34 hours ago In general, you should never change or alter a care report, unless: ... If a patient refuses emergency care, but is NOT rationally thinking. You should: Get law enforcement. ... report your suspicions to the paramedics and document carefully. Related questions. QUESTION. T or F: The basic Libertarian position holds that each of us has the right ... >> Go To The Portal
However, oral or written criticism of previous health care contributes nothing to the patient's needs. Patients may take casual remarks critical of prior care quite seriously, possibly destroying their relationships with previous caregivers and/or you.
Do not alter existing documentation or withhold elements of a medical record once a claim emerges. Periodically a physician defendant fails to heed this age-old advice. The plaintiff's attorney usually already has a copy of the records and the changes are immediately obvious. Even minor record alterations can greatly harm your credibility.
Following a call involving a high-profile individual, a police officer asks you for a copy of your patient care report. You should: advise the officer that he or she must obtain a legal subpoena to receive a copy of your report. provide care to the patient.
She is wearing several layers of clothing and complains of pain to her left arm, shoulder, and hip. Responding emergency medical technicians (EMTs) are en route to the scene. After ensuring a patent airway and adequate breathing and circulation, you should: carefully remove enough clothing so that you can conduct a complete full-body assessment.
Which of the following concepts is the first and MOST important when providing patient care? To comply with the standard of care, the EMR must: Treat the patient to the best of his or her ability and provide care that a reasonable, prudent person with similar training would provide under similar circumstances.
Which of the following MOST accurately defines negligence? Deviation from the standard of care that may result in further injury.
When functioning at a crime scene, the EMR should: avoid moving furniture unless it interferes with patient care. The scope of care under which the EMR functions is specified by the: EMS system medical director.
When arriving at a patient's residence, all of the following signs would indicate that the patient is visually impaired, except: a small dog penned up in the backyard.
Medical negligence is an act or omission by a health. care provider which deviates from accepted standards. of practice in the medical community and which. causes injury to the patient.
Two major aspects of health care that employees are responsible for are: 1)keeping patients and themselves safe and 2)providing the proper quality of care.
The manner in which the EMT must act or behave when caring for a patient is called the: standard of care.
The EMT's role in the quality improvement process includes becoming involved in the quality process, keeping carefully written documentation, obtaining feedback from patients and the hospital staff, continuing your education, and which of the following?
Within the scope of practice of an EMT, the primary ethical consideration is to make patient care and well-being a priority, even if this requires some personal sacrifices. ________ 2. Consent, or permission from the patient, is required for any treatment or action by the EMT.
What can a health care worker do to ensure that a patient understands medical information? Speak softly. Provide the information just after mealtime. Use appropriate lay terms.
Which of the following would be the EMR's most important initial responsibility when arriving at the scene of a multiple-patient incident? Assessing the environment to dectect possible threats to his or her safety.
In most states, personal information regarding can't be released to someone not directly involved in a patient's care unless: The patient signs a release and understands the nature of the release. Following a call involving a high-profile individual, a police officer asks you for a copy of your patient care report.
You are the first responder to arrive at the scene of a one-vehicle car crash. A paramedic crew is approximately 10 minutes away. The patient is outside of her car, sitting on the curb. As you approach her, she begins telling you what happened and asks you to take her blood pressure. This patient:
While functioning at the scene of a patient in cardiac arrest, you do not initiate cardiopulmonary resuscitation (CPR) because the patient is elderly and you think that he is probably dead.
a process for verifying your actions on a call using written or computer-based records.
the person being spoken to understands exactly what he or she is told.
during your assessment of a young woman with a sudden onset of abdominal pain, you ask the patient when the pain began. She does not immediately respond to your question. You should:
While functioning at the scene of a patient in cardiac arrest, you do not initiate cardiopulmonary resuscitation (CPR) because the patient is elderly and you think that he is probably dead. Paramedics arrive and determine that the patient has only been in cardiac arrest for 6 minutes.
Use leather gloves as a barrier against blood and fluids.
provide the appropriate care while disturbing the scene as little as possible.
To see his grandson graduate from high school, a man with a terminal illness promises to keep all of his doctor's appointments and take all of his medications exactly as prescribed. This is an example of:
rehabilitate yourself by drinking water or a sports drink.
a properly equipped vehicle that is staffed by EMT personnel.
EMS personnel are unable to give the patient adequate life-saving care in the field.
Current, complete records which assist diagnosis and treatment, and which communicate pertinent information to other caregivers also provide excellent records for risk management purposes. The use of encounter forms, checklists, flowsheets, and computer-assisted documentation for high volume activities can save time and may also reduce the communication problems and errors caused by illegible handwriting. Missing, incomplete, or illegible documentation can seriously impede patient care and the defense of a malpractice claim, even when the care was appropriate. The following advice on documentation includes issues identified through analysis of malpractice claims.
The medical record is a primary mechanism for providing continuity and communication among all practitioners involved in a patient's care. To gauge adequacy of your patient's medical records, consider what you would want documented if you were assuming management of the care of a patient you did not know.
Keep your records up-to-date in order to provide the best resource for patient care and evidence that appropriate and timely care was provided. Clinically pertinent information. The medical record is a primary mechanism for providing continuity and communication among all practitioners involved in a patient's care.
Current, complete records which assist diagnosis and treatment, and which communicate pertinent information to other caregivers also provide excellent records for risk management purposes.
What should not be documented. Derogatory or discriminatory remarks. In Massachusetts, patients have the right to access both office and institutional medical records and may be sensitive to notes they view as disrespectful or prejudicial. Include socio-economic information only if relevant to patient care.
Include copies of all clinically-related correspondence from and to patients, as well as notes from phone conversations and office discussions.
Medical records often reflect differing diagnoses and treatment recommendations among multiple caregivers. However, oral or written criticism of previous health care contributes nothing to the patient's needs. Patients may take casual remarks critical of prior care quite seriously, possibly destroying their relationships with previous caregivers and/or you.
You are the first responder to arrive at the scene of a one-vehicle car crash. A paramedic crew is approximately 10 minutes away. The patient is outside of her car, sitting on the curb. As you approach her, she begins telling you what happened and asks you to take her blood pressure. This patient:
While functioning at the scene of a patient in cardiac arrest, you do not initiate cardiopulmonary resuscitation (CPR) because the patient is elderly and you think that he is probably dead. Paramedics arrive and determine that the patient has only been in cardiac arrest for 6 minutes.
treat the patient to the best of his or her ability and provide care that a reasonable, prudent person with similar training would provide under similar circumstances.
you need to correct an error to ensure that the information is accurate.
a parent or legal guardian gives consent for treatment.
You may be held liable for failure to follow the standard of care.