Handout 6.2 Ethics Issue Root Cause 1, 2, or 3? Strategy 1 Strategy 2 Strategy 3 A chart audit revealed that It is unclear who is Translate the Circulate a flow chart Revise the job advance directives of chronic responsible for ensuring that among the dialysis description of the institution’s dialysis patients are not the advance directives are information booklet treatment team, dialysis social worker accurately completed (e.g., completed. on dialysis into showing all the steps to coordinate the missing information), making it Spanish, since that in the process. advance care planning unclear whether the documents is the native Highlight where the process. were valid and accurately language of many step for completing reflected patient preferences staff and patients advance directives about future care if they lost involved in dialysis comes in. decision-making capacity. treatment. Patients discharged from the An AMA discharge Remove the Interview AMA Conduct a staff survey institution against medical advice generates an auto-cancel feature for patients to determine on the institutional (AMA) are frequently discharged feature for all future future appointments if they are unable to culture to find out how without prescriptions or follow-up appointments. for all AMA and why it supports follow doctors’ orders, clinic appointments, and discharges. and might as well be punitive action by previously scheduled discharged. physicians against appointments are automatically patients. cancelled. Staff members with ethical Most staff do not know how Develop printed Hold focus groups to Train and certify concerns have not reported their to locate or use the materials explaining see how many staff department heads in concerns so they can be tool for referring how to navigate the believe that submitting the use of the addressed. ethical concerns to the new Web their ethical concerns tool for referring service’s consultation site. on the Web will get ethical concerns to the institution’s service. them in trouble. consultation service.
Handout 6.2 Ethics Issue Root Cause 1, 2, or 3? Strategy 1 Strategy 2 Strategy 3 A chart audit revealed that advance directives of chronic dialysis patients are not accurately completed (e.g., missing information), making it unclear whether the documents were valid and accurately reflected patient preferences about future care if they lost decision-making capacity. It is unclear who is responsible for ensuring that the advance directives are completed. Translate the institution’s information booklet on dialysis into Spanish, since that is the native language of many staff and patients involved in dialysis treatment. Circulate a flow chart among the dialysis treatment team, showing all the steps in the process. Highlight where the step for completing advance directives comes in. Revise the job description of the dialysis social worker to coordinate the advance care planning process. Patients discharged from the institution against medical advice (AMA) are frequently discharged without prescriptions or follow-up clinic appointments, and previously scheduled appointments are automatically cancelled. An AMA discharge generates an auto-cancel feature for all future appointments. Remove the feature for future appointments for all AMA discharges. Interview AMA patients to determine if they are unable to follow doctors’ orders, and might as well be discharged. Conduct a staff survey on the institutional culture to find out how and why it supports punitive action by physicians against patients. Staff members with ethical concerns have not reported their concerns so they can be addressed. Most staff do not know how to locate or use the tool for referring ethical concerns to the institution’s consultation service. Develop printed materials explaining how to navigate the service’s new Web site. Hold focus groups to see how many staff believe that submitting their ethical concerns on the Web will get them in trouble. Train and certify department heads in the use of the tool for referring ethical concerns to the consultation service.
PE_BtB_Mod6_Handouts_final.docx