Beginner's Guide to Healthcare Administration

Advanced Health Care Directives Overview

2006-08-14T15:54:08Z

Advanced health care directives allow you to indicate to your health care providers and your family what type of treatments you would want should you become incapacitated. Most of the time directives will only be used in the event you cannot make your own health care decisions. It is a terrible thought but should you develop a grave illness or an accident leaves you in a coma a directive makes your wishes clear. The federal Patient Self Determination Act must be provided to you by your health care providers. This Act gives the patient information about their rights to make their own healthcare decisions. Those decisions include your right to refuse or accept medical treatment. The Advance Health Care Directive is a document that instructs others about your care even if you can't tell them your wishes. There are a variety of documents that describe advanced directives including a Living Will, Health Care Power of Attorney and an Advance Health Care Directive. It isn't a pleasant task but it is important for those of us who are over 18 year of age. We don't like to think about ourselves in a position where we may not be able to speak for ourselves or share our wishes for our own healthcare. The advance directives are the assurance that the decisions regarding future medical care is in line with our wishes. The recent news stories regarding the woman who was in a coma with no Living Will made controversial headlines for over a year. This story should make us all more aware of the importance of advanced directives. You can also request in your advance directive if you want relief from pain even if doing so may hasten your death. Also included in the directive, you can state instructions about organ donations. Advance Health Care Directive forms are not difficult to complete. What makes it difficult is the content. Forms are available through state healthcare websites, senior services organizations, attorneys, geriatric care manager and hospitals and hospice organizations.

Types of Directives

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It is false to assume the reason for a directive means "don't treat." While it is true many Advanced Directives are made to avoid being kept alive against their wishes when death is near, but it doesn't mean don't give any medical treatment. They can be used to say that you want possible treatments that include pain control, comfort care and the respect for your dignity. There are three types of directives. Some better than others, but all can help in ensuring your medical wishes are carried out if you are unable to make them yourself.

Living Wills: The Living Will goes into effect if you are no longer able to make your own health care decisions. If you suffer serious brain damage or a massive stroke, you may be unconscious or unable to communicate with family and doctors. A Living Will lets those involved know your wishes concerning medical and lifesaving procedures. A Living Will also lets you state whether you want your life prolonged if you suffer from a terminal illness or if you are what doctors consider permanently unconscious. If there is no hope of recovery, the Living Will lets you decide whether certain treatments are withheld or withdrawn if the treatments are prolonging the dying process.

Health Care Power of Attorney: A HCPOA allows you to name someone to make healthcare decisions for you if you are unable to do so. The Health Care Power of Attorney is more flexible than a Living Will. It can cover any health care decisions, even if you are not terminally ill or permanently unconscious. The HCPOA is helpful in the case of Alzheimer's that affect your decision making or in cases of temporary unconsciousness. This document is similar to a Living Will in that you may state your wishes about treatments and medical procedures.

Choosing the right person or agent, for your Advance Directive is crucial. Unless otherwise stated, your Agent (also known as "Durable Power of Attorney") has the same authority over your healthcare as you do. This person must be someone you trust implicitly to make decisions for you. The Agent should know you well and care about you. It is usually a spouse. Most of the time someone authorizing a HCPOA, chooses a family member or very close friend. It is also wise to indicate a alternate person, too. This person has the legal authority to make decisions regarding artificial nutrition and hydration and other measures that may prolong life. Another positive in naming a proxy is that person can make the important decisions regarding day-to-day care including placement options and treatments.

Advanced Health Care Directive: This directive combines features of a Living Will and a Health Care Power of Attorney along with other options. This is a comprehensive document because it names a proxy and provides instructions about your wishes. States often differ in what they will accept as far as Advanced Healthcare Directives are concerned. Due to statutory restrictions, many attorneys suggest to clients that they complete separate documents-a Living Will and a Health Care Power of Attorney.

Finalizing the Directive

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Doctor: After completion of the advance directive, you should discuss it with your doctor before it is signed. The doctor may have suggestions you couldn't think of adding. Your doctor will likely be the one caring for you so he/she can assist in making your document medically friendly and make sure it makes sense. The doctor can help make your directive consistent and coherent.

Family: It is crucial to discuss your desires with family and friends. As much as you try, your advance directive may not cover everything that can crop up during medical procedures. If you discuss your wishes with several people, in all likelihood you will have a better chance of those wishes being granted. Discussions also ward off unpleasant family scenes and confrontations. Family members feel they have a moral obligation not necessarily a legal one when deciding your healthcare if you become incapacitated. The advance directive may help family members agree during the time of sadness and decision making. Most doctors rely on family involvement in decision making provided there are not disagreements. If you have not made your wishes known and problems arise, a hospital physician or specialist may become the default decision maker for your health.

Attorneys: A lawyer is not necessarily required to complete your Advance Directive. One is a helpful resource but not necessary to make your document legal.

States have different requirements as far as witness requirements. Check your states signature and witness mandates such as notaries, number of witnesses and who can be a witness. It is possible the witness must be an attorney. Copies of the directive should be given to your doctor, family members, your Agent if one is named and your attorney. Directives can be revoked or replaced at any time as long as you are capable of making your own medical decisions. The advance directive should be reviewed every two year or if your health changes. Directives are not just for the elderly. Your voice should be heard concerning your health and it relieves others from making difficult choices on your behalf. Actually, when someone who is younger becomes incapacitated decisions about prolonging or ending their death becomes more difficult to make. In some cases, they may be kept alive for decades against their wishes. Wishes know one knew existed. Advance Directives are important documents for all adults. Just remember, advance directives are the best assurance your decisions regarding future medical care are carried out to your specifications in case you become incapacitated.

Air Ambulance Overview

2006-10-06T14:25:13Z

Have you ever been faced with a situation where you are in a place where you need emergency medical attention but no ambulance can get to you? This can be frustrating especially since your life or the life of someone you know depends on getting help right away. What can you do in a case like this? Since a regular ambulance can't make it there, have the paramedic contact an air ambulance to pick you up. They can go places that a regular ambulance can't. This way you get medical help immediately and possibly save a life. If you never saw an air ambulance, you are probably wondering what one is and are there different types around? Air ambulances are grouped into two types:

• Private sector air ambulances: These types of air ambulances are quite expensive and if you need this service while traveling, you better hope your travelers insurance will cover the cost of using one.
• Publicly-owned air ambulance: This type of ambulance is usually provided by the U.S. Coast Guard and/or other agencies, depending on the area where the incident occurs. The one good thing about this service is it doesn't cost the person any money to use one. In most cases the vehicle used for transport is a helicopter.

Air Ambulances as a Form of Emergency Medical Care

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When you hear the word ambulance you can associate it with an emergency vehicle that comes to your location and transports a sick person to the nearest hospital. Well an air ambulance does the same thing, except there is one difference. An air ambulance uses an aircraft (in most cases a helicopter) to transport the sick person. An air ambulance doesn't just transport the sick or injured person to the nearest hospital; they also perform emergency medical assistance. Under most situations, air ambulances are equipped with the right materials and equipment to allow the crew to provide the proper first aid or medical treatment required. An example of such equipment would be a respirator, medicines, an ECG and monitoring unit, CPR equipment, a stretcher, and more.

If you get assistance from an air ambulance, you will normally find two or three paramedics, along with a flight nurse or physician to take care of the medical condition. All personnel aboard the air ambulance is properly trained and certified to handle the type of treatment they will encounter. Also, besides paramedics and a doctor or nurse, there are also pilots whose only duty is to fly the aircraft to where it has to go. They have extensive experience in avionic matters and know how to handle such an aircraft. This is necessary in case conditions in the air become unstable or hazardous.

There are two types of air ambulances in use. These are private sector air ambulances and publicly-owned air ambulances:

• Private sector air ambulances: These are very expensive to use. If you are a traveler, you better have adequate insurance coverage on yourself and anyone with you or you will be socked with a huge bill. The best way to travel is by being insured against sickness, accidents, or death. It is even recommended that you have in your insurance policy a provision where some kind of third-party provider will communicate with the air ambulance so you won't have to, especially if you have a person that is uninsured in your company.
• Publicly-owned air ambulance: This type of service is provided usually by the U.S. Coast Guard, although there have been other agencies that do have access to them. This of course at no cost to the person using their services. This type of company uses a helicopter to do the transporting.

Advantages and Disadvantages of Using Air Ambulances

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Air ambulances have saved countless lives since its inception back in the 40s. They have been used to help millions of people. However, just as there is a good side to using air ambulances, there is also a bad side to it. Air ambulances are able to be where regular ambulances cannot reach so they do serve a purpose but there are also dangers and risks involved. Here are the advantages and disadvantages of using air ambulances:

• Advantages: Using air ambulances helps get patients from the scene of the accident or location to the nearest hospital in quick fashion. They can drop down, pick up the patient and deliver them so as to get the medical help they need before it is too late. Medical staff on board can provide adequate first aid and treatment to the patient while in transit. This helps to lower the risk of serious complications.
• Disadvantages: Air ambulances face one problem, just as airplanes do. They do crash, killing not only the patient, but everyone on board. The problem in most cases is that the aircraft is not maintained as often as regular helicopters are because the aircraft is not in control of any airport maintenance staff. So often times the helicopter goes without proper maintenance. Because of these problems, the medical industry took steps to alleviate this by using one of two scenarios:
o Requiring the air ambulance to be kept at a specialty hospital where there is a department that can care for the helicopter.
o Base the helicopter in a rural area that is close to the patient and is in possess of a maintenance facility.

No matter what type of system you use, everyone on board the air ambulance, with the exception of the pilot are accredited and certified. They are also put through training programs to keep them updated on the newest technologies and procedures when working in an air ambulance.

What Air Ambulance Service To Use

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Obviously you want an air ambulance service that knows what they are doing, is certified, accredited, and has experience in the medical field. You also want them to be trained to handle emergency care when they arrive at the scene. In many situations, a person's life is at stake when even seconds are wasted. Therefore, you depend solely on an air ambulance to get to the scene, load the patient, take care of the patient while in transit, and get them to the nearest hospital quickly. The only question remains is which service to use. Well that depends on where you are located when your problem occurs. There are various ones around. Here are some that you may find helpful, but again, you need to know where you are going ahead of time to know if there is one in that area.

• National Air Ambulance: The National Air Ambulance service claims to be the first air ambulance to be licensed in Florida. They are located at Fort Lauderdale's International Airport. From here they can easily reach most areas, providing the best of medical care for all patients they pick up. They are available around the clock. To check them out just go to http://www.nationaljets.com/natjet/ambul/index.html.
• American Air Ambulance: American Air Ambulance is in operation 24 hours a day. They are considered the largest group of certified flight doctors, nurses, and technicians in the United States. They are the best in the business because they have 25,000 of flight time and have been in operating since 1986. They also have a flawless safety record. With 72 medical planes available, they can reach anywhere quickly. To learn more about them just to http://www.americanairambulance.com/index.html.
• Air Ambulance Specialists: Air Ambulance Specialists can arrange any kind of flight from domestic to international air medical transportation if need be. They use private medically equipped, fixed wing aircraft. So they can get you to where medical help is right way. They also provide three levels of service: basic life support, advanced life support, and critical care. To learn more about them and what they do check out http://www.airaasi.com/.
• US Air Ambulance: U.S. Air Ambulance is known as worldwide medical escorts. They have been operating since 1990 and have saved countless lives over the years. Their medical team is certified to handle aeromedical critical care. They are also available 24/7. To learn more about them including their pricing structure go to http://www.usairambulance.com/.

Universal Precautions Overview

2006-10-06T14:28:41Z

The phrase "Universal Precautions" has become familiar jargon in our day and age. Due to the increase of infectious diseases, health care facilities found it necessary to evaluate safety protocols. Universal precautions are a staple of the twenty-first century.

What are Universal Precautions?

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Universal precautions are simple infection control procedures set up to protect health care workers and patients from the risk of transmission of blood borne pathogens spread by specific body fluids and blood. These precautions were developed by the Laboratory Center for Disease Control, Health Canada and the U.S. Centers for Disease Control to eliminate unhealthy contact with patient body fluids and blood that are possible of infecting workers with disease. Under the universal precaution principle, workers are to assume that all patients have these infectious blood-borne diseases such as HIV and hepatitis B, in spite of the known status of the person. An integral aspect of universal precautions is improving protection during injections.

Why are universal precautions so prevalent now, and where are they heading?

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Universal precautions were widely encouraged after the AIDS outbreak in the 1980s. It should be noted, however, that is currently being considered to disregard the term "universal" as it indicates perfect protection, which universal precautions do not give.

Present proposals require a two-tiered system, employing the terms "standard" and "additional precautions". Standard precautions relate to any patient, regardless of what their infectious status is known or assumed to be. This pertains to all bodily fluids, excluding sweat, and includes both wet and dry blood. Additional precautions are employed over and above standard precautions for those patients who are identified or suspected of being contaminated. Additional precautions fluctuate in accordance with the infection control needs of a patient. There are several conditions indicating additional precautions:

• Diseases with air-borne transmissions (i.e. tuberculosis)
• Infection by direct or indirect contact with dried skin
• Prion diseases (i.e. Creutzfeldt-Jakob disease)
• Diseases with droplet transmission (i.e. rubella, mumps, influenza)

Is it necessary to have Universal Precautions at every workplace?

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Universal Precautions are not necessary at every workplace; however, they are necessary at some key workplaces.

Those workplaces that require universal precautions to be applied are those where workers come into contact with the following body fluids:

• Blood
• Vaginal secretions
• Semen
• Amniotic fluid
• Cerebrospinal fluid
• Pericardial fluid
• Synovial fluid
• Pleural fluid
• Peritoneal fluid

The bodily fluids that universal precautions do not apply to include the following:

• Feces
• Urine
• Tears
• Nasal secretions
• Perspiration
• Vomitus
• Sputum
• Saliva (It should be noted this does not apply to the dental office as saliva is often mixed with blood.)

Keep in mind that if a fluid is not easily recognized, or if it is infected with blood, universal precautions should be applied. Universal precautions are advised not only for doctors, surgeons, nurses, and patients, but also for health care support workers. Even housekeeping staff may inadvertently come into contact with patients or bodily fluids.

Is there a way that workers can protect themselves from being infected with contaminated fluids?

2006-10-06T14:32:40Z

There are several barriers employed in order to protect workers from occupational exposure to contaminated fluids. These barriers include personal protective equipment (PPE), work practice controls, and engineering controls.

• Personal protective equipment (PPE): This equipment consists of lab coats, gloves, goggles, shoe covers, gowns, glasses with side shields, and resuscitation bags. The primary purpose of personal protective equipment is to protect the workers clothes, skin, and mucous membranes from contamination. PPE serves as a barrier between the workers body and any blood and body fluids.
• Work practice controls: These controls are practical procedures that lessen the probability of a worker being exposed by altering the manner in which a task is performed. Some examples of actions in a work environment that require particular consideration to work practice controls include the following: handling of used needles and other sharps, hand washing, and gathering and transporting fluids and tissues in compliance with standard safe practices.
• Engineering controls: These controls are associated with separating or eliminating substances that may prove to be hazardous to those in the workplace. Examples of such engineering controls are the following: laser scalpels, sharps disposal containers, ventilation, and laboratory fume hoods.

How important is it to have Universal Precautions?

2006-10-06T14:33:11Z

It is very important to institute universal precautions for a variety of reasons. Any exposure to blood or body fluids signifies a possible cause of HIV infection. These exposures could be anything from skin-piercing actions with infected objects to open skin wounds that are susceptible to contaminated body fluid. You can never be too careful. In addition, health care procedures embody one way a person can inadvertently be contaminated with an HIV infection, although the risk is significantly low. One of the primary ways a person can be infected through health care procedures is by unsafe injection, which presently accounts for 3.9% to 7.0% of recent infections worldwide. Health care worker protection is an indispensable factor of any plan to thwart discrimination by health care workers against patients who have been infected by HIV. In addition, if a health care worker is personally protected from HIV infection, this ultimately results in safer more effective care.

Basic Steps to Getting Started with Universal Precautions

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Employing universal precautions in a workplace is not hard, and the peace of mind it provides both workers and patients is well worth the work and research invested. Below are some basic steps to employ when getting started with universal precautions.

• Throw away contaminated sharps immediately
• Wash hands with soap and water both before and after procedures
• Document the quality of the sterilization for all equipment used
• Use new, one-time use disposable injection equipment for all injections
• Disinfect instruments and other possible infected equipment
• Use protective barriers such as masks, gloves, goggles, and gowns for direct exposure to body fluids and blood
• Employ the necessary precautions when handling soiled linen. Clean outside the patient areas, use gloves when handling, and wash in hot water with detergent.
• Educate staff. It is essential that health care workers be aware of occupational risks and recognize the need to use universal precautions with all patients at all times. Both pre-service training and in-service training should be provided in health care facilities to educate both medical and non-medical personnel on universal precautions.

Final Thoughts

2006-10-06T14:34:01Z

Universal precautions are simple infection control procedures set up to protect health care workers and patients from the risk of transmission of blood borne pathogens spread by specific body fluids and blood. After the AIDS outbreak in the 1980s, universal precautions were highly recommended. Under the universal precaution principle, workers are to assume that all patients have infectious blood-borne diseases such as HIV and hepatitis B, regardless of the perceived or known status of the person. The desired result is increased safety of both health care workers and patients.

There are several barriers used to protect workers from occupational exposure to contaminated fluids. These barriers include personal protective equipment (PPE), work practice controls, and engineering controls. Hand washing, gloves, masks, proper ventilation all serve to increase safety protocols. Universal precautions are very important as it not only protects the workers but also prevents patient discrimination. It is currently being considered to disregard the term "universal" as it indicates perfect protection, which universal precautions do not give. The protection may not be perfect, but universal precautions definitely increase the prevention of contamination for millions of people.

Resources

http://www.ccohs.ca/oshanswers/prevention/ppe/universa.html

http://www.who.int/hiv/topics/precautions/universal/en/

http://en.wikipedia.org/wiki/Universal_precautions