Chapter 2 Notes & Slides Flashcards
Collaborative working relationships
: Cooperative partnerships between healthcare professionals to achieve shared goals in patient care.
Continuity of care
The seamless and coordinated delivery of healthcare services to ensure consistent and effective patient care.
Continuous quality improvement
An ongoing process of assessing and improving healthcare services to enhance patient outcomes and safety.
Critical pathway
A structured plan outlining the sequence of care and interventions for a specific medical condition or procedure.
Health information technology (Health IT)
The use of technology to manage and exchange healthcare information to improve patient care and efficiency.
Interdisciplinary care
Collaborative healthcare involving professionals from various disciplines to address complex patient needs.
Medical home
A primary care model that provides comprehensive, coordinated, and patient-centered care.
Multidisciplinary care
: Healthcare involving professionals from multiple disciplines who work together to address patient needs.
: Patient-focused care
A healthcare approach that prioritizes the individual needs and preferences of the patient.
Pay for performance
A reimbursement model that ties healthcare payments to the quality and outcomes of care provided.
Profession
A specialized occupation, such as medicine or nursing, that requires specific education and training.
Professional
An individual who is highly trained and qualified in a particular field, such as a healthcare professional.
Quality of care
The degree to which healthcare services meet established standards and achieve desired patient outcomes.
Characteristics of a Profession
ive generally recognized characteristics of a profession, including systematic theory, professional authority, community sanction, ethical codes, and professional culture.
Systematic Theory and Body of Knowledge
A distinguishing feature of a profession, it involves having extensive theoretical knowledge acquired through education and continuing education, which professionals use when providing services.
Professional Authority and Special Privileges
Refers to a professional’s ability to practice in their area of expertise and provide services that the public cannot perform for themselves. It includes the trust clients place in professionals’ judgment.
Social Utility and Community Sanction
Professions are believed to serve a socially necessary function and provide vital services to society. Community sanction, such as licensure and title restrictions, acknowledges the importance of professions.
Ethical Codes and Internal Control
Professionals are accountable through ethical codes, which go beyond legal requirements, and internal controls to maintain a standard of conduct within the profession.
Enforcement of Ethical Codes
Enforcement of ethical codes is often challenging but vital to a profession’s integrity and value
Professional Culture and Organizations
A profession’s culture includes values, norms, and symbols, such as beliefs in the importance of their expertise and unique service, accepted social behaviors, and specific identifiers like dress codes.
Values in Professional Culture
Central beliefs in a profession’s culture, including the importance of their expertise, the uniqueness of their service, and the essential role they play in society.
Norms in Professional Culture
Accepted ways of social behavior within a profession, guiding how professionals interact with each other and clients.
Symbols in Professional Culture
: Identifiers like specific insignia, vocabulary, and dress that distinguish members of a profession and reinforce their identity.
Individualized, Unstandardized Service
Healthcare often requires individualized and unstandardized services due to the unique needs and characteristics of patients, making flexibility and adaptability essential for healthcare providers.
Role of Pharmacists
Pharmacists distribute prescription drugs, provide advice on medication selection, dosages, interactions, and side effects, and monitor patients’ health and progress for safe and effective medication use.
Compounding
Compounding involves mixing ingredients to create medications and is a part of a pharmacist’s practice.
Pharmacist Education
Early education was through apprenticeships, but formal education began in the late 19th century. The Doctor of Pharmacy (PharmD) is now the minimum requirement for pharmacy practice.
Pharmacy Residency
Residency programs enhance pharmacists’ competencies in medication management, with PGY1 and PGY2 residencies available in various areas of practice.
Fellowship Training
Fellowships prepare pharmacists for independent research and are highly individualized postgraduate programs.
Pharmacy Licensure
: Pharmacists must hold a pharmacy license to practice in the United States, achieved by passing the NAPLEX and MPJE exams.
Continuing Education
All states and territories require continuing education credits for licensure renewal, aimed at maintaining and enhancing pharmacists’ professional competence.
Pharmacy Practice Environment
Pharmacists primarily focus on medication distribution and serve as sources of medication-related information for patients and healthcare providers, with their roles varying based on practice settings.
Specialization
Specialization is achieved after one is eligible to practice,
not before.
– In pharmacy, practitioners have the ability to advance their
abilities such that they can seek recognition of that training
through specialization.
The Board of Pharmacy Specialties (BPS ) recognizes
five areas of pharmacy specialization:
- nuclear pharmacy
- pharmacotherapy
- nutrition support pharmacy
- psychiatric pharmacy
- oncology pharmacy
2011, which speciality began to be recognized?
Beginning in 2011, the Board of Pharmacy
Specialties will begin recognizing specialization in
ambulatory care pharmacy.
Pharmacy Technician
: A pharmacy technician is an individual working under the supervision of a licensed pharmacist, assisting in pharmacy activities that do not require the professional judgment of a pharmacist.
Pharmacy Technician Education
Education and training requirements for pharmacy technicians vary by state, including age minimums, educational prerequisites, and training.
34 / 50 states
have established technician training
requirements.
Pharmacy Technician Licensure
Pharmacy technician regulation exists in 39 states, with national certification examinations available from organizations like the Pharmacy Technician Certification Board.
Pharmacy Technician Practice Environment
: Pharmacy technicians work in various settings, with most employed by retail pharmacies. They assist pharmacists with tasks such as prescription preparation, customer service, administrative duties, and more, always under the direct supervision of a pharmacist.
Pharmacy Technician Tasks
Pharmacy technicians assist pharmacists in various tasks, including preparing prescription medications (e.g., computer entry, counting, labeling), assisting customers, and performing administrative duties (e.g., record keeping, insurance claims, inventory control).
Physicians
Professionals concerned primarily with maintaining or restoring the health of their patients through the diagnosis and treatment of disease or injury.
Medical Education:
Formal medical education typically involves a post-baccalaureate four-year program, with the first two years focused on didactic learning and the last two years on clinical clerkships.
MD vs. DO:
Medical Doctors (MDs) and Doctors of Osteopathy (DOs). Both follow similar curricula, with DOs emphasizing osteopathic manipulative medicine.
Licensure
Physicians must pass a series of exams to obtain a medical license. This process includes exams taken during medical school and residency, assessing clinical knowledge, clinical skills, and suitability for unsupervised practice.
Continuing Education
Many medical boards require physicians to complete continuing medical education hours annually, typically between 20 and 50 hours. Some states also have specific content requirements.
Specialization
Physicians can choose to specialize in various medical fields. This is a voluntary process, and certification in specialties and subspecialties is offered by organizations such as the American Board of Medical Specialties and the American Osteopathic Association.
Practice Environment
The number of physicians in the United States has been increasing, but concerns about shortages persist, particularly with the aging population.
Primary Care Providers:
The number of primary care providers has increased dramatically.
The largest increases have been observed among nurse practitioners and physician assistants.
These healthcare professionals play crucial roles in delivering primary care services.
Physicians in Primary Care:
The increase in the number of physicians in primary care is largely attributed to foreign medical graduates.
It’s worth noting that specialists and subspecialists can also provide primary care to their patients, though there’s a trend towards more specialists.
Implications for Pharmacy:
The shift to more specialists and fewer primary care physicians has pharmacy implications. Pharmacists may play a larger role in patient-centered care and expanded drug therapy management where permitted.
Nursing Scope of Practice
Nurses protect, promote, and optimize health, prevent illness and injury, alleviate suffering through diagnosis and treatment, and advocate for individuals, families, communities, and populations.
RN
Registered Nurse
LPN
Licensed Practical Nurse
APN
Advanced Practice Nurse
RN vs. LPN:
RNs have a broader scope of practice than LPNs, and LPNs often work under the supervision of RNs.
Advanced Practice Nurses (APNs):
APNs, such as Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), Certified Registered Nurse Anesthetists (CRNAs), and Certified Nurse Midwives (CNMs), have advanced education and prescriptive authority in most jurisdictions.
Nursing Education:
LPNs typically complete a one-year program, while RNs can follow various educational pathways, including bachelor’s degrees, associate degrees, or diploma programs. APNs often hold master’s or doctoral degrees.
Nursing Licensure
Nurses must pass the NCLEX (National Council Licensure Examination) for their respective designations (NCLEX-RN for RNs and NCLEX-PN for LPNs).
Continued Competence (Nursing)
Many states require nurses to demonstrate continued competence through activities such as continuing education, practice requirements, and competency examinations.
Nursing Specialization:
Nurses can pursue certification in various specialties, including ambulatory care, pediatric nursing, and psychiatric and mental health nursing.
LPN Practice Settings:
LPNs work in settings like nursing homes, home health care, hospice, physician offices, and hospitals, assisting patients with activities of daily living.
RN Practice Settings:
: RNs work in diverse settings, with the majority in hospitals, ambulatory care, and public health. Their roles can vary widely based on specialization.
APN Practice Independence:
APNs may practice independently in some states, while others require collaborative agreements/protocols or supervision by physicians.
Doctor of Nursing Practice (DNP):
A doctoral-level degree for advanced practice nurses, focusing on clinical aspects of nursin
Physician Assistant (PA) Role
PAs practice medicine in a team environment under a physician’s direction. They conduct physical exams, diagnose and treat illnesses, order tests, counsel on preventive health care, assist in surgery, and prescribe medications.
PA Education:
PAs complete accredited programs, often lasting 26 months, with didactic instruction in medical and behavioral sciences and experiential learning through clinical rotations.
Continuing Medical Education:
PAs are required to complete 100 hours of continuing medical education every 2 years and are retested on their clinical skills every 6 years.
PA Licensure
All states and the District of Columbia have legislation governing the practice of PAs. PAs must pass the Physician Assistant National Certifying Examination administered by the NCCPA.
PA Practice Environment:
PAs work in various settings, with the majority employed in group medical practices, hospitals, and solo physician practices. Their specific duties are determined by the supervising physician and state law.
Multidisciplinary Care:
Multidisciplinary care involves various healthcare professionals working independently but collaboratively to benefit the patient’s well-being.
Interdisciplinary Care:
A collaborative approach involving multiple healthcare professionals working together to prioritize the well-being of the patient.
Stage 0 (Professional Awareness)
The initial stage of the pharmacist-physician working relationship characterized by discrete and minimal exchanges, short in duration, with no attempt to change the existing relationship.
Stage 1 (Professional Recognition):
Involves the pharmacist’s effort to establish a relationship with the physician by informing them of the services the pharmacist can provide, with the goal of building trust and enhancing the pharmacist’s usefulness to the physician.
Stage 2 (Exploration and Trial):
Requires some level of commitment from the physician beyond the first two stages, with the pharmacist remaining the primary initiator of interaction. Physicians may refer a few patients to assess the pharmacist’s ability to deliver promised services and evaluate the risks and benefits of collaboration.
Stage 3 (Professional Relationship Expansion):
Represents the natural progression of earlier stages, with the physician initiating exchanges, though the pharmacist still bears more responsibility as an initiator. Communication centers on the benefits of pharmacist services and feedback on past performance, with the potential for professional conflict.
Stage 4 (Commitment to Collaborative Working Relationship):
Achieved when the physician is convinced that the benefits of the collaborative relationship outweigh any risks. Commitment requires a relatively lengthy, consistent, and high-input relationship. Both parties need to attend to the relationship’s needs to maintain it. Collaboration is a two-way effort at this stage.
Continuity of Care:
The concept of ensuring the ongoing provision of healthcare services to an individual patient over time. It involves multiple healthcare providers, care settings, and information exchange.
Informational Continuity:
The use of information on past events and personal circumstances to make current care appropriate for each individual patient, focusing on disease or patient-specific information transfer.
Management Continuity:
A consistent and coherent approach to managing a patient’s health condition that is responsive to their changing needs, requiring an established plan of care.
Relational Continuity:
An ongoing therapeutic relationship between a patient and one or more providers, characterized by trust and loyalty. Higher levels of relational continuity are associated with higher levels of patient satisfaction.
Medical Home:
it is a model or approach to healthcare delivery that emphasizes certain principles and characteristics of care. The concept of a medical home focuses on providing comprehensive, patient-centered, and coordinated care to patients. While it can involve healthcare facilities such as primary care practices, it’s more about how care is organized and delivered than the specific physical location. The goal is to ensure that patients receive accessible, high-quality care that meets their needs across various healthcare settings and providers.
Pharmacy Role in Medical Home:
Pharmacists can play a role in the patient-centered medical home model by contributing to a multidisciplinary team-based approach to patient care. They can engage in medication therapy management, open communication with physicians, and demonstrate their professional expertise within this model of care.
Definition of Quality
“Doing the right thing for the right patient, at the right time, in the right way, to achieve the best possible results.”
How Is Quality Assessed?
Methods of assessing healthcare quality, including clinical performance measures, patient assessments, and outcome measures.
Effective Healthcare
Healthcare services that increase the likelihood of desired health outcomes and are based on current professional knowledge.
Safe Healthcare
Healthcare that minimizes risks and potential harm to patients, preventing errors and injuries.
Timely Healthcare
Healthcare that provides services in a timely manner, reducing waiting times and delays for patients.
Patient-Centered Healthcare
Healthcare that is respectful and responsive to individual patient preferences, needs, and values, involving patients in their care decisions.
Equitable
Healthcare that provides equal access and treatment opportunities for all patients, regardless of their background or circumstances.
Accreditation
A process by which healthcare organizations meet national standards, including clinical performance measures, often through organizations like the Joint Commission.
Report Cards
Summary reports of key quality indicators and measures used to evaluate healthcare organizations, providers, or plans.
Patient Ratings
Evaluations of healthcare organizations and providers by patients, often collected through surveys and reported to help patients make choices.
Patient-Focused Care
A care model characterized by decentralization of services, interdisciplinary collaboration, and increased patient involvement.
TeamSTEPPS
Team Strategies and Tools to Enhance Performance and Patient Safety, a program for integrating teamwork principles into healthcare systems.
Reengineering
The fundamental rethinking and radical redesign of business processes to achieve improvements in quality, cost, service, and speed.
Critical Care Pathways
Comprehensive management plans that aim to optimize and streamline patient care, defining key steps in care processes.
Continuous Quality Improvement (CQI)
A process of improving healthcare quality by examining processes and involving interdisciplinary teams in process improvements.
FOCUS-PDCA
F: Find a process to improve.
* O: Organize a team that knows the process.
* C: Clarify current knowledge of the process.
* U: Understand sources of process variation.
* S: Select the process improvement.
* P: Plan the improvement.
* D: Do the improvement, collect data, and analyze data.
* C: Check and study the results.
* A: Act to hold the gain and to improve the process further.
Pay for Performance (P4P)
Quality-based purchasing using payment methods and incentives to encourage high-quality and patient-focused care.
Technological Advances
Advancements in healthcare technology, including handheld devices, e-prescribing, and electronic health/medical records (EHR/EMR).
