Care Coordination Flashcards
Care coordination
The deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of health care services
Who is involved in coordination care of the patient
PT,OT, dietary , pastoral care , case management , social worker , womb care , etc
What is the biggest thing about care coordination
They want us to do it
We should do it on every pt
It has to be deliberate if it is going to work.
Case manager
Care coordinates
Works with helping funding and what the patient needs outside of the hospital
Quality improvement
Put into place so we can make continuous improvement
What should be set into place for quality improvement
A standard such as we want zero falls.
What happens when we do not meet standard for quality improvement
What happened? And how are we going to improve it
What do we need in order for quality improvement to work
Buy in from everyone
What is quality improvement based on
EBP so if someone comes in with DKA with have DKA protocol ( insulin drip, fluids and sugar checks)
Continuous quality care
Promoting teamwork , focus on EBP and having buy in …
This shows if we are improving and increasing knowledge such as acccucheck once a year
Care should be
Safe
Effective
Patient centered
Equitable
Efficient
Timely
Equitable
Your care doesn’t change based on how much money someone has
Efficient
Avoiding wast so we can save money
( we have to save $ in order to give $)
Timely
How long were you in the ER with chest pain
How long were you in the ER with s/s of stroke
HCAPS
Monitor the hospital
Selective
Evaluate the hospital by a set of standards
What is the issue with HCAHPS
They add stuff such as pain management that is our of our control like in sickle cell patients
How can a nurse improve her communication?
Sit on the bed and talk to the pt
Be at eye level
Give pt time ( 30 sec)
Development of standards types
Outcome standards
Process standards
Structure standards
Outcome standards
Focuses on the results from the care given
For example- zero pt with CAUDI or infections ( because i did oral care pt did not get pneumonia ).
Process standards
Related to care delivery
For ex - we have 1 hr window to give medication .. if med is due at 0900 we can give it as early as 8 or 10
Structure standards
Related to the organization
Ex- so we have nurse manager on every unit or case manager or a case manager every 2 units
Outcome audits
Determined by the quality nursing care you did. As a result of direct care of pt .. this is where our nursing comes into play ( we have no pressure ulcers becuase we turn pt q4 or we dont have pneumonia because we do oral care q4)
Nursing sensitive and from direct care
Where our fall rates come in , CAUDI , and audits to make sure we are documenting effectively
Pt discharge delays
It’s important to work as a team to avoid this .. and to avoid med errors
Care variation
When we dont do what we are suppose to do .. why we have protocols to help us not have care variation
How can we avoid medical errors
Encouraging nurses to get as much sleep as possible
Double check your self
7 rights
Listen to your gut
How did we improve communication with providers and the lab
The lab has a 2 hour window to call about critical lab results
Magnet hospital
They follow protocoal and have less errors
We get money from the government and there is better pt outcomes
Lots of education
Who makes less errors
More educated nurse- BSN
Quality GAP
Difference in performance ( care we give) between top performing agency (magnet) and national average
Risk management
When we deal with ethical issues and this is our back up
Risk identification
As nurses it is our job to identify any potential risk
For ex - telling everyone a med looks like another med
CDC Identifying something such CAUDI as when pt gets UTI that they didnt have before so that is causing the UTI
Risk treatment
The treatment would be that a policy or procedure set into place for the that would determine do you even need a foley?
Not every pt needs a foley
They have to meet the criteria of “this is why the pt needs a foley”
Risk evaluation
Did it lower UTI rate by using that protocol ?
Sentinel events
Something that results in death or permanent harm
Or even severe temporary harm that requires life saving intervention to keep the pt stable
What’s the easiest way as a nurse to have quality improvement
Joining some kind of shared governance committee until you are experienced
And where ever you end up at get certified there
Clinical practice guidlines
Is why and how we get our protocols
Step by step process
Protocols are to make sure sentinel events do not happen
Root cause analysis
Ask WHY* to get to the root cause
National pt safety goals
Identify pt correctly
Improve staff communication
Med safety
Alarm safety
Prevent infection
Identify pt safety risk
Prevent mistakes in surgery
How can we avoid transfusion , chemotherapy or med errors ?
Identify the pt correctly
In what way have we improved communication with staff
Lab calling in for critical lab values and within two hours
Have to report critical test results as well as diagnostic results
How can we use medicine safety
Using the 7 rights
Labeling our meds
Or using dispensing tray w room #
Pull them out at bedside
Use a med bag and label w room #
PINCH drugs
STAR method
PINCH drugs
Potassium
Insulin
Narcan
Narcotics
Chemo
Heparin
STAR method and when we use it
Stop think act and review
For med vials that look alike and sound alike drugs
How can we use alarm safety
Silence them effectively dont let them keep going
Avoid alarm fatigue
How can we prevent infection
Washing hands for 20 seconds - sing happy birthday song
Know when to use hand sanitizer and when to wash your hands
Use green cap
Scrub the hub
Alcohol based hand sanitizer
Protocol to prevent CAUDI
When do you wash your hands
Handling a pt with CDIFF
Identify pt safety risk - how can we do this?
Assess for risk of suicide ideation
Do you have a plan? Etc
How can we prevent mistakes in surgery
Time out- right pt , consent, procedure, body part
Marking the body part where the surgery will take place
Are we allowed to sign consent
We can’t give the consent - if it is blood product yes..
The physician has to do that.
5 steps of risk management process
Identifying potential risk
Analyzing risk
Risk evaluation
Treating the risk
Monitoring and reviewing the risk
Fall risk
Non skid socks
Gown
Bracelet
3 side rails up
Make sure bed alarm is on to prevent future falls
If pt falls
Assess the pt
Vitals
Call the charge nurse and physician
Document
Most common sentinel event
Falls
Performing procedures on wrong pt
Unintended retention of foreign objects
Difference between versed and fentanyl
Versed stores up in the tissue and effects BP so it takes a while to fix
Fentanyl does not
Incident report
Encouraged to fill out for accidental mistakes so we can learn and grow from it
Nursing services organization
Insurance that covers 6 million per pt
$100 a yr
What is important to note when a case manager question comes up
Ask what’s going on and what works for the pt
Get more info “ tell me more”
Open ended questions to ask the pt
Poor processes can cause
Preventable mistakes, wrong surgery , medication errors
HCAPS is measured by
Communication with doc
Communication w nurse
Responsiveness of hospital staff
Pain management
Communication w meds
Discharge info
Cleanliness of environment
Quietness of hospital environment ( heal when sleep)
