issues Flashcards
glasgow sti + for reporting
gonorehhea, siph,clamidia, hiv and TB
must report: 3 vs not
animal bites, child vs elder abuse vs domestic violence
colaborative practice statement
collaboration is a true partnership in which all players have and desire power share goals and recognize and accept separate areas of responsibility
issues regarding access to care (4)
home health, hospice, skilled nursing facilities, private duty nursing.
hospice
needs 6month or less death diagnosis and is only receiving comfort measures
coding:
Eval and management codes identify the level of care provided, codes match the level of service provide to the complexity of the presenting problem
categories of third party payers: number one
medicare- sets the standard for reimbursement and cutting costs
new patient gets what exam
comprehensive
medicare A
inpatients hospital services and post hospital associated care
medicare B
physician visits, outpatint visits and labs plus some equiment (this is supplemntal- pt pays some percentage
medicare B NP’s get paid
85% - for what docs get while in collaboration
medicare C
A+B=C if you have A+B you can choose your hmo from a list
Medicare D
limited prescription coverage, pt pays premium and co-pay
which medicare types pays premium
B&D boy and dog
services that don’t meet Medicares definition of physicians services
regular physicals, health maintenance screening, counseling fro well patients,
medicare reimburses —-% of physicians fee delineated in medicare physician fee schedule
85% for a procedure its 80% of the 85%
incident billing
not allowed in the hospital, must bill under own number
medicaid
for low income, payments are made after all others pay
case management
purpose is to mobilize monitor and control cost.
root cause analysis
promote safety and move beyond culture of blams
sentinel events
unexpected occurrence involving death or serious physical psychological injury, or risk thereof- not always med errors, require immediate root cause analysis.
who mandates the scope of practice
the state board of nursing based on the legal allowances in that state
credentials
required education, licence and certification to practice as an NP, establish MINIMAL LEVELS of acceptable performance
licence
establishes the person is QUALIFIED to perform role
certification
met STANDARDS that show MASTERY granted by nongovernmental agencies
admitting privileges
granted by joint commission in 1983
competence
person can understand, reason, differentiate goo and bad and communicate
danforth amendet
anyone in federal facility to refuse care
nonmaleficence
do no harm
utilitarianism
produce the greatest good for greatest number
benificence
prevent harm and promote good
justice
be fair
fidelity
be faithful
veracity
truth
autonomy
respect individuals thoughts and actions
first np programs began in
in pediatrics
np’s came into hospitals
because of managed care hospital restructuring and reduction in resident hours
non experimental research
no experiment - descriptive-describes current situations and expost facto- in the past to examine relationships of variables
cross sectional
pop with similar attribute (atshma) and a different attribute (age) to find relationship of variables at a specific point in time
cohort-
lung cancer in a group
experimental-
includes experimental manipulation of variables utilizing RANDOMIZATION AND CONTROL if you lack one its quazi experimental
qualitative
used to explore phenomonon- researcher bias is a problem, cant generalize findings, produces rich data that is tough to get otherwise.
levels of evidence M-R-QE-QC-C-E
meta analysis, RCT, Quasi experimental, qualitative cohort, case control, expert opinion
level of significance
p value <0.5 means that experimental and control groups are considered to be significantly different
liability
actual or potential harm
sensitivity
true positivie- percent of people with the disease who test positive
specificity
true negative degree to which those without disease test negative
mentoring and coaching
instructing patints in how to successfully manage their own condition
role modeling
instructing the patients through examples of health care process in action- np instructs in healthy behavior
medical literature should be done at
6th to 8th grade level
joint comission lays outt
national patient safety goals
qi is
management process of monitoring, evaluating, and continuously reviewing and improving both quality of health care delivery and the health status of the target population
QSEN competencies
EBP patinet centerd care QI safety informatics teamwork and collaboration
mental health general
patient stress questionanaire - used in primary care
PHQ 9
most common tool for depression
self admin
reviews signs and symptos 0-3 score over the last 2 weeks
aniety disorders GAD 7
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
CAGE or CADE AID
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
wong baker FACES
pain
self assessment
chose among six faces
Ramsay Sedation Scale
concious pain if awake
3 responds to commands only
if asleep
6 no response to tap or loud auditory stim
BPI short form
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
RASS
10point observable behavior score scale for anxiety agitation and sedation
+4 combative
-5 uarosable
SAS
sedation agitation scale
7 dangerous agitation pulling at ET tube
6 restraint
1 unarosable
critical care pain observation tool
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
CAM ICU
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
gero mentla clock test
draw clock
1-6 score greater than or equal to three is some cognitive deficit
geratirc depression scale
self report
can be used in intact or mild moderate impariment
score greater than 5 suggest depression out of 15 questions
katz index of ADL’s
assessing self care function
bathing, dressing, deeding, toileting, contenence
get up and go test
rise from chaire walk turn back to chair turn around and sit, 1-5 great than or equla to 3 is risk of fall
pain assesssment in advanced dementia
breathing, negative vocalization, facial expressison body language, and consolability 7-10 sever pain
DME
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
hearing aids are
not DME
assistive devices
primary purpose is to maintain or improve an indiviuals function or Independence
wheelchair
prostheses
hearing aids
life support devices
used by qualified health professionals to support life in critically ill patients balloon pumps VAD dialysis Trans venous pacers
CAM
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,
CAM in parcticie ex
chronic pain- mindfulness meditation and pain management programs
AGCNP role in tests and procedures
facilitate the scheduling
educate the patient
perform or assist with the procedure
assess pt for adverse reaction after
preparing the paitient
ensure the pt understands the procedure
verify the pt has complied with pre procedural requiremnts
notify family about length of procedure
during the procedure
eval the pts anxiety
help pt relax
eval pts level of safety and comfort
after procedure
hep restore prediagnostic level of function,
monitor for signs of respiratory distress and bleeeding
dischage pt with written insturctions
goals of tecch in nursing
capture the tasks performed
enhance the scope of practice and EBP
make practice knowledge driven
experienced nurse informatics
make judgments based on trends of data
collaorate with informatics specialists in development of nursing systems
begining nuse informatics
computer literacy
information managgement- look up good data
use nurse specific software
use pt care tech, pumps monitors etc
benchmarking
comparison of one healthcare org anainst oher national ones
maintain quality
improve safety
continious improvement
improve customer satisfaction.
peer review
feedback is not anonomyous
formal process is necessary for magnet recognition
incorporates the nurses development stage
advance directive
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
healthcare directive
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
living will
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
living will pearls
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
Tital 1 of hippa
protects health insurance coverage for workers and thier fams if they change or lose their jobs - cobra
tital II of hippa
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.
offfice of civil rights enforces
hippa
protects privacy of health information
covered entities
health plans
most health care providers
health care clearing houses
communication do’s and donts
tell me is good
why is bad
privacy rule patients rights
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
those who DO NOT have to follow hippa
life insurers employers workers comp many schools many state agencies like child protective services many law enforcement agencies many municipal offices
patient safety and quality improvement act (PSQIA)
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
AHRQ
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
confidentiality vs DUTY to warn
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
health care delivery
begins at the local level
ex: start at the unit, then hospital,then community then region then nation
invasion of privacy
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
cobra is
18months
strongest teaching method is
return demonstration
lefort staging 1,2,3
1:floating palate
2 floating maxilla
3 floating face
msot powerful data collected from pt is
subjective data or data you observed.
healthy people 2020
increase quality and years of healthy life
eliminate health disparities among Americans
ANA’s nursing: a social policy statment 1995
collaboration is a true partnership, where everyone has and desires power,, share common goals, recognize and accept separate areas of responsibility and activity
third party payors who sets the reimbursement standard
medicare
problem focused
a limited exam, of the affected body area or organ system
expanded problem focused
limited exam of affected body area/organ and other symptomatic or related body area or organ
detaled
extended extened eam of bosy system or organ and related organs or symptoms
coprehensive
general multi system exam or complete exam of a single organ system and other symptomatic or related organ systems
medicare A
inpatient hospitilization, skilled nursing facilities, home health services, and or hospice associated with an inpatient event. most individuals 65 and older
medicare B
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
medicare C
A+B=C medicare advantage
pts whith A and B can enroll in provider orginizaiton undr C HMO PPO<
Medicare D
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
not “physicians services “ under medicare
regular physical exams
health maintence screenings
counseling for well patients
NP billing under B (medicare)
diagnosis
therapy
surgery consultation
care plan oversight
for an NP to qualify under medicare
hold state liscence as an NP
certified as NP by national certifying body
have at least an MSN
if NP meets medicare requirements
facility accepts medicare payment- 85% of physician schedule reate submitted under the NP’s provider number
NP can bill under B if services are
physician services -services that doc can bill medicare for
performed in collaboration with physcian
within scope of practice as defined by state law
medicare for procedure
80% of the 85% that the doc would get
practice must bill under the provider #of the clinician who preformed a given service
incident to biling
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
structures, processes and outcomes
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
PT vs OT
OT fine motor and psychomotor and helps pt rehabilitate back into ADLS and jobs
critical path
contains key patient care activities, and time frames for those activities which are needed for a specific case type or diagnosis related group
care map
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
