Christina Williamson, DHA(c),MSN, RN-BC
Veterans Healthcare System of the Ozarks
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Define Preventive Ethics and describe the
Preventive Ethics model.
Identify the key elements of the ISSUES
approach to reduce an ethical quality gap.
Apply the ISSUES approach to an
organizational ethical concern.
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A healthy ethical environment can:
◦ improve employee moral
◦ enhance productivity
◦ improve efficiency
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Do the right thing, do it well, and do it for the
right reasons.
 Technical
Quality
 Service Quality
 Ethics Quality
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Decisions and actions
Systems and processes
Environment and culture
Decisions and actions
Systems and processes
Environment and culture
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Shared decision making
Ethical practices in end-of-life care
Privacy and confidentiality
Professionalism
Resource allocation
Business and management
Research
Practices in the workplace
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Produce measurable improvements in the
organizations ethics practice.
Quality improvement interventions:
◦ Redesign work processes
◦ Implement checklists, reminders, and decision
support
◦ Develop policies and protocols that promote ethical
practices
◦ Educate patients and staff
A
systematic process for
identifying and addressing
health care ethics quality gaps
on system level ethics issues.
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process involves six steps:
Identify
Study
Select
Undertake
Evaluate
Sustain
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Be proactive in identifying ethics issues.
Does the issue give rise to an ethical concern
or suggest a quality gap?
Specify the improvement goal the team would
like to achieve.
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The use of electronic medical records and the
confidentiality of medical records.
Access to the computerized patient record
system.
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Diagram the process
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Gather data about best practices
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Gather data current practices
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Refine the improvement goal
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Providing the patient with the needed
reassurance their information is kept
confidential gives them a sense of security,
allowing the patient to feel free to make full
and frank disclosure of medical or
psychosocial history or symptoms.
Reminding staff of the need to diligently
protect patient confidentiality.
Patient Generated
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Address
Phone number
Next of kin
Date of birth
Marital status
Gender
Religion
Eligibility
Military service
Service connection
Medical history
Sensitive record
Healthcare Team
Generated
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Appointments
Allergies
Vitals
Medications
Appointment
Consults
Inpatient stays
Lab
Mental Health visits
Oncology reports
Pathology reports
Outpatient visits
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Electronic data sharing allows the consumer
full control of the health information.
Patient Safety Institute promotes a common
record controlled by the patient and the
provider.
Geisinger Health System created a fully
integrated medical record with electronic
communication between the physicians and
accessible to the patient and the caregiver.
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A Computerized Patient Record System
integrates various clinical packages including:
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Order Entry
Progress Notes
Discharge Summaries
Consult Results
Vital Signs
Problem List
Progress Notes
Discharge Summaries
Consult Results
Lab Results
Imaging Reports and
Medication Profiles
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Identify the major causes of the ethics gap.
◦ Root Cause Analysis
◦ Fishbone or Cause-and effect diagram
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Brainstorm strategies to narrow the gap.
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Choose one or more strategy.
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Identify personnel limits on access and
disclosure.
Identify processes in place that state
information can not be disclosed without
consent.
Security measures to protect personal
information.
Information shared outside of CPRS is
encrypted or sent within a secure site.
Inform patients of limits of confidentiality
protection.
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Identify the steps needed to carry out the
strategy.
Develop measures to assess and evaluate.
Execute the plan, make corrections based on
what works and what doesn’t.
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Information will be shared verbally and in
writing.
Patients will better understand the reason
why.
Information shared will include:
◦ the importance of a common health record
◦ the VHA supports the exchange of clinical data as
an effective method to improve the veteran’s
health.
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Check the results
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Adjust as necessary
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Evaluate the ISSUES process
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Clinic providers felt they do not have time to
go into detail as it relates to the use of an
electronic medical record.
Written information or patient care material
addressing this issue is not readily available.
Patients’ expressed unwillingness to have
their clinical data shared.
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The development of a script that summarizes
why and the importance of sharing healthcare
information.
Information to the inpatient handbook reads,
‘Information disclosure and confidentiality’: Your
medical record will be kept confidential. Access
to your electronic medical record, within the VA
system, may be viewed by authorized VA
personnel only.
MyHealthy Vet program.
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Integrate the change into standard operating
procedures.
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Disseminate the improvement.
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Continue monitoring.
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Customer service surveys
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Annual SHEP (inpatient and outpatient) report
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Self reported patient complaints
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Patient advocate feedback
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MRSA testing post mortem.
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Conflicting patient and provider expectations.
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Assessing decision making capacity.
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Do all patient with dementia lack decision
making capacity?
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From ……
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Reactive
Case based
Narrow
Silos
Punishment
Rules
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To ……
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Proactive
Systems oriented
Comprehensive
Collaboration
Motivation
Rules & Values