Clinical exam 2 - prof aspects of practice
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| What we are ALLOWED to do is (slide 1-4): | Scope of practice
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| What we MUST do is (slide 1-4): | Standards of care
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| What we SHOULD do is (slide 1-4): | Ethics
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| 3 levels of statements defining what we do are: | clinical practice standards (highest), clinical practice guidelines, position statements
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| 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
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| 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
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| 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
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| What is standard 1 (slide 6-1)? | perform & document a thorough pre-anesthesia assessment & evaluation
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| 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
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| 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)
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| What is standard 10 (slide 9-4)? | participate in ongoing review & eval of anesthesia care to assess quality & appropriateness
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| What is standard 11 (slide 9-4)? | respect & maintain basic rights of pts
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| 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
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| 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?
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| 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
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| 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.
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| 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
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| 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
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| 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
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| 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
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