Patient Safety and Ethics Flashcards

An 82-year-old patient with severe dementia is brought from a nursing home for a routine EEG. The patient is unable to state their name or understand the procedure. Who is the most appropriate individual to provide informed consent for the EEG?

Answer: The patient's legally authorized representative or next of kin.

When a patient lacks the cognitive capacity to make an informed decision, consent must be obtained from their legally authorized representative (e.g., a person with durable power of attorney for healthcare or a legal guardian). This individual is empowered to make healthcare decisions on the patient's behalf. The ordering physician determines medical necessity but cannot provide consent for the patient, and an accompanying nurse typically does not have legal authority to consent unless they are also the legal representative.

Which of the following actions by an EEG technologist is a direct violation of the Health Insurance Portability and Accountability Act (HIPAA)?

Answer: Looking up the medical records of a celebrity who is a patient in another part of the hospital out of curiosity.

Accessing a patient's protected health information (PHI) without a legitimate, job-related reason is a serious HIPAA violation. Curiosity is not a valid reason for accessing records. The other options describe appropriate actions: consulting with the care team, using secure devices, and gathering necessary clinical information are all permissible uses of PHI for patient care.

During a portable EEG in the ICU, the patient experiences a generalized tonic-clonic seizure. After ensuring the patient is safe and calling for nursing assistance, what is the technologist's primary responsibility related to the recording?

Answer: Continue recording and meticulously document all clinical manifestations and the exact time they occur.

The technologist's primary role during a seizure is to ensure patient safety first, then to obtain a high-quality recording of the clinical and electrographic event. Accurately annotating the recording with observed clinical signs (e.g., 'tonic stiffening of all limbs,' 'head turn to left,' 'clonic jerking of right arm') is crucial for the interpreting physician. Stopping the recording would mean losing the most critical diagnostic data. Administering medication is outside the technologist's scope of practice.

An alert and oriented adult patient provides consent for an EEG but adamantly refuses the hyperventilation (HV) activation procedure due to a history of panic attacks. Which of the following is the most appropriate course of action for the technologist?

Answer: Respect the patient's refusal, document it on the record, and proceed with the remainder of the EEG.

Competent adult patients have the right to refuse any part of a medical procedure. The technologist must respect the patient's autonomy. The proper action is to document the refusal clearly on the technologist's report and continue with the other parts of the study, such as photic stimulation and obtaining a sleep recording.

To minimize the risk of electrical shock to the patient, what is the single most important electrical safety practice in the EEG laboratory?

Answer: Plugging all patient-connected equipment into the same properly grounded, hospital-grade outlet cluster.

Using a single, common ground point for all equipment connected to the patient prevents the formation of ground loops and minimizes the risk of leakage currents passing through the patient. Plugging the EEG machine and any other connected devices into the same outlet block ensures they share a common ground reference. Applying multiple ground electrodes from different pieces of equipment can be dangerous and is known as 'double grounding'.

What is the standard infection control practice for disinfecting non-disposable surface cup electrodes after use on a patient with an intact scalp and no known infectious diseases?

Answer: Mechanically cleaning the electrodes, then immersing them in an appropriate intermediate-level disinfectant.

Standard procedure requires a two-step process: first, mechanically cleaning the electrode with a brush or abrasive paste to remove all conductive media and organic material, followed by immersion in an EPA-registered, hospital-grade intermediate-level disinfectant for the manufacturer-recommended time. Wiping with alcohol is insufficient, and autoclaving would damage the electrodes. Soapy water alone does not provide disinfection.