PRUDENT CLINICIAN UNDER SIMILAR CIRCUMSTANCES. Allows for little variation. Measures against which your practice may be judged in court
Clinical practice guidelines are (slide 5-3): official policy statements of a professional association that assist the CRNA to understand indications for & the methods to perform clinical procedures. A tool, not a rule
Position statements are (slide 5-4): documents that recommend clinical practice or reflect emerging trends that may notify the practitioner abt generic issues that impact practice
What is standard 1 (slide 6-1)? perform & document a thorough pre-anesthesia assessment & evaluation
What is standard 2 (slide 6-2)? obtain & document informed consent for the planned ANESTHETIC intervention from the pt or legal guardian, or verify that informed consent has been obtained & documented by a qualified professional
What is standard 3 (slide 6-3)? formulate a pt-specific plan for anesthesia care (which is based on comprehensive pt assessment, problem analysis, anticipated surgical or therapeutic procedure, pt & surgeon preference, & current anesthesia principles)
What is standard 4 (slide 6-4)? implement & adjust plan based on pt's physiologic response. Continuously assess pt's response to anesthetic, surgical intervention or procedure. Intervene as req'd to maintain the pt in satisfactory physiologic condition
Sources of standards of care are (slide 4-4): State & federal = JCAHO, office surgery regulatory agencies, board of nsg or DPH, FDA, Medicare, Medicaid. Insurers mandates (who may perform anesthesia & insert invasive lines) Personal standards
What is standard 5 (slide 7-1)? Monitor, eval, & document pt's physiologic condition as approp for type of anesthesia & specific pt needs. Alarms should be on & audible. CRNA should continuously tend to pt until responsibility of care has been accepted by another anesthesia professional
What is standard 6 (slide 8-3)? document pertinent anesthesia-related info on the pt's medical record in an accurate, complete, legible & timely manner
What is standard 7 (slide 8-4)? eval pt's status & determine when it is safe to transfer responsibility of care. Accurately report pt's condition, incl all essential info, & transfer responsibility of care to another qualified provider for continuity of care & pt safety
What is standard 8 (slide 9-2)? Adhere to approp SAFETY PRECAUTIONS to minimize fire, explosion, electrical shock, & equip malfxn risks. Ensure necessary equip was checked for proper fxn; document compliance. Anesthesia machine ability to detect DISCONNECTION. Monitor OXYGEN ANALYZER
What is standard 9 (slide 9-3)? verify infection control policies & procedures for personnel & equip exist w/in practice setting. Adhere to infection control policies & procedures to minimize risk of infection to pt, CRNA, & other healthcare providers
What is standard 10 (slide 9-4)? participate in ongoing review & eval of anesthesia care to assess quality & appropriateness
What is standard 11 (slide 9-4)? respect & maintain basic rights of pts
What are the 4 codes of ethics (p 10 & 11)? responsibility to pts, competence, responsibilities as a professional (responsible & accountable for the services they render & the actions they take), responsibility to society
What are the 5 steps in the decision making model (slide 4-1)? Is the act/task permitted/prohibited by laws & regulations? Is the skill for APRN w/i scope & standards of certifying body? Is the act taught in adv practice education prgm? Does employer allow you to perform act? Currently competent in the act?
Details of oxygenation standards in standard 5 are (slide 7-2): continuously monitor oxygenation by clinical observation & pulse ox. If indicated, continually monitor oxygenation by ABG analysis
Details of ventilation standards in standard 5 are (slide 7-3): cont monitor ventilation, verify intubation of trachea or placement of other artificial airway device by auscultation, chest excursion, confirmation of EtCO2. Cont monitor EtCO2.
Details of cardiovascular standards in standard 5 are (slide 7-4): continuously monitor CV status via EKG. Auscultate heart sounds as needed. Eval & document BP & HR at least every 5 min
Details of thermoregulation standards in standard 5 are (slide 7-4): when clinically significant changes in body temp are intended, anticipated, or suspected, monitor body temp in order to facilitate maintenance of normothermia
Details of neuromuscular standards in standard 5 are (slide 8-1): when NMBA are administered monitor neuromuscular response to assess depth of blockade & degree of recovery
Details of positioning standards in standard 5 are (slide 7-4): monitor & assess pt positioning & protective measures, except for those aspects that are performed exclusively by one or more other providers
Created by: Thommy413