Please enable JavaScript.
Coggle requires JavaScript to display documents.
public health, informed consent, changes in elderly, PDSA cycle, Core…
public health
informed consent
decision-making capacity
decision is consistent with patient's values and goals
patient is informed
patient express a choice
decision is not a result of mentak status, mood disorder
decision remains stable over time
patient ≧18years of age or otherwise legally emancipated
exception
legally incompetent: patient lack decision-making capacity
therapeutic privilege: when disclosure harm patient
waiver: patient explicitly lack of the right of informed consent
emergency situation
advance directive
written advence directive
medical power of attorney: patient make decision when parient lose capacity to make decision
oral advance directive: incapaciated patient's prior oral decision commonly used as guide
do not resuscitate order: DNR order prohibit resuscitation (CPR;心肺機能蘇生)
consent for minors
parental consent is not required: Sex (contraception, STIs, pregnancy), Drugs (substance abuse), Rock and roll (emergency/trauma)
parental consent should be obtained, but exceptions are exist for emergency treatment or if minor is legally emancipated
< 18 years old
confidentiality(守秘義務)
exception
potential physical harm to tohers is serious imminent
likelihood of harm to self is great
no alternative means exist to warn or to protect those at risk
physician can take step to prevent harm
example
suicidal/homicidal(殺人) patients
abuse
duty to protect
epileptic patient(てんかん患者) and other impaired automobile driver
reportable disease
respect patient privacy and autonomy
surrogate decision maker
spouse→adult children→parents→siblings→other relatives
understanding
voluntariness
capacity
disclosure
changes in elderly
sexual change
men: slower erection/ejaculation, longer refractory period
women: vaginal shortening, thining, dryness
↓vision and hearing
no intelligence decrease
↓renal, pulmonary and GI function
↓REM; ↑sleep onset latency; ↑early awaking
↑suicide rate
↓immune response
↓muscle mass, ↓fat
PDSA cycle
Do
Act
Study
improvement model
Plan
Core principle
beneficence
patient's best interest
justice
treat fairly and equitably
nonmaleficence(非有害)
do no harm
autonomy
obligation to respect patients as indivisuals, to create conditions necessary for autonomous choice, and honor preference in accepting or not accepting medical care
disease prevention
quaternary disease prevention
identifying patient at risk of unnecessary treatment, protecting from harm of new intervention
secondary disease prevention: screen early for and manage existing
tertiary disease prevention: treatment to reduce complications from disease
primary disease prevention: before it occurs
quality measurements
process
balancing
outcome
structual
type of medical errors
eg. identification, diagnosis, monitoring, nosocomial infection, medication, procedure, device, documentation, handoffs
should be disclosed
latent: indirect
active: at frontline operator
human factor design
forcing functions are the most effective
simplification: reduce wasteful activites
standardization: improve process reliability
medicare and medicaid
medicare: federal social healthcare program, available to patients≧65, or with certain disabilities
medicaid: joint federal and state health assistance for people with limited income and/or resources
error analysis
root cause analysis
retrospective
failure mode and effect analysis
forward-looking approach
Safety culture
organizational environment in which everyine can freely bring up safety concerns without fear of censure
swiss cheese model