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Internet research has been an issue for institutional review boards since its roots in the 1990s, and the challenges ethics boards face in reviewing such studies are in pioneer territory.
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"The paternalistic model assumes that there are shared objective criteria for determining what is best. Hence the physician can discern what is in the patient's best interest with limited patient participation . . . the physician acts as the patient's guardian, articulating and implementing what is best for the patient...The conception of patient autonomy is patient assent, either at the time or later, to the physician's determinations of what is best.""Four Models of the Physician-Patient Relationship." JAMA. April 22/29, 1992 Vol 267, No. 16.
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Paul Arnstein, RN, PhD, clinical nurse specialist for pain relief at Massachusetts General Hospital, is familiar with The Joint Commission's standards on pain. As president of the American Society for Pain Management Nursing and a liaison representing pain management, Arnstein recently attended an annual meeting with TJC.
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Have you revisited your pain policy? Are you auditing compliance? How will you fare when Joint Commission surveyors come to your facility? Hospital Peer Review spoke with three institutions about the challenges they faced, the interventions they made, and the successes they have seen.
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They just happened to go public at about the same time the Centers for Medicare & Medicaid Services' (CMS') final rule on "meaningful use" as part of the HITECH Act and The Leapfrog Group's study results on computerized physician order entry (CPOE) systems and its subsequent call for action to monitor the safety of such systems and to develop best practices.
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The traditional hospital system in which physicians are staffed during the day and on call at night is not the only model. And certainly, as the health care industry becomes more aware of the quality of care for the traditional off-peak shifts, that model could change quite radically in the future.
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Whether it's over-alerting or under-alerting, it's a problem. A number of studies have taken on computerized physician order entry (CPOE), but the latest findings from a Leapfrog Group study made public June 28 shows CPOE problems can lead to harmful or even fatal errors.
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From about 7 a.m. to 7 p.m. Monday to Friday a hospital is a busy place with a host of clinical and administrative staff and department chairs and chiefs. But on nights and weekends, it's often quite different.
