Legal implications of the Patient Self-Determination Act.

Passage of the Patient Self-Determination Act provides professional nurses with the opportunity to expand their existing roles of educator and advocate. Institutional policies and procedures implementing the Act should be flexible enough to permit registered nurses to answer questions about the right to refuse medical treatment and how to implement that right. Patients and their families have been asking nurses these questions since before the Quinlan case was decided in 1976.     

The Patient Self-determination Act: has it reached the end of its life?

The Patient Self-determination Act requires that patients be informed in writing of their right to accept or refuse treatment and the right to an advance directive. For the past 15 years, hospitals have been providing these written materials, yet advance directives are still not adequately directing end-of-life care. Barriers and facilitators to implementation of this law are discussed, as well as the role of nursing management in meeting its true intent.     

Advanced directives. In search of self-determination

Patients are seeking self-determination in health-care through the use of advanced directives. The author discusses advanced directives focusing on patient rights in decision making, autonomy, and the right to refuse life-sustaining treatment. Highlighted is the Patient Self-Determination Act of 1990, including strategies for its implementation in healthcare agencies.     

“The Emperor's new clothes”: discourse analysis on how the patient is constructed in the new Swedish Patient Act

The Swedish welfare debate increasingly focuses on market liberal notions and its healthcare perspective aims for more patient‐centered care. This article examines the new Swedish Patient Act describing and analyzing how the patient is constructed in government documents. This study takes a Foucauldian discourse analysis approach following Willig's analysis guide. The act contains an entitlement discourse for patients and a requirement discourse for healthcare personnel. These two discourses are governed by a values‐based healthcare discourse. Neo‐liberal ideology, in the form of New Public Management discourse, focusing on the value of efficiency and competition, is given a hegemonic position as laws and regulations are used to strengthen it. The new Swedish Patient Act seems to further strengthen this development. The Act underlines the increased entitlement for patients, but it is not legally binding as it offers patients only indirect entitlement to influence and control their care. To safeguard the patient's entitlement under the Patient Act, healthcare personnel should be made aware of the contents of the Act, so that they can contribute to the creation of systems and working methods that facilitate respect of the Act's provisions in daily healthcare work.     

Healthcare reform after the supreme court ruling: implications for nurse executives

ABSTRACT: On June 28, 2012, the US Supreme Court upheld the provisions of the Patient Protection and Affordable Care Act of 2010, as amended by the Healthcare and Education Reconciliation Act of 2010, with the exception that the Department of Health and Human Services may not withhold existing Medicaid funding from states that refuse to adopt the Medicaid expansion, but rather only new Medicaid funding associated with the expansion. This article will review the impact of this ruling on healthcare providers with a focus on the practice of the nurse executive.     

Recent developments in health law relevant to health care providers.

Because health law is changing continually, clinicians must be updated periodically. This article discusses two significant legal developments: the defeat of court-ordered cesarean sections and the new Patient Self-Determination Act. A decision reached by the Court of Appeals for the District of Columbia asserted that medical decisions on behalf of a woman and her fetus should be made by the pregnant woman if she is conscious and alert. Although this decision does not supply all the answers, it reiterates judicial support for the primacy of a woman's rights when her welfare is endangered by a procedure designed to safeguard a fetus. The Patient Self-Determination Act, effective December 1991, requires health care providers at hospitals and other sites to supply all adult patients with written information advising them of their rights, to explain the provider's policy for implementing those rights and to document any advance directives supplied by patients.     

Durable Medical Equipment Ruling: Impact on Nurse Practitioner Role

In an effort to generate billions of dollars in federal savings, the Patient Protection and Affordable Care Act, also known as the Affordable Care Act, signed into law provisions that will fight against monetary waste, fraud, and abuse perpetrated against the Centers for Medicare and Medicaid Services yearly. According to Section 6407 of the Affordable Care Act, nurse practitioners will not be allowed to order certain durable medical equipment for Medicare and Medicaid patients without written physician consent and a face-to-face encounter with their patient at least 6 months before providing the written order, likely causing NPs logistical and scope of practice problems.     

Health Care Policy 2011: implications for pharmacists

OBJECTIVE: The enactment of the Patient Protection and Affordable Care Act of 2010 set the stage for a new era. The 2010 Congressional election results and recent court rulings challenging the constitutionality of various provisions of the Act suggest that implementation will be anything but straightforward. The proposed changes in health insurance, along with modifications in current reimbursement models, will alter the health-care environment. It is important for pharmacists to be aware of these opportunities and the resultant changes in public expectations. It is with these considerations in mind that The Annals announces the creation of a Health Care Policy expert panel to initiate commentary and discussion regarding health-care policy issues of relevance to the pharmacy community.     

Patient Safety and Quality Improvement Act of 2005

OBJECTIVE: To review Public Law (PL) 109-41-the Patient Safety and Quality Improvement Act of 2005 (PSQIA)-and summarize key medication error research that contributed to congressional recognition of the need for this legislation. DATA SOURCES: Relevant publications related to medication error research, patient safety programs, and the legislative history of and commentary on PL 109-41, published in English, were identified by MEDLINE, PREMEDLINE, Thomas (Library of Congress), and Internet search engine-assisted searches using the terms healthcare quality, medication error, patient safety, PL 109-41, and quality improvement. Additional citations were identified from references cited in related publications. STUDY SELECTION AND DATA EXTRACTION: All relevant publications were reviewed. Summarization of the PSQIA was carried out by legal textual analysis. DATA SYNTHESIS: PL 109-41 provides privilege and confidentiality for patient safety work product (PSWP) developed for reporting to patient safety organizations (PSOs). It does not establish federal mandatory reporting of significant errors; rather, it relies on existing state reporting systems. The Act does not preempt stronger state protections for PSWP. The Agency for Healthcare Research and Quality is directed to certify PSOs and promote the establishment of a national network of patient safety databases. Whistleblower protection and penalties for unauthorized disclosure of PSWP are among its enforcement mechanisms. CONCLUSIONS: The Act protects clinicians who report minor errors to PSOs and protects the information from disclosure, but providers must increasingly embrace a culture of interdisciplinary concern for patient safety if this protection is to have real impact on patient care.     

The Patient Self-Determination Act: the ethical dimensions.

Advanced, sophisticated technology, rising health care costs, and consumerism all combined to drive the development of the Patient Self-Determination Act. Ethical implications include, but are not limited, to the principles of autonomy and beneficence. Paternalism is also discussed as a compromise to autonomy. Caring is used to focus on the contextual perspective of both patients and nurses for ethical decision making. Implications for future ethical practice conclude the discussion.     

QAPI how do you measure up?: Preparing for public reporting in hospice: an overview for success

With the passage of The Patient Protection and Affordable Care Act, Public Law 111-148 (Affordable Care Act), public reporting for hospice will be required. A high-functioning Quality Assessment Performance Improvement (QAPI) program is the foundation for improved patient outcomes and the platform for public reporting. Assessing the effectiveness of a hospice's QAPI program now and then taking it to the next level will prepare organizations for when public reporting is here.     

Diabetes medication incidents in the care home setting

This article analyses data received from a Freedom of Information Act 2000 request made to the National Patient Safety Agency in June 2010. Information was requested about adverse drug event reports in relation to insulin therapy and oral glucose-lowering agents in the care home setting. Data identified were reported to the National Patient Safety Agency between January 12005 and December 312009 and were processed through the National Reporting and Learning Service. There were 684 reports related to insulin and 84 incidents related to oral glucose-lowering agents. The most common error involved wrong or unclear dose: 173 reports for insulin, including one death, and 20 reports for oral glucose-lowering agents. Evidence shows that residents with diabetes in care homes are at risk of harm from adverse drug events involving insulin and oral glucose-lowering agents.     

Proposed regulations for enforcement of the Patient Safety and Quality Improvement Act of 2005

The Patient Safety and Quality Improvement "proposed rule" (2008) was published in the Federal Register on February 12, 2008. This "proposed rule," with a comment period extending to April 14, 2008, was created for the purpose of implementing specific facets of the Patient Safety and Quality Improvement Act of 2005; those dealing with the establishment of Patient Safety Organizations (PSOs), confidentiality protection for patient safety activities, and patient safety work product, and reporting by the Secretary of the Department of Health and Human Services (HHS) to Congress regarding successful strategies that have reduced medical errors and have thereby increased patient safety.     

Rights to information access under the Data Protection Act

A patient has a legal right to access personal information held by health professionals on the basis of statutory provisions, such as the Data Protection Act 1998 and the regulations made under that Act, the Access to Health Reports Act 1988 (which is considered in a later article), and also on the basis of the common law, i.e. judge made or case law. Neither legal rights, however, give the patient an absolute right, but are qualified.     

A nursing perspective on advance directives.

The nurse's role in implementing the Patient Self-Determination Act is often unclear. This article describes the clinical use of advance directives, discusses related ethical concepts, and identifies methods nurses could use for initiating discussions about advance directives.     

Gastroenterologists and accountable care organizations

Within the Patient Protection and Affordable Care Act of 2010 is a provision setting up a program for the implementation of accountable care organizations (ACOs). This article explains the proposed ACO model and discusses major implications regarding this model of health care reform including the following: What will it take to implement the program successfully? What are the opportunities for savings under the model? What are the potential downfalls of the program as proposed? What impact would the implementation of an ACO have on the practice of gastroenterology?     

Impact of the new US health-care-reform legislation on the pharmaceutical industry: who are the real winners?

Over the past two years, the US pharmaceutical and biotechnology industries were preparing themselves for passage of some type of health-reform legislation with a clear appreciation-and concern-about the enormous impact any law would be likely to have on the structure and viability of the research-based industry. Now, with final passage in March 2010 of the Patient Protection and Affordable Care Act and its companion "quick-fix" and budget bill, the Health Care and Education Reconciliation Act, it is a good time to take a look at how the industry fared and assess how the various provisions of the health-care reform bill might affect the industry's long-term prosperity and growth.