ACSR cheat sheet

ACSR credentialing bodies set scope-of-practice limits; tasks outside the defined scope require delegation or referral regardless of employer request.

Informed consent elements: patient capacity, disclosure of risks/benefits/alternatives, voluntariness, and documentation of the discussion.

HIPAA permits disclosure for treatment, payment, and operations without authorization; all other uses need written authorization with revocation rights.

Minimum necessary standard: share only the least protected health information needed for the stated purpose.

Mandatory reporting triggers typically include suspected abuse of children, elders, or dependent adults, and specified communicable diseases.

Breach notification: notify affected individuals without unreasonable delay and no later than 60 days after discovery.

Retention rules vary by record type and jurisdiction; when two rules conflict, the longer retention period controls.

Scope violations are usually reported to the credentialing board, not resolved internally; self-reporting obligations may apply.

Primary survey order: airway, breathing, circulation, disability, exposure - reassess after every intervention.

Shock triad of deterioration: falling blood pressure, rising heart rate, narrowing pulse pressure; hypotension is a late sign.

Glasgow Coma Scale ranges 3-15; score 8 or below indicates need for airway protection assessment.

Adult normal ranges: respiratory rate 12-20/min, SpO2 94-100%, systolic BP 90-120 mmHg, temperature 36.1-37.2 C.

Pain assessment uses patient self-report as the standard; numeric 0-10 or Wong-Baker faces for those who cannot use numbers.

Allergy documentation must record the agent, reaction type, severity, and date before any medication administration.

Focused assessment compares affected versus unaffected side, then documents laterality, quality, onset, duration, and aggravating factors.

Delegation decision rule: task stability, predictability, and required judgment determine whether it can be assigned to unlicensed staff.

Aseptic technique: hand hygiene, sterile field boundaries, no reaching over sterile areas, and contaminated items are replaced not reused.

Verify patient identity with two identifiers before any procedure, specimen collection, or medication administration.

Time-out before invasive procedures confirms patient, site/side, procedure, and consent aloud with the team.

Specimen labeling occurs at the bedside immediately after collection; unlabeled specimens are rejected by laboratories.

Sharps handling: never recap by hand, activate safety devices, and dispose in puncture-resistant containers at point of use.

Equipment checks before use: integrity, expiration date, calibration status, and correct settings confirmed against the order.

Vital sign recheck intervals after an intervention follow policy; abnormal findings require escalation per protocol, not watchful waiting.

Documentation of a procedure includes indication, consent, technique, findings, specimens, patient tolerance, and complications.

Hand hygiene moments: before patient contact, before aseptic task, after body fluid exposure risk, after contact, and after contact with surroundings.

Transmission-based precautions: contact for MRSA/C. difficile, droplet for influenza, airborne with N95 for tuberculosis and measles.

Fall risk interventions apply to any patient with altered mental status, recent fall, mobility impairment, or high-risk medications.

Root cause analysis targets system failures, not individual blame; corrective actions must be measurable and tracked.

Sentinel events require immediate containment, disclosure to the patient, and a formal review process.

Medication high-alert classes (anticoagulants, insulin, opioids, concentrated electrolytes) need independent double-checks.

Incident reporting is non-punitive and must be timely; the report is not a substitute for clinical documentation in the record.

Error prevention hierarchy: elimination, substitution, engineering controls, administrative controls, then personal protective equipment.

Chart entries are contemporaneous, accurate, complete, legible, and authenticated with name/credential, date, and time.

Late entries are labeled as late with the actual entry date and the date of the event documented.

Corrections use a single line through the error, initialed, with the correct information added; never erase or use correction fluid.

Subjective and objective data are separated; direct patient quotes are placed in quotation marks.

Documentation reflects only care the author performed or directly observed; charting for others is falsification.

Use objective descriptors (size, color, amount, duration) rather than judgmental terms such as 'good' or 'appears fine'.

Refusals are documented with what was refused, the risks explained, the patient's stated reason, and notification of the provider.

Abbreviations follow an approved facility list; prohibited abbreviations (e.g., U for unit, QD) are never used.

Ethical principles: autonomy (patient choice), beneficence (do good), nonmaleficence (avoid harm), justice (fair allocation), veracity (truthfulness).

Informed refusal requires the same capacity and disclosure standards as informed consent, plus documentation of the refusal.

Conflict of interest is disclosed and removed from decision-making; personal gain never influences clinical recommendations.

Confidentiality persists after death and across employment changes unless law requires disclosure.

Assertiveness script for concerns: state the concern, the facts, the request, and escalate through the chain of command if unresolved.

Cultural humility: ask about language, decision-making roles, and health beliefs rather than assuming preferences.

Apology and disclosure after an error are ethical duties; they do not replace formal reporting obligations.

Boundaries: dual relationships and social media contact with patients increase risk and are governed by written policy.