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issues and policy > issues > Flashcards

issues Flashcards

1
Q

glasgow sti + for reporting

A

gonorehhea, siph,clamidia, hiv and TB

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2
Q

must report: 3 vs not

A

animal bites, child vs elder abuse vs domestic violence

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3
Q

colaborative practice statement

A

collaboration is a true partnership in which all players have and desire power share goals and recognize and accept separate areas of responsibility

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4
Q

issues regarding access to care (4)

A

home health, hospice, skilled nursing facilities, private duty nursing.

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5
Q

hospice

A

needs 6month or less death diagnosis and is only receiving comfort measures

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6
Q

coding:

A

Eval and management codes identify the level of care provided, codes match the level of service provide to the complexity of the presenting problem

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7
Q

categories of third party payers: number one

A

medicare- sets the standard for reimbursement and cutting costs

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8
Q

new patient gets what exam

A

comprehensive

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9
Q

medicare A

A

inpatients hospital services and post hospital associated care

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10
Q

medicare B

A

physician visits, outpatint visits and labs plus some equiment (this is supplemntal- pt pays some percentage

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11
Q

medicare B NP’s get paid

A

85% - for what docs get while in collaboration

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12
Q

medicare C

A

A+B=C if you have A+B you can choose your hmo from a list

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13
Q

Medicare D

A

limited prescription coverage, pt pays premium and co-pay

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14
Q

which medicare types pays premium

A

B&D boy and dog

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15
Q

services that don’t meet Medicares definition of physicians services

A

regular physicals, health maintenance screening, counseling fro well patients,

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16
Q

medicare reimburses —-% of physicians fee delineated in medicare physician fee schedule

A

85% for a procedure its 80% of the 85%

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17
Q

incident billing

A

not allowed in the hospital, must bill under own number

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18
Q

medicaid

A

for low income, payments are made after all others pay

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19
Q

case management

A

purpose is to mobilize monitor and control cost.

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20
Q

root cause analysis

A

promote safety and move beyond culture of blams

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21
Q

sentinel events

A

unexpected occurrence involving death or serious physical psychological injury, or risk thereof- not always med errors, require immediate root cause analysis.

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22
Q

who mandates the scope of practice

A

the state board of nursing based on the legal allowances in that state

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23
Q

credentials

A

required education, licence and certification to practice as an NP, establish MINIMAL LEVELS of acceptable performance

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24
Q

licence

A

establishes the person is QUALIFIED to perform role

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25
Q

certification

A

met STANDARDS that show MASTERY granted by nongovernmental agencies

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26
Q

admitting privileges

A

granted by joint commission in 1983

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27
Q

competence

A

person can understand, reason, differentiate goo and bad and communicate

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28
Q

danforth amendet

A

anyone in federal facility to refuse care

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29
Q

nonmaleficence

A

do no harm

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30
Q

utilitarianism

A

produce the greatest good for greatest number

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31
Q

benificence

A

prevent harm and promote good

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32
Q

justice

A

be fair

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33
Q

fidelity

A

be faithful

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34
Q

veracity

A

truth

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35
Q

autonomy

A

respect individuals thoughts and actions

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36
Q

first np programs began in

A

in pediatrics

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37
Q

np’s came into hospitals

A

because of managed care hospital restructuring and reduction in resident hours

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38
Q

non experimental research

A

no experiment - descriptive-describes current situations and expost facto- in the past to examine relationships of variables

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39
Q

cross sectional

A

pop with similar attribute (atshma) and a different attribute (age) to find relationship of variables at a specific point in time

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40
Q

cohort-

A

lung cancer in a group

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41
Q

experimental-

A

includes experimental manipulation of variables utilizing RANDOMIZATION AND CONTROL if you lack one its quazi experimental

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42
Q

qualitative

A

used to explore phenomonon- researcher bias is a problem, cant generalize findings, produces rich data that is tough to get otherwise.

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43
Q

levels of evidence M-R-QE-QC-C-E

A

meta analysis, RCT, Quasi experimental, qualitative cohort, case control, expert opinion

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44
Q

level of significance

A

p value <0.5 means that experimental and control groups are considered to be significantly different

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45
Q

liability

A

actual or potential harm

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46
Q

sensitivity

A

true positivie- percent of people with the disease who test positive

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47
Q

specificity

A

true negative degree to which those without disease test negative

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48
Q

mentoring and coaching

A

instructing patints in how to successfully manage their own condition

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49
Q

role modeling

A

instructing the patients through examples of health care process in action- np instructs in healthy behavior

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50
Q

medical literature should be done at

A

6th to 8th grade level

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51
Q

joint comission lays outt

A

national patient safety goals

52
Q

qi is

A

management process of monitoring, evaluating, and continuously reviewing and improving both quality of health care delivery and the health status of the target population

53
Q

QSEN competencies

A 
EBP
patinet centerd care
QI 
safety 
informatics
teamwork and collaboration
54
Q

mental health general

A

patient stress questionanaire - used in primary care

55
Q

PHQ 9

A

most common tool for depression
self admin
reviews signs and symptos 0-3 score over the last 2 weeks

56
Q

aniety disorders GAD 7

A

self admin, identifies weather complete anxiety assesment is necessary 7 s and s overthe last 2 weeks

over 10 refer to psych mental health NP

57
Q

CAGE or CADE AID

A

self report for booze 0 wether complete etoh or booze is needed

yest to 2 or more means complete assessment is warrented

C-cut down
A-annoyed
G-guilty about drinking
E- early in morning drinking or drugs

58
Q

wong baker FACES

A

pain
self assessment
chose among six faces

59
Q

Ramsay Sedation Scale

A

concious pain if awake

3 responds to commands only

if asleep

6 no response to tap or loud auditory stim

60
Q

BPI short form

A

severity of pain and impact of pain on function
self report or interview
severity, impact on adl, location, pain med, releife from meds

good for chronic diseases

61
Q

RASS

A

10point observable behavior score scale for anxiety agitation and sedation
+4 combative
-5 uarosable

62
Q

SAS

A

sedation agitation scale
7 dangerous agitation pulling at ET tube
6 restraint

1 unarosable

63
Q

critical care pain observation tool

A 
used in critical care unit to eval pain 
1 facial expressionn 0 is chill 3 is squrenched up 
2 body movement
3 muscle tension 
4 vocalization or compliance with vent

score 0,1,2 range from 0-8 total

64
Q

CAM ICU

A

delirum and altered mental status in the ICU
1 acute onset of mental status change or fluctuationg
2 inattention
3disorganized thinking
4 altereled leel of conciousness

65
Q

gero mentla clock test

A

draw clock

1-6 score greater than or equal to three is some cognitive deficit

66
Q

geratirc depression scale

A

self report
can be used in intact or mild moderate impariment
score greater than 5 suggest depression out of 15 questions

67
Q

katz index of ADL’s

A

assessing self care function

bathing, dressing, deeding, toileting, contenence

68
Q

get up and go test

A

rise from chaire walk turn back to chair turn around and sit, 1-5 great than or equla to 3 is risk of fall

69
Q

pain assesssment in advanced dementia

A

breathing, negative vocalization, facial expressison body language, and consolability 7-10 sever pain

70
Q

DME

A 
for everdya or extended use
should be durable
medical reason
not usefull for non sick or injured person
will last 3 years
used in home

cane or crutches

71
Q

hearing aids are

A

not DME

72
Q

assistive devices

A

primary purpose is to maintain or improve an indiviuals function or Independence
wheelchair
prostheses
hearing aids

73
Q

life support devices

A 
used by qualified health professionals to support life in critically ill patients 
balloon pumps 
VAD
dialysis 
Trans venous pacers
74
Q

CAM

A

refers to treatments that are used along with or in palce of conventional medicine

focus on the whole person
includes physical, emotional, mental, and spiritual health,

75
Q

CAM in parcticie ex

A

chronic pain- mindfulness meditation and pain management programs

76
Q

AGCNP role in tests and procedures

A

facilitate the scheduling
educate the patient
perform or assist with the procedure
assess pt for adverse reaction after

77
Q

preparing the paitient

A

ensure the pt understands the procedure
verify the pt has complied with pre procedural requiremnts
notify family about length of procedure

78
Q

during the procedure

A

eval the pts anxiety
help pt relax
eval pts level of safety and comfort

79
Q

after procedure

A

hep restore prediagnostic level of function,
monitor for signs of respiratory distress and bleeeding
dischage pt with written insturctions

80
Q

goals of tecch in nursing

A

capture the tasks performed
enhance the scope of practice and EBP
make practice knowledge driven

81
Q

experienced nurse informatics

A

make judgments based on trends of data

collaorate with informatics specialists in development of nursing systems

82
Q

begining nuse informatics

A

computer literacy
information managgement- look up good data
use nurse specific software
use pt care tech, pumps monitors etc

83
Q

benchmarking

A

comparison of one healthcare org anainst oher national ones

maintain quality
improve safety
continious improvement
improve customer satisfaction.

84
Q

peer review

A

feedback is not anonomyous
formal process is necessary for magnet recognition
incorporates the nurses development stage

85
Q

advance directive

A

written statement of a patients intent regarding medical treatment- pt self determination act of 1990requires that all patients entering a hospital should be advised of their right to execute an advanced directive

86
Q

healthcare directive

A

TYPE OF ADVACED DIRECTIVE that may or may not include a living will and or specifications regaring durable power of attorney in one or two separate documents

87
Q

living will

A

written compilation of statements in document format that specifies which life prolonging measures one does and does not want to be take if he or she becomes incapacitated

88
Q

living will pearls

A

most states- recognize as long as it is specific
often include granting durable power of attourney to a proxy for healthcare dicisions
power of attourney must be in writing before it will be honored by most institutions

89
Q

Tital 1 of hippa

A

protects health insurance coverage for workers and thier fams if they change or lose their jobs - cobra

90
Q

tital II of hippa

A

known as AS or administrative simplifications provisions,, requires the establishment of national standards for electronic health care transactions, and national identifiers for providers insurance plans and employers.

91
Q

offfice of civil rights enforces

A

hippa

protects privacy of health information

92
Q

covered entities

A

health plans
most health care providers
health care clearing houses

93
Q

communication do’s and donts

A

tell me is good

why is bad

94
Q

privacy rule patients rights

A

pts can always
see and get records
have corrections added to their record
receive notice on how their info may be used or shared
decide if they want to give permission before infor can be used like for marketing
receive a report about why their infor was shared and for what purpose
file complaints with healthcare providers, insurance, and the govt if data is not being protected

95
Q

those who DO NOT have to follow hippa

A 
life insurers
employers
workers comp
many schools
many state agencies like child protective services
many law enforcement agencies
many municipal offices
96
Q

patient safety and quality improvement act (PSQIA)

A

volantary reprting system to enhance the data available and assess and resolve patient safety and health care quality issues

used to encourage reporting of medical errors without fear of liability. aim is greater reporting

97
Q

AHRQ

A

agency for healthcare research and quality

lists patient safety orginizaitons whihc are external experts established by the paitent safety act to collect and analyze patient safety information

98
Q

confidentiality vs DUTY to warn

A

duty to warn supersedes the right to confidentiality if harm to OTHERS can happen

duty to protect patient from harming SELF supercedes right to confidentially

99
Q

health care delivery

A

begins at the local level

ex: start at the unit, then hospital,then community then region then nation

100
Q

invasion of privacy

A

damages ones reputaiotn as a result of sharing info without consent

cant be made if info is accurate, given in good faith, and receiver had a valid reason for getting it, ie consulting practitioner had a valid reason for getting the info

101
Q

cobra is

A

18months

102
Q

strongest teaching method is

A

return demonstration

103
Q

lefort staging 1,2,3

A

1:floating palate
2 floating maxilla
3 floating face

104
Q

msot powerful data collected from pt is

A

subjective data or data you observed.

105
Q

healthy people 2020

A

increase quality and years of healthy life

eliminate health disparities among Americans

106
Q

ANA’s nursing: a social policy statment 1995

A

collaboration is a true partnership, where everyone has and desires power,, share common goals, recognize and accept separate areas of responsibility and activity

107
Q

third party payors who sets the reimbursement standard

A

medicare

108
Q

problem focused

A

a limited exam, of the affected body area or organ system

109
Q

expanded problem focused

A

limited exam of affected body area/organ and other symptomatic or related body area or organ

110
Q

detaled

A

extended extened eam of bosy system or organ and related organs or symptoms

111
Q

coprehensive

A

general multi system exam or complete exam of a single organ system and other symptomatic or related organ systems

112
Q

medicare A

A

inpatient hospitilization, skilled nursing facilities, home health services, and or hospice associated with an inpatient event. most individuals 65 and older

113
Q

medicare B

A

physician services, outpatient hospital services, labs and diagnostics, medical equipment, and some home health

is supplemental requring a premium
NPS get 85% of what a doc would get
medicare pays 80% and pt pays 20

114
Q

medicare C

A

A+B=C medicare advantage

pts whith A and B can enroll in provider orginizaiton undr C HMO PPO<

115
Q

Medicare D

A

limited prescription drug coverage
d=drugs
offered by private insurance and approved my medicare
monthly premium required
co=pay is required
assistance available for poor
penalty may apply for people not enrolled when first eligible

116
Q

not “physicians services “ under medicare

A

regular physical exams
health maintence screenings
counseling for well patients

117
Q

NP billing under B (medicare)

A

diagnosis
therapy
surgery consultation
care plan oversight

118
Q

for an NP to qualify under medicare

A

hold state liscence as an NP
certified as NP by national certifying body
have at least an MSN

119
Q

if NP meets medicare requirements

A

facility accepts medicare payment- 85% of physician schedule reate submitted under the NP’s provider number

120
Q

NP can bill under B if services are

A

physician services -services that doc can bill medicare for
performed in collaboration with physcian
within scope of practice as defined by state law

121
Q

medicare for procedure

A

80% of the 85% that the doc would get

practice must bill under the provider #of the clinician who preformed a given service

122
Q

incident to biling

A

services billed under the physicians provider number t get the full 100%

integral, although incidental, part of the physicians professsional service
commonly rendered without charge or included in the physicians bill
commonly furnished in docs office or clinic
needs direct supervision of the physician
doc must preform initial service and subsequent services for frequency which refleccts active participation in treatmet

Incident to cant be done in the hospital

NP can bill in INcident to style for things like EKGs if all the rules apply

123
Q

structures, processes and outcomes

A

structures: inputs into care, resources, equipment, numbers and qualifications of staff

processess of care: include assessments, planning, preforming treatments, and managing complications

Outcomes: include complications adverse event reporting, short term results, and long term results of patient health and funciton

124
Q

PT vs OT

A

OT fine motor and psychomotor and helps pt rehabilitate back into ADLS and jobs

125
Q

critical path

A

contains key patient care activities, and time frames for those activities which are needed for a specific case type or diagnosis related group

126
Q

care map

A

newer version of critical path, blueprint for planning and managing care delivered by all disciplines
starts with critical path and includes a day to day goal set and final desired clinical outcome

issues and policy (22 decks)

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