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part1:Unit 6: Discussion – Ethics


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Risk managers work with the public, patient’s family, and staff so it is imperative that risk managers have a working knowledge basic knowledge of basic ethical principles. The risk manager has a code of ethics that guides them in their decision making. One of the most vital components of the code of ethics for the risk manager deals with confidentiality of patient, physician, and hospital medical information. This is mandated by HIPAA and guides the risk manager in their role.

Aligned to ULO(s)

ULO1: Explore the ethical issues and the risks that need to be mitigated in situations involving DNR decisions, advanced healthcare directives, and patients’ rights in nursing homes (CLO1, CLO2)

ULO2: Discuss state regulations related to DNR considerations in nursing homes (CLO5)

Discussion Due Dates


Online Students

Blended Students

Initial post

By Wednesday at 11:59 P.M., CT.

Five (5) hours prior to the scheduled class session.

Two peer responses

By Sunday at 11:59 P.M., CT.


Initial Post

Peer Responses

Initial Post

Ninety five-year-old Mrs. Jones has been a patient at Living Oaks nursing home (a state nursing home chain) for over 10 years. She has had multiple sclerosis for the last 15 years and has been suffering from chronic asthma attacks. Dr. Santana is the Medical Director at the nursing home and takes care of Mrs Jones. During the last year, she was admitted to the local hospital several times for severe complications with the multiple sclerosis and asthma.

Unfortunately, Mrs. Jones suffers a massive heart attack in the middle of the night at Living Oaks. Mrs. Jones family has not signed a Do Not Resuscitate (DNR) for her and the nurses are unable to get ahold of her son who lives 500 miles away. They recall that Dr. Santana had indicated previously that there was no DNR on file for the patient. The nurses present are not sure about the situation and reached out to the Director of Nursing for help in this ethical dilemma. The Director of Nursing found herself as an ethical dilemma too about what to do…

Assume that you are the Risk Manager at Living Oaks nursing home (a state nursing home chain, with the headquarters in the city where you reside).

Prepare a memorandum addressing the ethics and the risks that need to be mitigated in the situation involving DNR decisions, advanced healthcare directives, and patients’ rights in your state nursing homes. Are there state regulations requiring the DNR being on the patient record in nursing homes? Note the location (city and state) of your hypothetical nursing home at the top portion of your memo. Research and use state specific applicable regulations.

The initial posting should be prepared as a Microsoftâ„¢ Word document, and then

posted directly to the discussion thread and also

attached to the unit discussion thread. There is no minimum or maximum in terms of the word count; however, the response should explicitly address all required components of this discussion assignment. The document should be prepared as a practical business deliverable (single-spaced) and reflect higher-level cognitive processing (analysis, synthesis, and evaluation).

Support the initial posting with at least 3 references of credible or peer-reviewed sources. The in-text citations and the list of references should be consistent with the APA writing style (7th ed.). To earn the maximum number of points for the initial posting, the overall quality of the writing should be consistent with that expected of a college student and industry professional.

part 2 I attached the document below

-Develop an action plan to address the root causes I identified in the root cause analysis I prepared.

-Complete your portion of the paper

-Identify and input speaking points and media to the presentation in the power point.

-Take ownership of the project deliverable; ensuring proper APA 7th formatting, making sure the storyline flows and that references are appropriate.

Unit 8: Team Project Deliverable – Patient Falls
Keila Merino, Brian Ragsdale, Isabela Jacobson, Jesus Canales
Park University
HC463: Third Party Reimbursement and Risk Management
Dr. Chad Moretz
Strive on writing 1.5 single space pages per person. After formatting for double space per APA
7th, that will give the paper 10 pages of content.
The presentation should be 20 minutes in length with all team members participating (~5 minutes
for each person) with time for discussion at the end of the presentation.
Patient Falls
Part 1 Jesus
How prevalent are injuries resulting from patient falls in the United States?
On average, how many days to the hospital stay after a fall with injury adds?
What is the average cost of care for a fall with injury?
What are the most common contributing factors pertaining to falls with injury?
What are the proven successful strategies to patient falls prevention?
What actions are recommended by the Joint Commission to health care
organizations prevent patient falls and fall-related injury?
Explain how the concepts behind hospital negligence relate to patient falls and
fall-related injuries. How does patient negligence differ from medical error and how
does it relate to patient satisfaction?
Why does negligence occur in the healthcare setting?
Is negligence an ethical challenge for the health care system?
What are the consequences of negligence in the healthcare settings?
When a patient with Medicare coverage falls out of bed, who pays for
treatment of the fall-related health issues?
What is a list of ‘reasonably preventable’ mistakes, termed ‘never-events’?
Part 2
Isabela Summarize the facts in Harkins v. Natchitoches Parish Hospital.
On April 14, 1994, a woman named Melba Harkins had just completed her regular
evening workout at the hospital as a part of her functional rehabilitation program. On this
evening, Mrs. Hawkins was walking across the grass towards her car, which she had done many
times before, when she tripped and fell over a black vinyl garden border that was partially hidden
in the grass.
The results from this fall ended up causing Ms. Harkins to have a neighbor bring her back
to the hospital shortly after going home due to the pain she was in, and the doctors had
confirmed that she had a dislocated right shoulder.
Two weeks after the fall, Mrs. Harkins had her shoulder treated by Dr. Dean. It was
discovered that she was experiencing degenerative changes that would need to be operated on to
repair a torn rotator cuff. After the surgery and the final check-up, the doctor sent the patient
home with no restrictions or limitations of movement and only to practice home stretches.
The patient never regained full use of the shoulder after the injury; doctors determined
that the surgery might have to be redone but did not recommend this. The patient opted out of
future surgeries and now lives in constant pain. Going from being entirely independent to
needing care around her living space, she cannot use her shoulder to its full capacity.
Further, discuss the impact this failure to exercise reasonable care had on internal and
external stakeholders.
For internal stakeholders, there will now be the risk of scrutiny from the external
stakeholders as it was the doctors’ fault that they did not exercise care correctly. The job of an
internal stakeholder is defined as “those entities that are integrally involved in the healthcare
system and would be substantially affected by reforms to the system.” (Admin, 2011). The lack
of care the patient received from the organization will now represent how this clinic can proceed
with other patients, whether this is true or not.
For external stakeholders, this incident can be a deterrent from wanting to invest in this
facility as it has proved itself not to have the patient’s best interest. Especially after, “The failure
to either remove the vinyl or place warning signs that it was there is a failure to exercise
reasonable care, and under the theory of negligence, the defendants must be responsible for the
injuries sustained by this plaintiff.” (Harkins v. Natchitoches Parish, 1997)
Examine the legal implications related to healthcare organization compliance.
Healthcare Organization Compliance is “the process of abiding by all legal, professional, and
ethical compliance standards in healthcare.” (Symplr, 2021). This means that there are rules and
regulations to account for the forever-changing ways of healthcare treatment and technology. In
this case, the patient has gotten injured due to negligence from the failure to remove vinyl or
place warning signs about potential dangers to patients. This resulted in a lawsuit against the
Review any legal requirements associated with the case such as for example, reporting
The main reason the court decided to side with the plaintiff was the hospital’s failure to
remove vinyl or place warning signs. To follow, it must prove it acted reasonably to discover and
correct a dangerous condition in its business activity. This means that the hospital is liable for
any potential dangers to visitors on its premises. It can also be seen in the Reynolds vs. St Francis
(1992) case that “the trial court found that defendant failed to prove that its employees had not
caused the slippery substance to be on the steps and further that defendant’s inspection and
cleanup procedures were not adequate under the circumstances.” This statement is applicable
because in both court cases, it can be seen that there was the inability to prove that the
defendants hadn’t caused both instances to occur, which still makes the hospital liable for the
injuries that employees might have caused.
Analyze the ethical implications associated with the case. Be sure not to confuse ethical and
legal implications.
The ethical implications of this case are the injury of another bodily autonomy, which is
seen as the injury to the patient. There is also little justice served by the hospital when it comes
to the patient and their damage, as they begin to deny that there was no liability and that the
patient was not in the correct mindset to accurately recall the location of where she fell. This
statement can also be considered minimizing the fact. Luckily, the hospital could not provide
evidence that the patient was incorrect, which resulted in the court siding with the patient.
According to De George (1982), “The hospital’s primary obligations are to develop
norms to which the hospital and staff must conform, to serve patients by providing the best care
possible, to allocate resources to better respond to the needs of the community, and to create
policies which allow staff members to refrain from performing acts which they consider
immoral.”. This is relevant to the case because it is common to associate liability with ethics, as
liability fundamentally assigns responsibility. Even though there was not one person who placed
the vinyl with the intention to cause harm, it is the responsibility of the hospital to assume
liability for that occurrence.
Discuss the problem of items on the patient parking lot that are dangerous
for being tripping on, especially if such items are hidden in the grass and not easily
Trips are caused when the forward motion of a person’s foot is halted mid stride and the
person’s body is forward of their base of support or center of gravity, forcing the person off
balance. Trips are more likely to occur when a person does not perceive or expect a trip hazard.
As demonstrated in Harkins v. Natchitoches Parish Hospital, items in patient parking lots that are
hidden or not easily visible increase the probability of a trip and subsequent injury that the
hospital is liable for. While a new parking lot or parking structure is reasonably free from trip
hazards after construction, they must be maintained to ensure that it is safe and secure for its
users. (Parking lot trip hazards, 2019)
Use the Joint Commission Framework for Conducting a Root Cause
Analysis template to prepare a root cause analysis of an adverse event in Harkins v.
Natchitoches Parish Hospital.·
Use the analysis questions in the template
(pp.3-11) to prepare a Root-Cause Analysis of the adverse event in the scenario.
The Joint Commission (n.d.) developed a 24-question root cause analysis (RCA) tool to help
organizations complete a thorough analysis after adverse safety events or when a condition could
have caused patient harm. The goal of an RCA is not to establish blame for an event. Rather, it is
to identify and implement sustainable system-based improvements that will make patient care
safer across the continuum of care (NSPF, 2015). After reviewing the case of Harkins and
Natchitoches (1997), there is not enough information to conduct a thorough RCA. However,
assumptions can be made about the conditions at Natchitoches Parish Hospital that might have
caused Ms. Harkin’s fall. After factoring in the assumptions, Ms. Harkin’s fall can be attributed
to organizational, process, workforce, environmental, and equipment factors.
Mention something about the fall being on the grass.
Organizational and Process
Natchitoches Parish Hospital does not consider the ground and parking lot outside of the hospital
as a part of their safety requirement. Although the grassy area between the parking lot and the
hospital entrance is not a traditional sidewalk, the area that Ms. Harkins tripped on was
commonly used by all hospital entrants. The owner, in this case being the hospital, is responsible
for the safety and maintenance of the grassy area and the rest of the grounds of the hospital.
Since the area outside the hospital is not a part of the systems safety program, no one routinely
inspects the grounds as a part of their job description, nor are the results of such inspection
monitored by the safety division. Had someone inspected the grassy area of the fall, the black
vinyl garden border would have been observed and removed. Fact for why the hospital didnt
consider the grounds a part of the safety program.
Management / Workforce:
The groundskeeping staff is responsible for the outward and professional appearance of the
hospital. As a part of the system’s safety program, groundskeepers inspect and identify hazards,
and report their findings to the safety division. However, since the groundskeeping staff is
undermanned, there is less time for the staff to focus on safety concerns and accomplish their
other tasks. (are they undepaid)
The incident occurred around 7:00 p.m.. Although there is adequate lighting in the parking lot
and hospital entrance, there is a dark area in-between the two locations. This dark spot is also the
same area that the fall occured. While people tend to exercise more vigilance when walking in
dark areas, Ms. Harkins just completed a workout and may not have had the mental ability to
exercise such vigilance. Adequate lighting in the grassy area would have given Ms. Harkins the
opportunity to observe and avoid the black plastic vinyl on top of a green grass contrast.
Objects in the ground shift over time with earth movement and erosion. The position of the
plastic vinyl was in such a way that it was easily hidden from plain sight and higher than normal
to be a trip hazard. The vinyl may have been installed correctly, but there is a reasonable chance
that the position of vinyl may have shifted due to environmental conditions.
An inspection of the walkway from the parking lot to the hospital entrance shows that there is no
fence or barrier to indicate a safe walkway. Initial construction of the facility provided a concrete
sidewalk from the parking lot to the hospital entrance, but patrons created their own walkway
through the grassy area as it is a more direct route. If the groundskeeping plan consists of trip
hazards, physical barriers such as a fence or administrative barriers such as signs and lighting
should clearly identify the desired walking path.
-The Joint Commission. (n.d.). Root cause analysis tool stands the test of time. https://www.joint
-National Patient Safety Foundation. (2016). RCA2: Improving root cause analyses and actions
to prevent harm. Retrieved from Institute for Healthcare Improvement:
-Harkins v. Natchitoches Parish Hospital, 696 So.2d 19 (1997).
-Parking lot trip hazards. (2019). Robson Forensic:
Use the organization plan of action / risk reduction strategies in the template
(p.12) to prepare
Harkins v. Natchitoches Parish Hospital (Links to an external site.), 696 So.2d 19 (1997).
Retrieved from: https://www.leagle.com/decision/1997715696so2d191710
Online Root Cause Analysis Toolkit – Minnesota Dept. of Health
The Joint Commission. (n.d.). Root cause analysis tool stands the test of time. https://www.joint
National Patient Safety Foundation. (2016). RCA2: Improving root cause analyses and actions to
prevent harm. Retrieved from Institute for Healthcare Improvement:
Harkins v. Natchitoches Parish Hospital, 696 So.2d 19 (1997).
De George RT. (1982). The moral responsibility of the hospital. J Med Philos.
Healthcare compliance: All you need to know. symplr. (2021).
Health Care Reform: Duties and responsibilities of the stakeholders. Institute of Clinical
Bioethics. (2011, September 6). https://sites.sju.edu/icb/health-care-reform-duties-andresponsibilities-of-the-stakeholders/
Morton, H. (n.d.). Medical Liability/Medical Malpractice Laws. Medical Liability/medical
malpractice laws. https://www.ncsl.org/research/financial-services-andcommerce/medical-liability-medical-malpractice-laws.aspx
Resnik, D. (2020). What is Ethics in Research & Why is it important? National Institute of
Environmental Health Sciences.

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