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Learn the key items in new guidelines
Focus is on quality, measurement
The revised "Core Competencies for Health Care Ethics Consultation," by the American Society for Bioethics and Humanities (ASBH) contains new sections and tables addressing procedural standards and quality assessment.
"The report looks at what is the minimum infrastructure of an ethics consultation," says Anita J. Tarzian, PhD, RN, associate professor, family & community health, University of Maryland School of Nursing, and program coordinator for the Maryland Health Care Ethics Committee Network, Law & Health Care Program, University of Maryland School of Law, all in Baltimore, MD. "The initial core competencies report focused on what individual ethics consultants need. This revised document recognizes there needs to be an infrastructure and institutional support."
Hospitals need a policy that defines who can request ethics consultations, how these are handled, and how to evaluate them, Tarzian says.
Here are some of the new features of the core competencies guidelines:
Establish a framework for clinical and organizational ethics consultation.
Andrea Frolic, PhD, a clinical and organizational ethicist at Hamilton Health Science of McMaster University Medical Center in Hamilton, Ontario, Canada, says, "What I like about this new version is they include both clinical and organizational ethics consultation. The skills often are overlapping, and we see them as related rather than distinctive practices."
The revised guidelines expand the traditional scope of ethics consultants from being patient-specific to recognizing they might be consulted about business ethics issues, policy ethics issues, and other issues in the organizational realm, Frolic says.
"I like how this document addresses the broader practice and has a much more inclusive definition of the role of an ethics consultant, and it mirrors a lot of people's actual practice, which I think is helpful," she says.
Address HCEC evaluation and quality improvement practices.
The report evaluates consults in terms of ethics services, says Mary V. Rorty, PhD, MA, an adjunct clinical associate professor at Stanford (CA) University. "It's more about whether you have a machine that could do the job that the outcome of the job that's done," Rorty explains.
The guidelines include a table that divides the category of evaluating quality into three sections, related to structure, process, and outcomes. Examples of the recommendations under each of these sections are as follows:
Structure. "Identify root causes, underlying structural gaps (e.g., staff shortages, historical precedent, lack of funds for continuing education)."
Process. "Identify major root causes underlying process gaps (e.g., lack clear policy standards, resistance to change, unable to formulate ethics question, competing demands on staff time)."
Outcomes. "Identify major root causes underlying any satisfaction gap (e.g., misunderstanding of the consultation process, lack of timeliness, role confusion)."
Members of ethics committees could evaluate their programs by collecting data on the types of ethics consults referred to the committee and break these down by department, Tarzian suggests. "They could see that we're getting a lot of consult requests on when you can stop the ventilator in patients with X syndrome, so maybe we need to develop an educational intervention to help staff with this," she says.