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Rights to opt out of summary care records Examine their meaning as applicable to the NASH Constitution or alternative national deadlines 13 b) Evaluate measures which may be used to inform patients of their rights and responsibilities and recommend areas for improvement within your organization ; 16 Task 4 Ensuring health and safety is an important responsibility not only for the Managers but all associated with the premises.
Evaluate your organization’s health and safety policy and procedures in line with legislative requirements and propose recommendations on how health and safety should be managed 17 Task 5 Ensuring compliance to employment law and regulations is essential to meeting the halogens of employing and maintaining the employment relationship. A) Review the legal/regulatory requirements in creating the employment relationship 19 b) Evaluate your organization’s employment practices, procedures and policies including the legal principles regarding discrimination against current legislation. 0 References Appendices TASK 1 Managing medical ethics is a fundamental part of a Manager’s role. It is the and apply them within the organization a) Reflect on the Journey of medical ethics and interpret how the principles of the Hippocratic Oath are applied within your organization. Ethics is defined as; ‘a social, religious or civil code of behavior considered correct, especially that of a particular group, profession or individual’ (Collins Dictionary, 2014) Ethics in Western medicine were documented in the form of the Hippocratic Total (appendix 1).
Essentially the oath is a beacon, a set of beliefs that physicians vow to work within. Over time many attempts have been made at modernizing the oath to concur with modern day medicine (appendix 2). In more recent times the World Medical Association (WHAM)2 ‘has become the recognized authority to speak for the doctors of he world in international affairs’ (World Medical Association, 2014).
From the outset it was felt that there should be an; ‘establishment of a suitable oath or pledge to be administered as a part of the graduation or licensing ceremony would help to impress on newly qualified doctors the fundamental ethics of medicine and would assist in raising the general standards of professional conduct’ (World Medical Association 2014). In order to accomplish this, the WHAM studied the various international medical oaths in use with the aim of compiling a single “Charter of Medicine” which could be used internationally.
This modernized version of the Hippocratic Oath was named the ‘Declaration of Geneva’3 (appendix 3). By 1949, in response to a report on War Crimes and Medicine’, the WHAM had compiled and adopted the ‘International Code of Medical Ethics’ (appendix 4). Within the Practice Within the practice, both Gasp felt that the Hippocratic Oath has little relevance today and is merely a tradition which is part of the pomp of a doctor’s graduation ceremony.
One doctor noted that he did not believe that ethics could be taught, that ethics is something that is instilled within you and is a natural part of a doctor’s role. The other doctor noted that you are brought up on the principles of the Hippocratic Oath and that as a doctor in the 21st century you are guided by professional guidelines and codes of conduct as set out by the General Medical Council (GUM), British Medical Association (BAM) The Royal College of General Practitioners (RECAP), Local Medical Committees (ELM) and practicing colleagues.
The Gem’s ‘Good medical practice (2013)’4 (appendix 5) sets the standards expected of all doctors and essentially upholds the principles of the Hippocratic Oath. All doctors must be milliamp with and adhere to this as failure to do this may put their registration in jeopardy. Both Gasp at the practice take part in GAP Revalidation. Requirements of holding, using and accessing data. Confidentiality is a basic human right protected by the Human Rights Act 1998.
Information Governance 6 is the framework which exists within NASH Wales to ensure the ethical use, confidentiality and security of all person identifiable information (pit), and this is the framework within which the practice operates. The Data Protection Act 1988 places a legal obligation on anyone who stores or uses ATA to ensure that the data is kept secure, accurate and up to date. The Act was created to protect individuals from misuse of this data. Organizations have the right to hold information about an individual but an individual has right to know what is held about them.
The Act is underpinned by a set of eight principles which if followed should ensure compliance (appendix 6) In the health environment, the Calotte Principles (appendix 7) are equally important, providing organizations with a set of recommendations and principles to help ensure that pi is adequately protected. There are six Calotte Principles: 1 . Justify the Purpose 2. Don’t use patient identifiable information unless it is absolutely necessary 3. Use the minimum necessary patient identifiable information 4.
Access to patient identifiable information should be on a strict need to know basis 5. Everyone with access to patient identifiable information should be aware of their responsibilities: 6. Understand and comply with the law Situations arise when it is necessary to breach confidentiality; I. E. When there is a moral or ethical issue or when a breach is in the person’s best interest. These are some of the steps taken by the practice to ensure that confidentiality is maintained; Doctors and nurses are guided by their governing bodies.
Confidentiality agreement signed by employee on induction and clause included in employment contract (appendix 8 &9) Annual staff appraisals where any weaknesses and training needs can be identified Information governance e-training Patients’ informed of their rights, verbally, via practice leaflet and practice website. Practice is registered with the Information Commissioner’s Office (ICC)7 medico-legal ethics in relation to duty of care. Medico-legal issues can be complex because they are not only concerned with ethics but also medical and legal aspects.
In English tort law, an individual may owe a duty of care to another, to ensure that they do not suffer any unreasonable harm or loss. If such a duty is found to be breached, a legal liability is imposed upon the wrongdoer to compensate the victim for any losses they incur, a claim of negligence Generally, a duty of care arises where one individual or group undertakes an activity which could reasonably harm another, either physically, mentally, or economically.
Where an individual has not created a tuition which may cause harm, no duty of care exists. To this end, the practice owes a duty of care to all involved in its activities and this is firmly embedded in the practices’ ethos. All Gasp are registered with the GUM and nurses with the Nursing and Midwifery Council. Where is necessitates, staff are registered with the Medical Protection Society (MSP)9. Employment for any post at the practice is subject to a satisfactory criminal record background chuckle.
There is a coherent complaints policy in place (appendix 8) and as previously mentioned policies exist for data protection and infallibility, the practice complies with the Freedom of Information publication scheme. Any significant events are discussed and reported to the Local Health Board (LAB). I conclude that there are no obvious areas of concern. However, the creation of a mission statement would convey the practice’s ethical values to service users. D)Regulatory bodies are used as a means of support in the event of fraud and identify evidence of potential fraud or malpractice within your organization.
There are three principles that govern all who work at the practice, 1. Accountability 2. Probity 3. Openness The practice is committed to the elimination of any fraud or malpractice (here forward malpractice) within its activities and to this end has policies and procedures in place to deal with any occurrences. (appendix 9 &1 0) As a first step any suspicions should be reported to a line manager who should make a written record of the discussion and inform the Practice Manager or Senior Partner who in turn would instigate an internal investigation.
The member of staff reporting malpractice will be kept informed as to the outcome of the investigation. The anonymity of the complainant will be maintained where possible. Every case of suspected malpractice will be rigorously investigated with the police being called if it appears that a criminal offence has been committed. The practice disciplinary procedures will be followed with any gross misconduct subject to summary dismissal. Action will be taken to recover any losses to the Practice.
The Practice encourages anyone having reasonable suspicion of malpractice to report them. As per the Public Interest Disclosure Act 1998, the Practice will enforce the ‘no detriment’ principle, that is, that no employee will suffer in any way as a result of reporting seasonably held suspicions providing these were genuinely held and considered. If the matter needs to be referred externally, the NASH has a Counter Fraud Service and each Health Board in Wales has a Local Counter Fraud Specialist (LESS) as well as a NASH Fraud and Corruption Reporting Line.
Complaints involving clinicians and nurses may need to be referred to the GUM, MSP or similar governing body who would put their own policies and procedures into action. Task 2 affecting your organization. Decision making regarding the treatment and care of patients who lack capacity is overfed in England and Wales by the Mental Capacity Act 2005, which includes the Deprivation of Liberty Safeguards (appendix 11). The Act sets out the criteria and procedures to be followed in making decisions when patients lack capacity to make these decisions for themselves.
It also grants legal authority to certain people to make decisions on behalf of patients who lack capacity 2. All adults are presumed to have capacity to decide on their own medical treatment, unless there is significant evidence to suggest otherwise. Informed consent applies when a person can be said to have given consent based on clear appreciation and understanding of the facts, and the implications and consequences of an action. English law states that before any medical professional can examine or treat a patient, they must obtain informed consent to do so.
Consent can be oral, written or implied. If an adult lacks the capacity to give consent, in order to make a decision, the person’s “best interests” must be considered. To assess a child’s capacity to make decisions, it is asked whether a child is ‘Killing competent’ or whether they meet the ‘Fraser guidelines’. (appendix 12) Within the practice oral or implied consent is recorded on the clinical system and for NY procedures written consent is also obtained and transferred onto the patient’s medical record. Appendix 13) b) In your role as a Manager, identify the terms negligence and vicarious liability and evaluate their implications for the medical profession, the organization and the patients. Negligence “Conduct that falls below the standards of behavior established by law for the protection of others against unreasonable risk of harm. A person has acted negligently if he or she has departed from the conduct expected of a reasonably prudent person acting under similar circumstances”13. The Free Dictionary. Mom) Vicarious Liability “The tort doctrine that imposes responsibility upon one person for the failure of another, with whom the person has a special relationship (such as employer and employee), to exercise such care as a reasonably prudent person would use under similar circumstances”. 14 (The Free Dictionary. Com) The practice understands its duty of care and strives via policy, consultation, indemnity and training to minimizes and eliminate the risk of any occurrence of a claim of negligence and vicarious liability. Regardless of the severity of the gelignite, it may have mental, physical and financial effect on the patient.
For the practice and medical professional a detrimental effect on reputation and trust and employability with financial penalties leading to possible financial difficulties and a loss of the right to practice medicine. C) As a Manager evaluate how you ensure the staff within your organization comply workplace and include recommendations for improvement. Medico-legal requirements are all encompassing in a practice environment and staff are made fully aware of this during their induction. In addition to measures already mentioned,
Standing Operating Procedures exist for all tasks undertaken in the dispensary Information and clinical governance inspections by the Local Health Board Participate in Dispensing Services Quality Scheme Paper medical records are kept off site in professional secure storage Enforcing a ‘clear desk and ‘clear screen’ policy Verbal/formal feedback if any concerns / breaches are identified Continuous professional development Recommendations for improvements Undertake a comprehensive audit to assess understanding and compliance amongst staff to obtain a base line to build upon.
Strengthen procedures with regards to the SE/sharing of computer passwords Strengthen confidentiality procedures regarding giving information over the telephone Provide copies of policies to staff Consider employing a health and safety consultant to ensure all aspects are up to date and avoid complacency a)Select three of the patients’ right below Rights to choose a GAP Rights to hospital treatment Rights to refuse treatment Rights to opt out of summary care records The document pertaining to the patient’s rights and responsibilities with regards to the NASH is the NASH Constitutions 5.
The core principles of the NASH are common to all areas of the UK however the NASH Constitution is only applicable to England. Each of the devolved Governments in Wales, Scotland and Northern Ireland have their own health policies in place. The following relates to Wales; 1. Right to choose a GAP Residents in the I-J have the right to be registered with a GAP. This includes people from other European Economic Area (EYE) countries and abroad. Patients have the right to choose which practice they register with.
Crucially the patient is registering with the practice rather than an individual doctor. Patients do not have the right to insist to see a particular doctor. If a practice chooses to refuse a registration request it must have sufficient grounds for doing so and confirm those reasons in writing. Whatever the reason it must not have anything to do with race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition. If a patient needs a GAP while away from home in the UK they can visit another practice.
If away from home for ours or more, any GAP can treat them as a temporary patient. If they are going to be away from home for 3 months or more they should register with a GAP at the new address. If a patient moves out of the practice area but wishes to remain a patient at the practice, the Local Health Board (LAB) have to be informed to say that the practice is happy to continue treating them 2. Rights to hospital treatment Patients have a right to hospital treatment if; They are referred too specialist for treatment by their GAP.
Patients can ask for a particular doctor or consultant however it is not their right and the GAP can’t insist that they see a particular doctor or consultant, but they do have the right to see a doctor who is capable of dealing with their problem. They attend a special clinic they present to the Accident and Emergency department. Patients can state a preference but do not have the right to choose a hospital at which to receive treatment. In Wales, with fewer hospitals and these mainly concentrated in the North and South patient choice is not always practical.
Here the aim is to try and provide high quality health services as close to home as is safely possible. This may mean that patients need to travel some distance to access specialist services and this may include English hospitals. A patient’s right to hospital treatment might be refused if the treatment required is not available on the NASH or if they are violent or abusive towards NASH staff. . Right to opt out of Summary Care Record (SCAR) The equivalent to the SCAR in Wales is the Individual Health Record (AIR).
The AIR is a summary of a patient’s GAP record and allows Gasp and nurses at the Out of Hours Service to have access to some basic information about a patient’s medical history. Patients can opt out of the AIR at any time and this will prevent the release of any information from the GAP practice to the AIR. Patients can opt-in at any time. Evaluate measures which may be used to inform patients of their rights and responsibilities and recommend areas for improvement within your organization Within my organization the main method used is the practice leaflet and website, the contents which are identical.
All written material is produced bilingually. The practice leaflets are given to new patients at the time of registration, but over recent years they have not consistently been given out and long standing patients may have never received one. There are no posters or other forms of literature regarding patient’s rights and responsibilities on show. All staff have a high level of knowledge that they can communicate verbally but I believe there to be an assumption that patients ‘Just know the information.